Malignant mesothelioma

Our plain-English summary of Malignant mesothelioma, by I. Ahmed, S. Ahmed Tipu, S. Ishtiaq (Pakistan Journal of Medical Sciences, 2013).

The study

• Authors: I. Ahmed, S. Ahmed Tipu, S. Ishtiaq
• Journal: Pakistan Journal of Medical Sciences
• Published: 2013;29(6):1433-8
• Type of article: Review
• Cited by: 43 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Unlabelled: Malignant Mesothelioma (MM) is a rare but rapidly fatal and aggressive tumor of the pleura and peritoneum with limited knowledge of its natural history. The incidence has increased in the past two decades but still it is a rare tumor. Etiology of all forms of mesothelioma is strongly associated with industrial pollutants, of which asbestos is the principal carcinogen. Mesothelioma is an insidious neoplasm arising from mesothelial surfaces i.e., pleura (65%-70%), peritoneum (30%), tunica vaginalis testis, and pericardium (1%-2%). The diagnosis of peritoneal and Pleural mesothelioma is often delayed, due to a long latent period between onset and symptoms and the common and nonspecific clinical presentation. The definite diagnosis can only be established by diagnostic laparoscopy or open surgery along with biopsy to obtain histological examination and immunocytochemical analysis. Different treatment options are available but Surgery can achieve a complete or incomplete resection and Radical resection is the preferred treatment. Chemotherapy has an important role in palliative treatment. Photodynamic therapy is also an option under trial. Patients who successfully underwent surgical resection had a considerably longer median survival as well as a significantly higher 5-year survival. Source of Data/Study Selection: The data were collected from case reports, cross-sectional studies, Open-label studies and phase -II trials between 1973-2012.

Data Extraction: Web sites and other online resources of American college of surgeons, Medline, NCBI and Medscape resource centers were used to extract data.

Conclusion: Malignant Mesothelioma (MM) is a rare but rapidly fatal and aggressive tumor with limited knowledge of its natural history. The diagnosis of peritoneal and Pleural mesothelioma is often delayed, so level of index of suspicion must be kept high.

In plain English

This was a review article, not an original study. The authors drew on case reports, cross-sectional studies, open-label studies and phase II trials published between 1973 and 2012, found through Medline, NCBI, Medscape and American College of Surgeons online resources. Although titled malignant mesothelioma, most of the review dealt with peritoneal mesothelioma. Citing earlier work, the review described asbestos, primarily the crocidolite variety, as the main risk factor. It also noted that only 50% of patients with peritoneal mesothelioma have a history of asbestos exposure, and it listed radiation, talc, erionite and mica as other risk factors. It stated that mesothelioma arises from the pleura in 65% to 70% of cases, the peritoneum in 30% and the pericardium in 1% to 2%. It summarized diagnosis, which it said can only be made definitely by laparoscopy or open surgery with biopsy, and it summarized treatments. One cited study reported a median survival of 20 months for patients who had surgical resection versus 4 months for those who did not. The authors concluded that diagnosis is often delayed, so a high index of suspicion must be kept.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of published literature (case reports, cross-sectional studies, open-label studies and phase II trials from 1973 to 2012)
• Who was studied: No patients were studied directly. The review drew on literature and online resources from the American College of Surgeons, Medline, NCBI and Medscape, covering 1973 to 2012. The focus was mainly malignant peritoneal mesothelioma.
• Exposure: Asbestos, primarily the crocidolite variety, described as the main risk factor. Radiation, talc, erionite and mica exposure, and familial Mediterranean fever, were listed as other risk factors in some patients.
• Main results:
  • Citing earlier literature, the review stated that only 50% of patients with peritoneal mesothelioma have a history of asbestos exposure.
  • Citing earlier literature, the review stated that mesothelioma arises from the pleura in 65% to 70% of cases, the peritoneum in 30%, and the pericardium in 1% to 2%, and also from the tunica vaginalis testis.
  • The review stated that definite diagnosis can only be established by diagnostic laparoscopy or open surgery with biopsy.
  • Citing earlier literature, the review stated that because effective treatment is lacking, median survival for peritoneal mesothelioma is 5 to 12 months.
  • In a cited study, patients who had surgical resection had a median survival of 20 months versus 4 months for those who did not (P<0.001). Their 5-year survival was 28% versus 12% (P<0.001).
  • In a cited study, mean survival after cytoreductive surgery and intraperitoneal chemotherapy was 35.8 months with CC-0 or CC-1 resection and 6.5 months with CC-2 or CC-3 resection.
• The authors' conclusion: The authors concluded that malignant mesothelioma is a rare but rapidly fatal and aggressive tumor whose diagnosis is often delayed. They said a high index of suspicion must be kept and that further studies are required.

Topics

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Pleura, Peritoneum, Etiology, Mesothelioma, Neoplasm, Tunica Vaginalis, Pericardium.

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• Malignant peritoneal mesothelioma as a rare cause of ascites: a case report — I. Ahmed, A. Koulaouzidis, et al. (2008)

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