Mesothelioma

Exam Cram

• Mesothelioma is a cancer of the lining of the lung (pleural), usually caused by asbestos

• Presentation: progressive sob, reduced exercise tolerance, pleural effusions on chest XR

• Diagnosis: malignant cells on pleural biopsy

• Management: surgery, chemotherapy, radiotherapy, immunotherapy; end of Life Care 

Outline

Background

• Mesothelioma is a cancer of the connective tissue, 75% are the lung pleura but can be the abdominal peritoneum too

• Heavily associated with asbestos exposure, typically presenting with cancer 40yrs after exposure

• Mesothelioma is an aggressive cancer with a poor prognosis, life expectancy 8-22 months

Presentation

History

• Insidious onset of shortness of breath, reduced exercise tolerance & anorexia/ weight loss

• Cough, pleuritic chest pain

• 60M with asbestos exposure 40yrs ago: ship building, construction work, military veteran

Examination

• Cachexic

• Pleural effusion: stony dull percussion, reduced air entry, increased vocal resonance

• Hypoxic, tachypneic

Investigations

• Inflammatory markers (CRP, WCC): raised

• Chest XR: pleural effusion, pleural plaques

• CT-Thorax: pleural thickening

Diagnosis

Criteria: histological diagnosis on pleural biopsy or pleural fluid microscopy

Differentials:  pleural effusion- heart/ liver/ kidney failure, Lung Cancer, Pneumonia 

Classification

• Aetiology

• Severity

• Location

Management

Acute (stabilise):

• Chest drain if pleural effusion

• Oxygen if hypoxic

• Antibiotics if empyema

Long term

• Surgery

• Chemotherapy

• Immunotherapy

• Radiotherapy

• End of Life Care (palliative)

• Commonly receives government compensation due to asbestos exposure

Deeper Dive

Very rarely mesothelioma can cause cancer of the pericardium and testicular lining too. 

Resources and References

1. https://www.mesotheliomahope.com/

Page written in 2025.