Mesothelioma

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Mesothelioma

  1. 1. MESOTHELIOMA<br />DR/ OMAR HASHIM<br />
  2. 2. Mesotheluima is the malignant disease of the pleural , is an aggressive <br />Disease , arising from the serosal lining of the chest . Characterized by <br />Poor survival rate .<br />Aetiology ;-<br />Strongly associated with cigarette smoking .<br />Caused by asbestose exposure ( perlonged latent peroid after exposure ) <br />Erionite fibers <br />Thorium dioxide .<br />Pathology ;-<br />Mesothelioma arise from the parietal or visceral pleural and grow diffusely <br />Within the pleural space , commony associated with pleural effusion and <br />Encasement of the lunge by sold mass .<br />Tumour spread directly to the lunge , mediastinum & may cross the diaphragm<br />To involve peritoneum . Other organs which may involve e .g liver <br />Histological subtypes ;-<br /><ul><li>Epithelial (about 50 % ) .
  3. 3. Sarcomatous .
  4. 4. Mixed </li></li></ul><li>Clinical presentation ;-<br />Classical symptoms ;- <br /><ul><li>Non pleuritic chest pain .
  5. 5. Dyspnoea
  6. 6. systemic symptoms …. Fatigue ….W t loss ….. Sweating …& fever</li></ul>Physical EX - ;- <br /><ul><li>Finger clubbing .
  7. 7. Signs of pleural effusion or sold pleualtumour .</li></ul>Signs of advanced disease ;-<br /><ul><li>Palpable chest mass
  8. 8. Hoase voice , vocal cord palsy .
  9. 9. Svc Obs .
  10. 10. Horners syndrome .
  11. 11. ascites due to involvement of the peritoneum</li></li></ul><li>Workuo ;-<br />H & P , CXR , CT / MRI chest , PET / CT chest , P F T . ….. Looking for pleural<br />Thickening , effusion , contraction of ipsilateralhemithorax<br />Histological diagnosis ;- <br />Using least invasive tech - ;-<br /><ul><li>aspiration cytology .
  12. 12. Blind biopsy .
  13. 13. CT guided biopsy .
  14. 14. Thoracoscopy & biopsy </li></li></ul><li>STAGING ;-<br />TNM staging systems ;- <br />T1 ;-ipsilateralparital pleural .<br />T2 ;-iPsilateral lunge ,diaphragm , confluent involvement of visceral pleural<br />T3 ;-endothoracicfasica , mediastinal fat , focal chest wall , non transmural<br />Pericardium .<br />T4 ;-contralateral pleura , peritonum , rib , extensive chest wall or mediastinal<br />invasion , myocardium , brachial plexus , spine , malignant pericardial effusion<br />…………………………………………….<br />N1 ;- ipsilateralbronchopulmonary or hilar nodes .<br />N2 ;-subcarinalipsilateralmediastinal nodes .<br />N3 ;- contralateralmediastinal or ipsilateral / contralateral nodes .<br />………………………………………………<br />M1 ;-distant metastasis .<br />
  15. 15. TREATMENT ; stage 1 ,2 ;- if resectable N0 ; pneumonectomy ( epp ) -> 4—6<br />Week break ->-> RT 1.8 /54 GY .<br />IF resectable /N+ or medically unsuitable for EPP consider pleurectomy<br />/decortication ->4 –6 week RT 1.8 /54 GY <br />* IF surgically inoperable -> neoadjuvant chemo and reevaluate for resection<br />, if remain unresectable continue chemo .<br />MS ;;-stage 1 ;-35 months ……….. Stage 2 , 16 months .<br />Stage 3-4 ;- primary EPP followed by stage 3 ;- 12 months adjuvant RT ± chemo<br />Vs . Neo adj- chemo -> resection ->-> RT 1.8 /54 GY ± adj CT .<br />Stage 3 -> 12 months ……. Stage 4 -> 6months .<br />

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