Mesothelioma natural history: Difference between revisions

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{{CMG}}{{AE}}{{PSD}}, {{SR}}
{{CMG}}{{AE}}{{PSD}}, {{SR}}
==Overview==
==Overview==
==Natural History==
If left untreated, mesothelioma may progress to develop [[dyspnea]], [[dysphagia]], [[pleural effusion]], [[thrombophlebitis]], [[constrictive pericarditis]], [[hydrocele|recurrent hydrocele]], and [[metastases]], depending on the site involved. Complications of mesothelioma include [[pleural effusion]], [[spinal cord compression]], [[Horner's syndrome]], [[superior vena cava syndrome]], hyperviscocity syndrome, [[pericardial effusion]], [[cardiac tamponade]], [[heart failure]], [[ascites]], and [[hydrocele|recurrent hydrocele]]. The [[prognosis]] of mesothelioma depends on the [[Cell (biology)|cell]] subtype.<ref name="Survivalstatisticsformesothelioma1">Survival statistics for mesothelioma. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/prognosis-and-survival/survival-statistics/?region=on. Accessed on February 10, 2016</ref>
*Malignant mesothelioma is usually an aggressive disease.
 
==Natural History==  
*Malignant mesothelioma is usually an aggressive disease.<ref name="Survivalstatisticsformesothelioma1">Survival statistics for mesothelioma. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/prognosis-and-survival/survival-statistics/?region=on. Accessed on February 10, 2016</ref>
*The exposure to the [[asbestos]] that cause mesothelioma occurrs 25-40 years to appear.
*Metastasis outside the thoracic wall occurs late in the course of pleural mesothelioma. Common sites of metastasis for pleural mesothelioma include:<ref name="Ifmesotheliomaspreads1">If mesothelioma spreads. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/if-cancer-spreads/?region=on. Accessed on February 15, 2016</ref>
:*[[Mediastinum]]
:*[[Pericardium]]
:*[[Lymph nodes]]
:*[[Thoracic wall]]
:*[[lung|Contralateral lung]]
:*[[Diaphragm]]
:*[[Peritoneum]] (the membrane that lines the walls of the [[abdomen]] and [[pelvis]], and covers and supports most of the [[abdominal]] organs)
:*[[Liver]]
:*[[Adrenal gland]]
:*[[Kidney]]
:*[[Brain]]
*[[Peritoneal]] mesothelioma does not usually spread to the lymph nodes or distant organs. Common sites of metastasis for peritoneal mesothelioma include:<ref name="Ifmesotheliomaspreads1">If mesothelioma spreads. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/if-cancer-spreads/?region=on. Accessed on February 15, 2016</ref>
:*[[Serosa]] of the small and large intestine – can cause a [[bowel obstruction]]
:*[[pleural cavity|Unilateral or bilateral pleural cavities]]
:*[[Liver]]
:*[[Spleen]]


==Complications==
==Complications==
* Blood clots in the veins, which may cause [[thrombophlebitis]]
===Complications of Pleural Mesothelioma===
* [[Disseminated intravascular coagulation]], a disorder causing severe bleeding in many body organs
Common complications of pleural mesothelioma include:<ref name="complicationpleuralmesothelioma1">Complications of mesothelioma. Mayo clinic 2016. http://www.mayoclinic.org/diseases-conditions/mesothelioma/basics/complications/con-20026157. Accessed on February 13, 2016</ref><ref name="pmid23052177">{{cite journal| author=Mensi C, Termine L, Garberi A, Meroni S, Levi D, Balzarini L et al.| title=Spinal cord compression: an unusual presentation of malignant pleural mesothelioma. A case report and review of the literature. | journal=Tumori | year= 2012 | volume= 98 | issue= 4 | pages= e92-7 | pmid=23052177 | doi=10.1700/1146.12651 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23052177  }} </ref><ref name="pmid10390966">{{cite journal| author=Minami T, Matsumoto K, Aizawa H, Nakano H, Sugio K, Nakashima Y et al.| title=[Horner's syndrome in a patient with diffuse malignant pleural mesothelioma]. | journal=Nihon Kokyuki Gakkai Zasshi | year= 1999 | volume= 37 | issue= 4 | pages= 287-90 | pmid=10390966 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10390966  }} </ref><ref name="pmid6825037">{{cite journal| author=Ragalie GF, Varkey B, Choi H| title=Malignant pleural mesothelioma presenting as superior vena cava syndrome. | journal=Can Med Assoc J | year= 1983 | volume= 128 | issue= 6 | pages= 689-91, 740 | pmid=6825037 | doi= | pmc=PMC1875200 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6825037  }} </ref>
* Pulmonary emboli, or blood clots in the arteries of the lungs
*[[dysphagia|Difficulty swallowing]]
* Severe [[ascites]]
*[[Pain]] caused by pressure on the nerves and spinal cord
*[[Pleural effusion]]
*[[Atelectasis]]
*[[Hypercoagulability]] syndrome
*[[Spinal cord compression]]
*[[Horner's syndrome]]
*[[Superior vena cava syndrome]]
 
===Complications of Peritoneal Mesothelioma===
Common complications of peritoneal mesothelioma include:<ref name="complicationperitonealmesothelioma1">Clinical presentation of peritoneal mesothelioma. Dr Alexandra Stanislavsky et al. Radiopaedia 2016. http://radiopaedia.org/articles/peritoneal-mesothelioma. Accessed on February 13, 2016</ref>
*[[Anorexia]]
*[[Weight loss]]
*Hypercoagulability syndrome
*[[Ascites]]
 
===Complications of Pericardial Mesothelioma===
Common complications of pericardial mesothelioma include:<ref name="ddxpericardialmesothelioma1">Complications of pericardial mesothelioma. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/pericardial-mesothelioma. Accessed on February 13, 2016</ref>
*[[Constrictive pericarditis]]
*[[Pericardial effusion]]
*[[Cardiac tamponade]]
*[[Heart failure]]
 
===Complications of Tunica Vaginalis Testis Mesothelioma===
Common complications of tunica vaginalis testis mesothelioma include:<ref name="complictesticularmesothelioma">Clinical presentation of tunica vaginalis testis mesothelioma. Dr Matt A. Morgan and Dr Dalia Ibrahim et al. Radiopaedia 2016. http://radiopaedia.org/articles/tunica-vaginalis-testis-mesothelioma. Accessed on February 13, 2016</ref>
*[[hydrocele|Recurrent hydrocele]]


==Prognosis==
==Prognosis==
*The prognostic factors for mesothelioma include:<ref name=prognosismesothelioma1>Prognosis and survival for mesothelioma. Cancer canadian society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/prognosis-and-survival/?region=on. Accessed on February 8, 2016</ref>
*Prognosis in mesothelioma is difficult to assess consistently because there is great variability in the time before diagnosis and the rate of disease progression.<ref name="prognosismesothelioma1322">Diagnosis and Prognostic Factors of mesothelioma. National cancer institute 2016. http://www.cancer.gov/types/mesothelioma/hp/mesothelioma-treatment-pdq. Accessed on February 15, 2016</ref>
*The prognostic factors for mesothelioma include:<ref name="prognosismesothelioma1">Prognosis and survival for mesothelioma. Cancer canadian society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/prognosis-and-survival/?region=on. Accessed on February 8, 2016</ref>
:*'''Cell subtype''': Epithelioid mesothelioma is the most common subtype of mesothelioma and has a better prognosis than sarcomatoid or mixed (biphasic) types. Sarcomatoid subtype has the least favorable prognosis.
:*'''Cell subtype''': Epithelioid mesothelioma is the most common subtype of mesothelioma and has a better prognosis than sarcomatoid or mixed (biphasic) types. Sarcomatoid subtype has the least favorable prognosis.
:*'''Location of mesothelioma''': Pericardial mesothelioma is usually associated with a poorer prognosis than the other types of mesothelioma.
:*'''Location of mesothelioma''': Pericardial mesothelioma is usually associated with a poorer prognosis than the other types of mesothelioma.
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:*'''Sex''': Females seem to have a better prognosis than men.
:*'''Sex''': Females seem to have a better prognosis than men.
:*'''Lactate dehydrogenase (LDH) level''': People with increased LDH blood levels tend to have a less favorable prognosis than those with normal LDH levels. LDH is an enzyme in the blood that can be increased when there is damage to certain tissue or cancer.
:*'''Lactate dehydrogenase (LDH) level''': People with increased LDH blood levels tend to have a less favorable prognosis than those with normal LDH levels. LDH is an enzyme in the blood that can be increased when there is damage to certain tissue or cancer.
 
*Mesothelioma occurring in germline ''[[BAP1]]'' mutation carriers have been reported to be less aggressive clinically and associated with prolonged survival compared with sporadic mesothelioma.<ref name="ThomasChen2015">{{cite journal|last1=Thomas|first1=Anish|last2=Chen|first2=Yuanbin|last3=Yu|first3=Tinghui|last4=Gill|first4=Ammara|last5=Prasad|first5=Vinay|title=Distinctive clinical characteristics of malignant mesothelioma in young patients|journal=Oncotarget|volume=6|issue=18|year=2015|pages=16766–16773|issn=1949-2553|doi=10.18632/oncotarget.4414}}</ref>
A mesothelioma is a highly aggressive tumor that is generally deadly. Current treatment of malignant mesothelioma is designed to make the person with cancer comfortable. Although long-term survival cannot usually be expected, the case of famed paleontologist [[Stephen Jay Gould]] is a noted exception.
*As discussed earlier, the prognosis of mesothelioma depends on the cell subtype. The median survival time of various subtypes of mesothelioma are tabulated below.<ref name="Survivalstatisticsformesothelioma1">Survival statistics for mesothelioma. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/prognosis-and-survival/survival-statistics/?region=on. Accessed on February 10, 2016</ref>
 
Mesothelioma is not contagious and cannot be passed from one person to another. The exposure to the asbestos that caused the cancer occurred many years to several decades before the disease appeared. People who live with asbestos workers have a higher risk of getting this cancer.
 
Although mesothelioma is very unpleasant it's still important for person after treatment is over to keep up all follow-up appointments and that's vital because further testing is always needed to check whether cancer is coming back or to examine possible side effects that could be rather unpleasant and what's even worse permanent.


{| style="border: 0px; font-size: 90%; margin: 3px; width:600px"
{| style="border: 0px; font-size: 90%; margin: 3px; width:600px"
|valign=top|
| valign="top" |
|+
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Location of mesothelioma}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Location of mesothelioma}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Approximate median survival}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Approximate median survival}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align=center|[[Pleural]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pleural]]
| style="padding: 5px 5px; background: #F5F5F5;" align=center|4-18 months
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |4-18 months
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align=center|[[Peritoneal]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Peritoneal]]
| style="padding: 5px 5px; background: #F5F5F5;" align=center|5-12 months
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |5-12 months
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align=center|[[Pericardial]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pericardial]]
| style="padding: 5px 5px; background: #F5F5F5;" align=center|6 months
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |6 months
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align=center|[[Tunica vaginalis testis]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Tunica vaginalis testis]]
| style="padding: 5px 5px; background: #F5F5F5;" align=center|23 months
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |23 months
|}
|}


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[[Category:Asbestos]]
[[Category:Asbestos]]
[[Category:Occupational diseases]]
[[Category:Occupational diseases]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]

Latest revision as of 16:17, 25 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2], Sujit Routray, M.D. [3]

Overview

If left untreated, mesothelioma may progress to develop dyspnea, dysphagia, pleural effusion, thrombophlebitis, constrictive pericarditis, recurrent hydrocele, and metastases, depending on the site involved. Complications of mesothelioma include pleural effusion, spinal cord compression, Horner's syndrome, superior vena cava syndrome, hyperviscocity syndrome, pericardial effusion, cardiac tamponade, heart failure, ascites, and recurrent hydrocele. The prognosis of mesothelioma depends on the cell subtype.[1]

Natural History

  • Malignant mesothelioma is usually an aggressive disease.[1]
  • The exposure to the asbestos that cause mesothelioma occurrs 25-40 years to appear.
  • Metastasis outside the thoracic wall occurs late in the course of pleural mesothelioma. Common sites of metastasis for pleural mesothelioma include:[2]
  • Peritoneal mesothelioma does not usually spread to the lymph nodes or distant organs. Common sites of metastasis for peritoneal mesothelioma include:[2]

Complications

Complications of Pleural Mesothelioma

Common complications of pleural mesothelioma include:[3][4][5][6]

Complications of Peritoneal Mesothelioma

Common complications of peritoneal mesothelioma include:[7]

Complications of Pericardial Mesothelioma

Common complications of pericardial mesothelioma include:[8]

Complications of Tunica Vaginalis Testis Mesothelioma

Common complications of tunica vaginalis testis mesothelioma include:[9]

Prognosis

  • Prognosis in mesothelioma is difficult to assess consistently because there is great variability in the time before diagnosis and the rate of disease progression.[10]
  • The prognostic factors for mesothelioma include:[11]
  • Cell subtype: Epithelioid mesothelioma is the most common subtype of mesothelioma and has a better prognosis than sarcomatoid or mixed (biphasic) types. Sarcomatoid subtype has the least favorable prognosis.
  • Location of mesothelioma: Pericardial mesothelioma is usually associated with a poorer prognosis than the other types of mesothelioma.
  • Surgical removal: Mesothelioma that can be resected has a more favorable prognosis than mesothelioma that has spread too far and is unresectable. Clear surgical margins improve prognosis. Mesothelioma is often a diffuse disease and doesn’t stay localized. This makes it difficult to get clear surgical margins.
  • Stage: Stage plays a role in prognosis for people who have surgery. The stage of mesothelioma does not impact survival for people who do not have surgery. Generally, early stage mesothelioma has a better prognosis than more advanced stages. If mesothelioma has spread to the lymph nodes, it is usually associated with a less favorable prognosis.
  • Symptoms: The presence of chest pain with pleural mesothelioma or excessive weight loss is associated with a poorer prognosis. Chest pain suggests there may advanced disease that is unresectable.
  • Thrombocytosis: Thrombocytosis is associated with a poorer prognosis.
  • Leukocytosis: Leukocytosis is associated with a poorer prognosis.
  • Performance status: People with a good performance status have a better prognosis than those with a poor performance status.
  • Age: Younger people have a better prognosis than older people.
  • Sex: Females seem to have a better prognosis than men.
  • Lactate dehydrogenase (LDH) level: People with increased LDH blood levels tend to have a less favorable prognosis than those with normal LDH levels. LDH is an enzyme in the blood that can be increased when there is damage to certain tissue or cancer.
  • Mesothelioma occurring in germline BAP1 mutation carriers have been reported to be less aggressive clinically and associated with prolonged survival compared with sporadic mesothelioma.[12]
  • As discussed earlier, the prognosis of mesothelioma depends on the cell subtype. The median survival time of various subtypes of mesothelioma are tabulated below.[1]
Location of mesothelioma Approximate median survival
Pleural 4-18 months
Peritoneal 5-12 months
Pericardial 6 months
Tunica vaginalis testis 23 months

References

  1. ↑ 1.0 1.1 1.2 Survival statistics for mesothelioma. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/prognosis-and-survival/survival-statistics/?region=on. Accessed on February 10, 2016
  2. ↑ 2.0 2.1 If mesothelioma spreads. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/if-cancer-spreads/?region=on. Accessed on February 15, 2016
  3. ↑ Complications of mesothelioma. Mayo clinic 2016. http://www.mayoclinic.org/diseases-conditions/mesothelioma/basics/complications/con-20026157. Accessed on February 13, 2016
  4. ↑ Mensi C, Termine L, Garberi A, Meroni S, Levi D, Balzarini L; et al. (2012). "Spinal cord compression: an unusual presentation of malignant pleural mesothelioma. A case report and review of the literature". Tumori. 98 (4): e92–7. doi:10.1700/1146.12651. PMID 23052177.
  5. ↑ Minami T, Matsumoto K, Aizawa H, Nakano H, Sugio K, Nakashima Y; et al. (1999). "[Horner's syndrome in a patient with diffuse malignant pleural mesothelioma]". Nihon Kokyuki Gakkai Zasshi. 37 (4): 287–90. PMID 10390966.
  6. ↑ Ragalie GF, Varkey B, Choi H (1983). "Malignant pleural mesothelioma presenting as superior vena cava syndrome". Can Med Assoc J. 128 (6): 689–91, 740. PMC 1875200. PMID 6825037.
  7. ↑ Clinical presentation of peritoneal mesothelioma. Dr Alexandra Stanislavsky et al. Radiopaedia 2016. http://radiopaedia.org/articles/peritoneal-mesothelioma. Accessed on February 13, 2016
  8. ↑ Complications of pericardial mesothelioma. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/pericardial-mesothelioma. Accessed on February 13, 2016
  9. ↑ Clinical presentation of tunica vaginalis testis mesothelioma. Dr Matt A. Morgan and Dr Dalia Ibrahim et al. Radiopaedia 2016. http://radiopaedia.org/articles/tunica-vaginalis-testis-mesothelioma. Accessed on February 13, 2016
  10. ↑ Diagnosis and Prognostic Factors of mesothelioma. National cancer institute 2016. http://www.cancer.gov/types/mesothelioma/hp/mesothelioma-treatment-pdq. Accessed on February 15, 2016
  11. ↑ Prognosis and survival for mesothelioma. Cancer canadian society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/prognosis-and-survival/?region=on. Accessed on February 8, 2016
  12. ↑ Thomas, Anish; Chen, Yuanbin; Yu, Tinghui; Gill, Ammara; Prasad, Vinay (2015). "Distinctive clinical characteristics of malignant mesothelioma in young patients". Oncotarget. 6 (18): 16766–16773. doi:10.18632/oncotarget.4414. ISSN 1949-2553.


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