Management of malignant pleural mesothelioma – part 1: epidemiology, diagnosis, and staging

Abstract

SummaryMalignant pleural mesothelioma is a rare malignant disease that in the majority of cases is associated with asbestos exposure. The incidence in Europe is about 20 per million inhabitants and it is increasing worldwide. Initial symptoms are shortness of breath, pleural effusion, cough, and chest pain. The typical growth pattern is along the pleural surface; however, infiltration of the lung and/or mediastinal and chest wall structures can occur in a more advanced stage. Ultimately, distant metastases outside the chest can result. Several histological subtypes of pleural mesothelioma exist, which must be differentiated from either benign diseases or metastases in the pleural space by other tumor entities. This differential diagnosis can be very difficult and a large panel of immunohistochemical markers is required to establish the exact diagnosis. The standard procedure for confirming the disease and obtaining sufficient tissue for the diagnosis is videothoracoscopy. Full thickness biopsies are required, while transthoracic needle puncture of pleural fluid or tissue is considered to be insufficient for a cytological diagnosis. Complete and detailed staging is mandatory for categorization of the disease as well as for therapeutic decision making.

Hyaluronic acid enhances cell migration and invasion via the YAP1/TAZ-RHAMM axis in malignant pleural mesothelioma

“…Malignant mesothelioma is an aggressive neoplasm arising from the pleura, pericardium, and peritoneum. It is induced by long-term exposure to asbestos, a naturally occurring silicate mineral, and its incidence and associated mortality rate are increasing in most countries [ 1 , 2 ]. Although the usage of asbestos is now restricted, it is considered that the incidence of mesothelioma will continue to increase because of the long time taken for mesothelioma to develop following exposure to asbestos, in some cases 15 to 40 years [ 3 , 4 ].…”

Epidemiology of Mesothelioma

“…In Europe, the average incidence is 20 per million inhabitants/year. The incidence varies between 7 per million in Japan and 40 per million in Australia [96,97]. The incidence has steadily increased in the last twenty years in Europe in the industrialized countries and is expected to peak around 2020-2025 [56,76].…”

Clinical diagnosis of malignant pleural mesothelioma

“…Symptoms associated with advanced stage of disease include weight loss, fatigue, cachexia, fevers and night sweats; at this stage thrombocytosis, hypoalbuminemia, elevated erythrocyte sedimentation rate, and anaemia (3,5) are often detected.…”

“…Total incidence is highest in the United States and United Kingdom although, per capita, Australia and Italy also rank highly (1,2). Most patients present at diagnosis with advanced disease; prognosis is poor with a median survival ranging from 7 to 12 months with supportive care or chemotherapy, respectively (3).…”