Mesothelioma is a cancer that typically affects middle-aged or older men who were exposed to asbestos on the job. But even younger patients with no known history of asbestos exposure may develop mesothelioma, and should be evaluated if they have signs of the disease, according to a recent review in the West Virginia Medical Journal. Even when mesothelioma is properly diagnosed, treatment options remain limited and the prognosis is usually grim, the authors say.
The review presented the case of a 38-year-old, otherwise healthy woman who developed shortness of breath and chest pain, which worsened over time. Pathology tests revealed cancerous cells that are typical of mesothelioma, even though the woman had no apparent risks for the disease. “The family denied any known history of asbestos exposure, either in her or other family members,” says lead study author Carol Montjoy, MD, Fellow in the West Virginia University Section of Pulmonary/CCM.
Dr. Montjoy and her colleagues say this case illustrates the need to consider a diagnosis of mesothelioma in patients who have a growth in the pleura (the lining of the chest and lungs), even if they don’t fit the typical profile of a mesothelioma patient.
Even with the best techniques available today, mesothelioma remains an elusive cancer—difficult to detect, and challenging to treat. X-ray and computed tomography (CT) scans can identify growths in the pleura, but when tissue samples are examined, mesothelioma is difficult to distinguish from adenocarcinoma (a type of cancer that begins in glandular tissue). The use of immunohistochemical stains—a technique that stains cancer cells to identify biological markers for cancer—has helped doctors more accurately diagnose mesothelioma, but once this cancer has been identified, there is often little doctors can do to attack it.
“Mesothelioma, unfortunately, is an aggressive tumor with a poor response to multiple common modalities, including surgery, chemotherapy, and radiation treatment,” Dr. Montjoy says. These treatments can only improve survival time by a few months (an untreated mesothelioma patient may live 4-13 months, while a treated patient lives 6-18 months).
Researchers are currently investigating new treatment strategies, which they hope will improve the prognosis for mesothelioma patients. One relatively new treatment option attempts to improve survival by combining therapies. Patients first have radical surgery called extrapleural pneumonectomy (EPP), which removes part of the lung, its lining, the lining of the heart, and the diaphragm. Surgery is followed by a combination of chemotherapy and radiation.
Yet even this aggressive approach does not appear to offer patients much of a benefit. Although one study reported that patients who had this therapy survived an average of 23 months, other research has not produced the same results. “Currently, data is still being collected to determine if outcomes with this approach are any better; so far, most studies indicate that this approach does not offer any substantial benefit,” Dr. Montjoy says. For now, mesothelioma “remains an aggressive tumor with a dismal prognosis,” the authors conclude.
Montjoy C, Parker J, Petsonk L, Teba L, Fallon K. Mesothelioma Review. West Virginia Medical Journal. 2009;105:13-16.