What is mesothelioma? Can you get compensation?

Mesothelioma is a malignancy of mesothelial cells, most frequently arising in the pleura (≈75%), but also in the peritoneum, pericardium, and tunica vaginalis.


2. 🌍 Epidemiology & Global Burden

  • Annual incidence: ~31,900 new cases in 2021 (~0.40 per 100,000) globally; approximately 29,600 deaths (~0.38 per 100,000) PMC+4PMC+4Wikipedia+4CDC+1Wikipedia+1.
  • From 1990 to 2021, incidence and mortality nearly doubled (+93% and +96% respectively); predominantly in males (3-fold higher than females) .
  • Higher burden in high SDI countries (e.g., Australasia, Europe), but rapid increase in low- and middle-SDI regions PMC+1SpringerLink+1.
  • Peak incidence occurs in older age groups (70–89 years) due to long latency post-asbestos exposure Wikipedia+5PMC+5Wikipedia+5.
  • In the U.S., 2,803 cases reported in 2021, consistent with a gradual decline following reduced asbestos exposure CDC.
  • UK geography: ~2,600 diagnoses and ~2,500 deaths annually; pleural mesothelioma is 18th most common cause of cancer death MDPI.

3. 🧬 Risk Factors & Pathogenesis

  • Asbestos exposure is the main risk: responsible for ~92% of mesothelioma-related DALYs/deaths ScienceDirect+9SpringerLink+9PMC+9.
  • Latency: typically 20–50 years post-exposure .
  • Secondary exposure (e.g., laundering asbestos-contaminated clothes) also carries risk .
  • Additional factors: simian virus 40 (SV40), radiation exposure, BAP1 tumor suppressor gene mutations Wikipedia.

4. 🔍 Clinical Manifestations

Pleural Mesothelioma

  • Dyspnea, non-pleuritic chest pain, pleural effusion, systemic symptoms (fever, weight loss) .

Peritoneal Mesothelioma

  • Abdominal pain, bloating, ascites, weight loss, anemia.

Less common sites

  • Pericardial mesothelioma (median survival ~10 months), tunica vaginalis origin Wikipedia.

5. 📋 Staging


6. 🧪 Diagnostic Strategy

  1. Imaging
    • Chest X-ray/CT: pleural thickening, plaques, effusion.
    • MRI: better for local invasion, diaphragm and chest wall involvement.
    • PET-CT: helpful for staging and metastasis detection.
  2. Tissue diagnosis
    • Image-guided biopsy, thoracoscopy, or laparoscopy depending on site.
  3. Serum biomarkers (emerging tools)

7. 🛠 Treatment Advances

A. Surgery

  • Extrapleural pneumonectomy or pleurectomy-decortication for early-stage, operable patients.

B. Radiation Therapy

  • Adjuvant/definitive radiation after surgery; palliation for symptomatic relief.

C. Systemic Therapy

  • First-line (pleural)
    • Nivolumab + ipilimumab improved 2-year survival (41% vs ~27%) per CheckMate-743 MDPI+5PMC+5ScienceDirect+5.
    • Previously platinum + pemetrexed; now immunotherapy is preferred, especially in non-epithelioid histology Wikipedia+2MDPI+2Mesothelioma Center+2.
    • Pembrolizumab + chemotherapy (cisplatin/pemetrexed) approved in 2024: hazard ratio 0.79 (21% risk reduction) .
  • ICI Monotherapy
    • Nivolumab: 47% disease control at 12 weeks (NivoMes, MERIT) MDPI.
    • Pembrolizumab (KEYNOTE‑028): 20% response, 52% stable disease MDPI.
  • Peritoneal mesothelioma
    • Cytoreductive surgery + HIPEC improves survival.

8. 🧬 Prognosis

  • Historically poor: 12–21 months OS; 5-year survival ~8–12% Wikipedia.
  • Better survival noted in women, younger patients, and epithelioid histology Wikipedia.
  • Immunotherapy has improved 2-year survival rates substantially (e.g., 41% with nivolumab-ipilimumab) .

9. ⚖️ Public Health & Compensation

  • Asbestos-related mesothelioma is highly occupational; regulatory bans have lowered incidence in developed nations, but rates continue rising in developing countries Wikipedia.
  • Patients may seek legal compensation, including trust funds and voc rehab options, often yielding settlements of $1–2 million Mesothelioma Center.

🔑 Key Takeaways for Clinicians

  • Mesothelioma incidence is rising globally despite asbestos bans, due to long latency and emerging exposures PMC.
  • Diagnosis requires multimodal imaging plus tissue histology.
  • Immunotherapy (nivolumab + ipilimumab or pembrolizumab + chemo) sets the new standard for unresectable pleural disease MDPI+2jtocrr.org+2Mesothelioma Center+2.
  • Prognosis remains poor, but immunotherapy offers meaningful survival gains.
  • Continued public health efforts and legal/policy measures are key in reducing future risk.

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