Mesotheliomas are tumors that arise from the mesothelial cells of the pleural cavities. Contrary to lung cancers, mesotheliomas are not associated with smoking. The majority of mesotheliomas however, are related to asbestos exposure. Epidemiologic studies have shown that more than 80% of mesotheliomas are associated with asbestos exposure. It has been shown that up to 40 years of relatively short-term (less than 1 to 2 years) exposures to asbestos in a patient's past have been mostly associated with the development of these malignant tumors. This observation underscores the utmost importance of procuring a complete and thorough history, especially when it comes to patients' occupational and environmental exposures. At the beginning of the 21st century, more than 2,000 cases of mesothelioma among asbestos-exposed workers were reported. This number however is still significantly lower than the risk of lung cancer among the same asbestos-exposed group.
Mesotheliomas are locally invasive tumors. Thus, the usual presentation of patients with mesotheliomas includes shortness of breath and chest pain. The chest pain is mostly due to the local and aggressive extension of the tumor in the chest cavity. However, a good 50% of these tumors still metastasize. A simple diagnostic procedure such as a simple chest radiography will likely to reveal a pleural effusion, a generalized thickening of the pleura, and a shrunken hemithorax. The pleural effusion present is likely to obscure the presence of the underlying mesothelioma. A good clue to look for would be whether there is a shifting of the mediastinal structures toward the opposite side of the chest wall. In the presence of a mesothelioma, there is some sort of rigidity that is conferred to the chest wall. Thus, there will be no mediastinal shift of structures seen. Although not 100% conclusive, this is a very simple and efficient way of weeding out pleural effusion caused by a mesothelioma from pleural effusions caused by other factors.
Chest radiographs and CT scans may also reveal signs consistent with asbestosis. Asbestos-related pleural disease usually manifest as bilateral calcified pleural plaques on chest radiographs. With a high-resolution CT scan of the thorax, the telltale signs of bilateral subpleural reticulation which are highly representative of fibrotic disease due to asbestosis can be seen.
Another major diagnostic hurdle that can surface with mesotheliomas is in figuring out how to go about differentiating whether a particular tumor is from a peripherally spreading pulmonary adenocarcinoma or from an adenocarcinoma that has metastasized to the pleura from an extrathoracic primary site. For a definitive diagnosis, a thoracoscopy or an open pleural biopsy using video-assisted thoracic surgery and special immunohistochemical staining is usually warranted. Cytologic examination of the pleural fluid can also be employed to help come up with the diagnosis. However, biopsy of the pleura is the gold standard for diagnosis.
Currently, there is no effective therapy to stop the growth of mesotheliomas. At present, therapy is directed towards symptomatic relief and in improving the quality of life of patients. Opiates can be used to treat the chest pain. Oxygen and or opiates can both be employed to address the shortness of breath of the patient.
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