Mesothelioma natural history
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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
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 of the chest occurs late in the course of pleural mesothelioma. Common sites where pleural mesothelioma spreads include:[2]
- Mediastinum
- Pericardium
- Lymph nodes
- Thoracic wall
- 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
Complications
Complications of Pleural Mesothelioma
Common complications of pleural mesothelioma include:[3][4][5][6]
- Difficulty swallowing
- 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:[7]
- Anorexia
- Weight loss
- Hypercoagulability syndrome
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]
- Blood clots in the veins, which may cause thrombophlebitis
- Disseminated intravascular coagulation, a disorder causing severe bleeding in many body organsy 13
- Pulmonary emboli, or blood clots in the arteries of the lungs
- Severe ascites
Prognosis
- The prognostic factors for mesothelioma include:[10]
- 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.[11]
- 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.
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
- ↑ 1.0 1.1 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
- ↑ 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
- ↑ Complications of mesothelioma. Mayo clinic 2016. http://www.mayoclinic.org/diseases-conditions/mesothelioma/basics/complications/con-20026157. Accessed on February 13, 2016
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Clinical presentation of peritoneal mesothelioma. Dr Alexandra Stanislavsky et al. Radiopaedia 2016. http://radiopaedia.org/articles/peritoneal-mesothelioma. Accessed on February 13, 2016
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ 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.