Mesothelioma

Our plain-English summary of Mesothelioma, by G. Fuhrer, A.A. Lazarus (Disease-a-month, 2011).

The study

• Authors: G. Fuhrer, A.A. Lazarus
• Journal: Disease-a-month
• Published: 2011;57(1):40-54
• Type of article: Review
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This narrative review summarized the epidemiology, pathogenesis, clinical presentation, diagnosis, staging, prognosis and management of mesothelioma, with special attention to articles and guidelines published in the preceding three years. The authors described occupational exposure to asbestos fibers as the primary risk factor. They identified the amphibole fibers crocidolite, amosite and tremolite as the major carcinogens. They noted a latency of 20 to 40 years and about 2500 cases a year in the USA, and cited Italian Mesothelioma Registry data suggesting a median latency of 44.6 years. Other exposures and risk factors discussed included domestic asbestos exposure, erionite in Turkish villages, radiation therapy, simian virus 40 and genetic predisposition. Pathogenesis was described as chronic inflammation caused by fibers, leading to a cascade of gene mutations. The review covered symptoms and imaging with CT, MRI and PET-CT. It also covered pathologic diagnosis with immunohistochemical markers, and serum and pleural fluid markers, none of which had been shown to be accurate enough to replace pathologic examination. Treatments reviewed included extrapleural pneumonectomy, pleurectomy/decortication, intensity-modulated radiation therapy and chemotherapy. In a cited randomized trial, pemetrexed plus cisplatin gave a 12- versus 9-month median survival compared with cisplatin alone. The authors concluded that trimodality therapy appeared to be the most effective strategy, that prognosis remained poor, and that an increasing number of cases would likely appear over the next decade because of the long latency.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was a narrative review, not an original study, of mesothelioma, a cancer of the lining of the chest (pleura) and abdomen (peritoneum). The authors covered causes, disease development, symptoms, diagnosis and treatment, focusing on articles and guidelines from the previous three years. They described occupational asbestos exposure as the primary risk factor and named the amphibole fibers crocidolite, amosite and tremolite as the major carcinogens. They also discussed other proposed risk factors: erionite, an asbestos-like fiber in stones used in Turkish village homes; radiation therapy; and the virus SV40. From the literature, they reported a 20- to 40-year latency between exposure and disease, about 2500 US cases a year, and that definite diagnosis requires pathologic examination. On treatment, they cited a randomized trial in patients not eligible for curative surgery, in which pemetrexed with cisplatin gave a 12-month median survival, versus 9 months for cisplatin alone. The authors concluded that asbestos and asbestos-like fibers account for most cases, that combined chemotherapy, surgery and radiation (trimodality therapy) appears most effective, and that prognosis remains poor.

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 and guidelines (no original data)
• Who was studied: No study population of its own. The review covers published work on pleural and peritoneal mesothelioma (and rarer sites).
• Exposure: Mainly occupational asbestos exposure, with the amphibole fibers crocidolite, amosite and tremolite described as the major carcinogens. Also reviewed: domestic asbestos exposure, erionite, radiation therapy and SV40.
• Main results:
  • The authors stated a 20- to 40-year latency between asbestos exposure and mesothelioma, and a current US incidence of approximately 2500 cases per year. They noted that Italian Mesothelioma Registry data suggest a longer median latency of 44.6 years.
  • In a cited retrospective Australian study, as described by the authors, odds ratios were 3.1 for pleural plaques and 3.3 for asbestosis. The authors said this risk was associated only with peritoneal mesothelioma, not pleural mesothelioma.
  • In a cited retrospective study of more than 250,000 women with breast cancer or Hodgkin's disease registered with the National Cancer Institute, the results did not support a role of radiation therapy in developing mesothelioma.
  • The authors reported that SV40-like DNA sequences have been found in up to 60% of mesotheliomas studied, and that the data on SV40 as a source of exposure are mixed.
  • A definite diagnosis requires pathologic examination. According to the authors, pleural fluid cytology is 25-33% sensitive and closed-needle pleural biopsy 21-77%.
  • In a cited randomized controlled trial of patients not eligible for curative surgery, pemetrexed with cisplatin gave a 12-month median survival, compared with 9 months for cisplatin alone.
  • In a cited phase II trial (77 patients received chemotherapy; 44 also received surgery by extrapleural pneumonectomy plus radiation), completing all three treatments was associated with a 29.1-month median survival. The whole cohort had a 16.8-month median survival.
• The authors' conclusion: The authors concluded that exposure to asbestos and asbestos-like fibers accounts for most cases, mostly occupational in North America. They expected case numbers to likely rise over the next decade because of the long latency, said trimodality therapy appears most effective, and said overall prognosis continues to be poor.
• Limitations the authors state:
  • The authors noted that studies comparing the two main surgical approaches are largely retrospective.
  • The authors noted that randomized controlled trial data on trimodality therapy are lacking.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Epidemiology, Staging, Prognosis, Occupational Exposure, Amphibole Group, Crocidolite, Amosite.

Related studies

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• Asbestos and lung diseases: introduction and epidemiology — J.A. Nations, A.A. Lazarus (2011)
• Lung inflammation caused by inhaled toxicants: a review — J. Wong, B.E. Magun, et al. (2016)
• Pulmonary endpoints (lung carcinomas and asbestosis) following inhalation exposure to asbestos — B.T. Mossman, M. Lippmann, et al. (2011)
• Review of carbon nanotubes toxicity and exposure--appraisal of human health risk assessment based on open literature — K. Aschberger, H.J. Johnston, et al. (2010)
• Carcinogenic hazards from inhaled carbon black, titanium dioxide, and talc not containing asbestos or asbestiform fibers: recent evaluations by an IARC Monographs Working Group — R.A. Baan (2007)

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