Pleural mesothelioma (malignant mesothelioma) is a rare malignancy originating from the superficial cells of the pleural lining. Sometimes it can also develop in the pericardium and peritoneum. Pleural mesothelioma is most often diagnosed in men over 60 years of age. Unfortunately, due to the low characteristic symptoms, it is diagnosed late and treatment is usually not satisfactory. Can you get mesothelioma without asbestos exposure?
The observed increase in morbidity and deaths in the last decade most likely results not from actual higher morbidity, but from the improvement of diagnostic methods, both in the possibility of collecting material for testing and precise pathological assessment allowing differential diagnosis with metastatic adenocarcinoma. The availability of computed tomography and videotoracoscopy and the possibility of immunohistochemical assessment have significantly improved the effectiveness of diagnosis, and the awareness of the existence of therapeutic options in the treatment of cancer, including mesothelioma, is an additional stimulus for doctors diagnosing the patient.
Diagnosis of pleural mesothelioma
Diagnosis of lung cancer should aim to diagnose pleural disease, confirm the neoplastic nature of the lesions and differentiate with metastasis of another cancer, as well as assess the extent of the disease. Due to diagnostic difficulties of pleural mesothelioma, close cooperation between oncologist, pathologist, radiodiagnostic and clinician is necessary. Appropriate volume of material should also be obtained for molecular diagnostics. In most patients, malignant pleural mesothelioma is diagnosed at the local stage. Metastases in distant organs are rare. Subject examination includes an interview for asbestos exposure and lung cancer symptoms associated with the location of the primary lesion and local spread along the pleural surface (chest wall pain, shortness of breath, symptoms of a threatening cardiac tamponade). The physical examination includes a typical assessment of the respiratory system and chest. Conventional chest X-ray may suggest suspected pleural mesothelioma, but the most accurate imaging method is computed tomography. For patients who are potentially eligible for complete surgical treatment, magnetic resonance imaging may be helpful. PET-CT examination is not applicable.
Does asbestos only cause mesothelioma?
Although asbestos is a major risk factor for mesothelioma, exposure to asbestos alone does not affect every affected individual. Causes of non-asbestos mesothelioma have been suggested. Volcanic mineral, known as erionite, can also cause mesothelioma. Erionit was first associated with the disorder due to the significantly increased incidence of mesothelioma in Cappadocia, in the central part of Anatola, Turkey. Researchers believe that genetic factors in the native population may also play a significant role in the increased incidence of disorders in the region. However, no genetic factor has been identified in Cappadocia so far. Erionite is a fibrous material belonging to the group of minerals called zeolites. Zeolites are chemically related to asbestos. Erionit is found in the United States, especially in North Dakota, Western States and often in quarries or road development projects.
In rare cases, people develop mesothelioma without obvious exposure to asbestos or erionite. The cause in such cases is unknown (idiopathic or spontaneous mesothelioma). In such cases, it is possible that individuals have experienced unknown exposure to asbestos or erionite. It is also possible that there are other causative agents that cause the development of mesothelioma, such as radiation and possibly some chemicals or viruses.