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Mesothelioma: What PCPs need to know
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Researchers recently reported “significant progress” in explaining the mechanisms of asbestos carcinogenesis and of mesothelioma pathogenesis, which has allowed for novel screening and therapy targets. However, the American Cancer Society says “much remains to be learned” about the disease that more than 20 million people in the U.S. are at risk for developing due to asbestos exposure, according to one research team.
About 3,000 new cases of mesothelioma are diagnosed each year, so to increase general awareness, the Mesothelioma Applied Research Foundation has been commemorating Mesothelioma Awareness Day every Sept. 26 since 2004.
In recognition of this event, Healio Family Medicine asked Humberto Choi, MD, of the pulmonology department at Cleveland Clinic to explain how to tell if patients are at risk for the disease, warning signs, what treatment options are available, and other important information about the disease – by Janel Miller
Q: What are the risk factors for mesothelioma?
A: Most cases of mesothelioma are linked to asbestos exposure but there are cases where the exposure is not very clear. Other causes include radiation exposure, and possible genetic predisposition.
Q: What are the warning signs of the disease?
A: Symptoms are not very specific and may not be evident until the disease is advanced in the chest or abdomen. Symptoms from mesothelioma affect the pleura (lining around the lungs) and include shortness of breath and chest pain. This could be because of the tumor itself or because of fluid accumulation around the lungs. Mesothelioma can also affect the peritoneum (lining around the bowels and other organs in the abdomen). Symptoms from abdominal involvement may vary and include abdominal pain, bloating and constipation.
Q: Are there other diseases that mesothelioma is sometimes mistaken for, and how can a primary care physician distinguish between these diseases?
A: Mesothelioma can be difficult to diagnose because it can look like different diseases. It can be mistaken for lung infections, inflammatory diseases that are not infections, and different types of cancer, like lung cancer. Obviously, because the range of diagnosis is large and the prognosis and treatment would be very different [depending on the actual diagnosis], a definitive diagnosis is required. A mesothelioma diagnosis requires an invasive procedure like a biopsy or surgery.
Q: When does the care of a patient with mesothelioma need to move on from primary care and onto a specialist?
A: The care should move on as soon as there are imaging findings that are suspicious for mesothelioma. A specialist evaluation would be helpful to determine next steps especially when they involve the choice of diagnostic procedures and treatment.
Q: What are the treatment options for patients with mesothelioma?
A: The options depend on many factors but mainly on how healthy someone is and how extensive the disease is. Options include surgery and chemotherapy depending on how extensive the disease is. It is important for someone to be treated by a multidisciplinary team that is experienced in treating this disease.
Q: What is the cure rate for the disease? What is the prognosis if one follows their treatments?
A: Unfortunately, very few patients are cured from mesothelioma. Patients may die from direct extension of the tumor or from consequences from tumor invasion like bowel obstruction. The overall survival is 9 to 17 months from diagnosis. Certain types of mesothelioma can be more aggressive than others, but overall all of them carry a poor prognosis.
References:
American Cancer Society. What’s New in Malignant Mesothelioma Research and Treatment? https://www.cancer.org/cancer/malignant-mesothelioma/about/new-research.html. Accessed Sept. 21, 2018.
Carbone M, et al. J Cell Physiol. 2012;doi:10.1002/jcp.22724.
Carbone M, Yang H. Ann Transl Med. 2017;doi:10.21037/atm.2017.04.29.
Mesothelioma. Mesothelioma Awareness Day. https://mesothelioma.net/mesothelioma-awareness-day/. Accessed Sept. 21, 2018.
Disclosures: Choi reports no relevant financial disclosures. Please see the studies for all other authors’ relevant financial disclosures.