Mesothelioma overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]
Overview
Mesothelioma is a rare, highly aggressive cancer which arises from the mesothelial cells which form the lining of the pleural, and less frequently the peritoneal, pericardial, and tunica vaginalis cavities.[1][2] Mesothelioma is a form of cancer that is most commonly caused by exposure to asbestos.[3]
Historical Perspective
Wagner et al. were the first to discover the association between asbestos exposure and development of mesothelioma.[4]
Classification
Mesothelioma may be classified into several subtypes based on the location (pleural, peritoneal, pericardial, cystic/multicystic, and tunica vaginalis testis), histology (epithelial, sarcomatoid, and biphasic), and potential to spread (benign and malignant).[5][6]
Pathophysiology
Asbestos causes DNA damage directly by mechanically interfering with the segregation of chromosomes during mitosis and indirectly by inducing mesothelial cells and macrophages, to release mutagenic reactive oxygen and nitrogen species.[4] Asbestos fibres have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favor the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences. Genes involved in the pathogenesis of mesothelioma include BAP1, CDKN2A, WT1, NF2, and TP53.[4][7][8][9][10][11][12] On gross pathology, pleural mesothelioma is characterized by discrete plaques and nodules that coalesce to produce a sheet-like tumor, with the pleural surface seeding of malignant mesothelioma cells.[13] Based on the histology, mesothelioma may be classified into 3 subtypes: epithelial, sarcomatoid, and biphagic.[5] Mesothelioma is demonstrated by positivity to tumor markers, such as calretinin, epithelial membrane antigen, cytokeratin, and mesothelin.[14][15]
Causes
Common causes of mesothelioma include asbestos-fibre exposure, erionite-fibre exposure, Simian virus 40, and radiation exposure.[16]
Differentiating Mesothelioma from other Diseases
Mesothelioma must be differentiated from pleural effusion, lung cancer, pulmonary tuberculosis, peritoneal tuberculosis, pseudomyxoma peritonei, constrictive pericarditis, ovarian cystadenoma, and mesothelial hyperplasia of the testis.[17][18][19][20][21][22][23]
Epidemiology and Demographics
Mesothelioma is a rare disease which accounts for 5-28% of all malignancies that involve the pleura.[13] The incidence of mesothelioma is estimated to be 3,000 cases annually.[1] The incidence of pleural mesothelioma is approximately 1 per 100,000 individuals in the United States.[24] Males are more commonly affected with mesothelioma than females. The male to female ratio is approximately 3 to 1.[13] The incidence of mesothelioma increases with age; the median age at diagnosis for pleural mesothelioma and peritoneal mesothelioma are 74 years and 68 years, respectively.[4] There is no racial predilection to mesothelioma.[13]
Risk Factors
The most potent risk factor in the development of mesothelioma is asbestos exopsure. Other risk factors include erionite-fibre exposure, Simian virus 40, and radiation exposure.[25]
Screening
Natural History, Complications and Prognosis
Diagnosis
Staging
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
CT
MRI
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Summary of Treatment for Pleural Mesothelioma
Summary of Treatment for Peritoneal Mesothelioma
Primary Prevention
Secondary Prevention
References
- ↑ 1.0 1.1 Philip A. Rascoe, Xiaobo X. Cao and W. Roy Smythe (2012). Molecular Pathogenesis of Malignant Pleural Mesothelioma, Mesotheliomas - Synonyms and Definition, Epidemiology, Etiology, Pathogenesis, Cyto-Histopathological Features, Clinic, Diagnosis, Treatment, Prognosis, Dr Alexander Zubritsky (Ed.), ISBN: 978-953-307-845-8, InTech, Available from: http://www.intechopen.com/books/mesotheliomas-synonyms-and-definition-epidemiology-etiology-pathogenesis-cyto-histopathological-features-clinic-diagnosis-treatment-prognosis/molecular-pathogenesis-of-malignant-pleural-mesothelioma
- ↑ Mesothelioma. Wikipedia 2016. https://en.wikipedia.org/wiki/Mesothelioma. Accessed on February 3, 2016
- ↑ "Mesothelioma risks and causes : Cancer Research UK : CancerHelp UK". Cancerhelp.org.uk. 2010-06-23. Retrieved 2010-08-20.
- ↑ 4.0 4.1 4.2 4.3 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.
- ↑ 5.0 5.1 Mesothelioma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/mesothelioma. Accessed on February 8, 2016
- ↑ What is mesothelioma. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/mesothelioma/?region=on. Accessed on February 8, 2016
- ↑ Ladanyi M (2005). "Implications of P16/CDKN2A deletion in pleural mesotheliomas". Lung Cancer. 49 Suppl 1: S95–8. doi:10.1016/j.lungcan.2005.03.017. PMID 15950811.
- ↑ Kumar-Singh S, Segers K, Rodeck U, Backhovens H, Bogers J, Weyler J; et al. (1997). "WT1 mutation in malignant mesothelioma and WT1 immunoreactivity in relation to p53 and growth factor receptor expression, cell-type transition, and prognosis". J Pathol. 181 (1): 67–74. doi:10.1002/(SICI)1096-9896(199701)181:1<67::AID-PATH723>3.0.CO;2-Z. PMID 9072005.
- ↑ Ladanyi M, Zauderer MG, Krug LM, Ito T, McMillan R, Bott M; et al. (2012). "New strategies in pleural mesothelioma: BAP1 and NF2 as novel targets for therapeutic development and risk assessment". Clin Cancer Res. 18 (17): 4485–90. doi:10.1158/1078-0432.CCR-11-2375. PMC 3432735. PMID 22825583.
- ↑ Andujar P, Pairon JC, Renier A, Descatha A, Hysi I, Abd-Alsamad I; et al. (2013). "Differential mutation profiles and similar intronic TP53 polymorphisms in asbestos-related lung cancer and pleural mesothelioma". Mutagenesis. 28 (3): 323–31. doi:10.1093/mutage/get008. PMID 23435014.
- ↑ Opitz I, Soltermann A, Abaecherli M, Hinterberger M, Probst-Hensch N, Stahel R; et al. (2008). "PTEN expression is a strong predictor of survival in mesothelioma patients". Eur J Cardiothorac Surg. 33 (3): 502–6. doi:10.1016/j.ejcts.2007.09.045. PMID 18248818.
- ↑ Murakami H, Mizuno T, Taniguchi T, Fujii M, Ishiguro F, Fukui T; et al. (2011). "LATS2 is a tumor suppressor gene of malignant mesothelioma". Cancer Res. 71 (3): 873–83. doi:10.1158/0008-5472.CAN-10-2164. PMID 21245096.
- ↑ 13.0 13.1 13.2 13.3 Mesothelioma. CGMH.ORG 2016. https://www1.cgmh.org.tw/intr/intr5/c6700/OBGYN/f/web/Mesothelioma/index.htm. Accessed on February 15, 2016
- ↑ Pathology of mesothelioma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/mesothelioma. Accessed on February 10, 2016
- ↑ Immunohistochemistry of mesothelioma. Wikipedia 2016. https://en.wikipedia.org/wiki/Mesothelioma. Accessed on February 12, 2016
- ↑ Risk factors for mesothelioma. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/risks/?region=on. Accessed on February 8, 2016
- ↑ Differential diagnosis of mesothelioma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/mesothelioma. Accessed on February 12, 2016
- ↑ Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/pleural-tumours. Accessed on February 12, 2016
- ↑ Differential diagnosis of peritoneal mesothelioma. Dr Alexandra Stanislavsky et al. Radiopaedia 2016. http://radiopaedia.org/articles/peritoneal-mesothelioma. Accessed on February 12, 2016
- ↑ Primary peritoneal neoplasms. Dr Praveen Jha and Radswiki et al. Radiopaedia 2016. http://radiopaedia.org/articles/primary-peritoneal-neoplasms. Accessed on February 12, 2016
- ↑ Seek a Second Opinion to Avoid Misdiagnosis of Pericardial Mesothelioma. Asbestos.com 2016. http://www.asbestos.com/mesothelioma/pericardial.php. Accessed on February 12, 2016
- ↑ Differential diagnosis of multicystic mesothelioma. Dr Aditya Shetty and Dr Yuranga Weerakkody et al. Raiopaedia 2016. http://radiopaedia.org/articles/multicystic-mesothelioma. Accessed on February 12, 2016
- ↑ Chekol, Seble S; Sun, Chen-Chin (2012). "Malignant Mesothelioma of the Tunica Vaginalis Testis: Diagnostic Studies and Differential Diagnosis". Archives of Pathology & Laboratory Medicine. 136 (1): 113–117. doi:10.5858/arpa.2010-0550-RS. ISSN 0003-9985.
- ↑ Saint-Pierre, Mathieu D.; Pease, Christopher; Mithoowani, Hamid; Zhang, Tinghua; Nicholas, Garth A.; Laurie, Scott A.; Wheatley-Price, Paul (2015). "Malignant Pleural Mesothelioma Outcomes in the Era of Combined Platinum and Folate Antimetabolite Chemotherapy". Lung Cancer International. 2015: 1–7. doi:10.1155/2015/590148. ISSN 2090-3197.
- ↑ Mesothelioma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al.Radiopaedia 2016. http://radiopaedia.org/articles/mesothelioma. Accessed on 13th January, 2016