Malignant mesothelioma has a number of characteristics with respect to its diagnosis, natural history and management that separates it from other malignancies. Over the past half-century, its diagnosis has frequently been difficult to establish in individual cases.
This is because the disease usually already involves the pleural or peritoneal cavity exten- sively when it presents and clinically mimics secondary cancer; because the diagnosis ulti- mately depends on cytological or histological appearances, which are difficult to differen- tiate from reactive pleural diseases on the one hand and secondary cancers (especially adenocarcinoma) on the other; because for many years the sheer existence of the tumour was denied by the world’s most eminent pathologists; and because there are no unique tumour markers, in serum or effusion, to identify it and follow its course.
Often it is the clinical and radiological appearances as well as the behaviour of ma- lignant mesothelioma that are as helpful for diagnosis as cytology or histopathology. In particular, malignant mesothelioma tends to extend locally within and around the cavity of its origin and patients uncommonly exhibit clinical features of metastatic malignancy. The relationship of asbestos exposure to the development of malignant mesothelioma has been well established and accepted since the seminal report by Wagner et al. in 1960.
Minor degrees of exposure, such as washing of asbestos-contaminated work clothes by workers’ wives, have increasingly been recognised as potential sources of significant exposure. Despite that, in 20% or more of the patients no history of definite exposure to asbestos can be identified. Unlike the instance of lung cancer, smoking does not increase the risk of mesothelioma in asbestos-exposed individuals.Irradiation has been reported as an uncommon cause of mesothelioma.
This is because the disease usually already involves the pleural or peritoneal cavity exten- sively when it presents and clinically mimics secondary cancer; because the diagnosis ulti- mately depends on cytological or histological appearances, which are difficult to differen- tiate from reactive pleural diseases on the one hand and secondary cancers (especially adenocarcinoma) on the other; because for many years the sheer existence of the tumour was denied by the world’s most eminent pathologists; and because there are no unique tumour markers, in serum or effusion, to identify it and follow its course.
Often it is the clinical and radiological appearances as well as the behaviour of ma- lignant mesothelioma that are as helpful for diagnosis as cytology or histopathology. In particular, malignant mesothelioma tends to extend locally within and around the cavity of its origin and patients uncommonly exhibit clinical features of metastatic malignancy. The relationship of asbestos exposure to the development of malignant mesothelioma has been well established and accepted since the seminal report by Wagner et al. in 1960.
Minor degrees of exposure, such as washing of asbestos-contaminated work clothes by workers’ wives, have increasingly been recognised as potential sources of significant exposure. Despite that, in 20% or more of the patients no history of definite exposure to asbestos can be identified. Unlike the instance of lung cancer, smoking does not increase the risk of mesothelioma in asbestos-exposed individuals.Irradiation has been reported as an uncommon cause of mesothelioma.
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