Epidemiology
- Incidence: 3.00 cases per 100,000 person-years
- Peak incidence: 70+ years
- Sex ratio: more common in males 3:1
| Condition | Relative incidence |
|---|---|
| Lung cancer | 25.67 |
| Mesothelioma | 1 |
| <1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Clinical features
Features
- Dyspnoea, weight loss, chest wall pain
- Clubbing
- 30% present as painless pleural effusion
- Only 20% have pre-existing asbestosis
- History of asbestos exposure in 85-90%, latent period of 30-40 years
Referral criteria
NICE cancer referral guidelines for mesothelioma suggest the following:
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for mesothelioma if they have chest X‑ray findings that suggest mesothelioma.
Offer an urgent chest X‑ray (to be performed within 2 weeks) to assess for mesothelioma in people aged 40 and over, if:
Consider an urgent chest X‑ray (to be performed within 2 weeks) to assess for mesothelioma in people aged 40 and over with either:
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for mesothelioma if they have chest X‑ray findings that suggest mesothelioma.
Offer an urgent chest X‑ray (to be performed within 2 weeks) to assess for mesothelioma in people aged 40 and over, if:
- they have 2 or more of the following unexplained symptoms, or
- they have 1 or more of the following unexplained symptoms and have ever smoked, or
- they have 1 or more of the following unexplained symptoms and have been exposed to asbestos:
- cough
- fatigue
- shortness of breath
- chest pain
- weight loss
- appetite loss.
Consider an urgent chest X‑ray (to be performed within 2 weeks) to assess for mesothelioma in people aged 40 and over with either:
- finger clubbing or
- chest signs compatible with pleural disease.
Investigations
Investigation/diagnosis
- suspicion is normally raised by a chest x-ray showing either a pleural effusion or pleural thickening
- the next step is normally a pleural CT
- if a pleural effusion is present fluid should be sent for MC&S, biochemistry and cytology (but cytology is only helpful in 20-30% of cases)
- local anaesthetic thoracoscopy is increasingly used to investigate cytology negative exudative effusions as it has a high diagnostic yield (around 95%)
- if an area of pleural nodularity is seen on CT then an image-guided pleural biopsy may be used
Management
Management
- Symptomatic
- Industrial compensation
- Chemotherapy, Surgery if operable
- Prognosis poor, median survival 12 months