Mesothelioma

Overview

A malignant tumour of mesothelial cells, most often arising in the pleura. Associated with prior asbestos exposure, typically 20–40 years earlier — Australia has one of the highest rates of mesothelioma in the world because of historical widespread asbestos use and mining (see Occupational Lung Disease for the broader asbestos-exposure picture).

Clinical features

Chest pain, dyspnoea, weight loss, recurrent pleural effusions.

Diagnosis

Based on histology and pleural fluid/tissue biopsy.

Prognosis and treatment

Prognosis is very poor and management is usually palliative. Immunotherapy (nivolumab + ipilimumab) has become a treatment option for unresectable mesothelioma in some settings, improving survival compared with older chemotherapy-only regimens, but does not change the overall poor-prognosis framing for most patients.