Aggressive malignant tumour of the mesothelium, 90% arise from the pleura

Aetiology

• Strongly linked to asbestos exposure
  • Long latency period - 20-40 years post exposure
  • Most strongly associated with chrysotile asbestos fibres

Clinical features

• Often presents with pleural effusion - progressive dyspnoea, stony dull percussion
• Chest pain
• Weight loss

Investigations

• CXR: pleural effusion, ‘pleural mass with lobulated margin’, pleural thickening indicates asbestos exposure
• CT: pleural mass, allows staging
• Histological investigations:
  • Thorascopy: biopsy of tumour
  • Aspiration of pleural fluid: lymphocytes and low glucose indicates malignancy

Management

• Only palliative options (chemo/radiotherapy) as excision is usually not possible
• Poor prognosis - life expectance 12 months post diagnosis
• Managing a malignant pleural effusion: TALC (sclerosing agent), long term pleural catheter