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
If left untreated, mesothelioma may progress to develop dyspnea, dysphagia, pleural effusion, thrombophlebitis, constrictive pericarditis, recurrent hydrocele, and metastases, depending on the site involved.[1][2][3][4][5][6][7] 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.[2][3][4][5][6][8][7] 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:[9]
- 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
- Peritoneal mesothelioma does not usually spread to the lymph nodes or distant organs. Common sites of metastasis for peritoneal mesothelioma include:[9]
- Serosa of the small and large intestine – can cause a bowel obstruction
- Unilateral or bilateral pleural cavities
- Liver
- Spleen
Complications
Complications of Pleural Mesothelioma
Common complications of pleural mesothelioma include:[2][3][4][5]
- 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:[6]
- Anorexia
- Weight loss
- Hypercoagulability syndrome
- Ascites
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:[7]
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]
- 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 1.2 1.3 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
- ↑ 2.0 2.1 2.2 Complications of mesothelioma. Mayo clinic 2016. http://www.mayoclinic.org/diseases-conditions/mesothelioma/basics/complications/con-20026157. Accessed on February 13, 2016
- ↑ 3.0 3.1 3.2 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.
- ↑ 4.0 4.1 4.2 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.
- ↑ 5.0 5.1 5.2 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.
- ↑ 6.0 6.1 6.2 Clinical presentation of peritoneal mesothelioma. Dr Alexandra Stanislavsky et al. Radiopaedia 2016. http://radiopaedia.org/articles/peritoneal-mesothelioma. Accessed on February 13, 2016
- ↑ 7.0 7.1 7.2 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
- ↑ 8.0 8.1 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
- ↑ 9.0 9.1 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
- ↑ 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.