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
- Stage I: limited disease within mesothelium.
- Stage II: invasion into lymph nodes or adjacent structures.
- Stage III: chest wall, esophageal spread.
- Stage IV: metastatic dissemination; unresectable Wikipedia+15Wikipedia+15CDC+15Wikipedia+3jtocrr.org+3Mesothelioma Center+3.
6. 🧪 Diagnostic Strategy
- 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.
- Tissue diagnosis
- Image-guided biopsy, thoracoscopy, or laparoscopy depending on site.
- Serum biomarkers (emerging tools)
- SMRP, fibulin‑3, osteopontin—but not yet standard for screening Wikipedia+1Wikipedia+1.
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
- 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.