Malignant mesothelioma: A narrative review of the literature

Abstract

Malignant mesothelioma, predominantly linked to asbestos exposure, is an aggressive cancer originating from mesothelial cells, which safeguard internal organs. Although rare, mesothelioma frequently affects the pleural layer surrounding the lungs. While asbestos, particularly amosite and crocidolite types, is the chief risk factor, the disease's infrequency means not every exposed individual contracts it. This malignancy, especially its pleural form, mainly arises from inhaled asbestos, causing cellular disruptions and eventual cancerous growths. Occupational exposure is common in professions like shipbuilding, mining, and insulation tasks, among others. The U.S. registers approximately 2,500 mesothelioma cases yearly, with the disease predominantly affecting older males following decades of asbestos exposure. Epidemiologically, areas with rampant asbestos use, such as China, report higher incidences, while regions like Hong Kong exhibit low rates despite high exposure. From a pathophysiological standpoint, mesothelioma exists in three primary forms: epithelioid, sarcomatoid, and mixed, with epithelioid variants having better prognoses. Clinical evaluations primarily involve chest CT scans and thoracoscopic biopsies. Distinguishing malignant pleural mesothelioma from other conditions is crucial. Prognostication is complicated, but several vital factors, such as disease stage and histological type, influence outcomes. Two main scoring systems, the Cancer and Leukemia Group B (CALGB) index and the European Organisation for the Research and Treatment of Cancer (EORTC) index, assist in patient stratification. Regarding treatment, standard therapeutic strategies, barring localized forms, seldom offer a cure. Procedures like pleurectomy offer symptom relief, while trimodality therapy combines chemotherapy, surgery, and radiation, often showing promising results when applied in specialized centers. Phase II studies indicate extended survival rates with post-surgery adjuvant radiation therapy.