Mesothe Mesothe elioma elioma - Flying u Flying u nder the - PowerPoint PPT Presentation

Mesothe Mesothe elioma elioma - Flying u Flying u nder the nder the Rad dar Dr.George K Karimundackal Consultant,Th C lt t Th h horacic Services i S i Tata Memo orial Hospital

Backg Backg ground ground • Malignant neoplas • M li t l sm arising from the i i f th pleural or peritone pleural or peritone al surface al surface • 75-80% arise in th 75-80% arise in th e pleura e pleura • Peritoneum perica Peritoneum, perica ardium ardium

• Strong co-relation n with exposure to asbestos asbestos • First established i • First established i in 1960(South Africa) in 1960(South Africa) • Most common in I • Most common in I Industrial workers Industrial workers • First degree relati • Fi t d l ti ves also affected l ff t d • Rare without asbe estos exposure

ence ence Incid Incid US figures

UK figures

The TM The TM H Story H Story • 127 cases (1985 - 2008) • 116 pleural mesoth helioma • 11 peritoneal meso othelioma • Male : Female - 91 1: 36 • 50% in the age ran nge 40 - 60

The l ast 5 years(200 years(200 03-2008) 03 2008) • 36 cases • Male : Female - 2 4 : 12 • Median Age - 46

Mesothelioma nds nds Lung Cancer Tre Tre

Lung Cancer Mesothelioma

State wise di t ib distrib bution b ti • Maharashtra - 14 • Madhyapradesh - y p 4 • Rajasthan - 3 Rajasthan 3 • Bihar - 2 Bihar 2 • Gujarat - 2 Gujarat - 2 • Orissa • Orissa - 3 3

Expo Expo osure osure • Only 3 / 36 patients Only 3 / 36 patients had definite history had definite history of exposure. p • May be a reflection May be a reflection of the poor data of the poor data capture mechanism m

Manag Manag gement gement • N • No consensus guid id d li delines • Surgery - integral p part of curative treatment treatment • Broadly based on • Broadly based on Stage, Stage Cardiopulmonary r Cardiopulmonary r reserve and reserve and Performance statu us.

ging ging Stag Stag

Treatment Treatment Modalities Modalities • Early Stage y g • Surgery followed b g y by adjuvant y j chemotherapy and d radiation • Neoadjuvant chem motherapy followed by surgery and radiati surgery and radiati ion ion • Advanced Disease Advanced Disease e • Palliative chemoth • Palliative chemoth erapy erapy

Surgical Surgical Options Options • Extrapleural pneum monectomy • Decortication

In T In T TMH TMH • 4 / 36 patients und derwent surgery • 3 - Extrapleural pn neumonectomy • 1- Decortication • Remaining - pallia ative chemotherapy/bes st supportive care

Cas Cas se 1 se 1 • 55 year old male y • Factory worker Factory worker • Bilaspur Bilaspur • h/o recent onset dy h/o recent onset dy yspnoea and pleural yspnoea and pleural effusion aspirated p multiple times p • Pleural fluid cytolo y ogy - adenoca gy • TMH review Epith heloid mesothelioma

Localized disease Underwent left extrapleural t l l pneumonectomy Adjuvant chemotherapy and radiation

Cas se 2 1 year old male Office worker hane Sarcomatoid mesothelioma th li NACT - Pemetrexed

Cas Cas se 3 se 3 51 year old male 51 year old male T Treated as metastatic d i adenoca with palliative chemotherapy. TMH review - mesothelioma Contralateral metastases at time of re evaluation time of re evaluation 2 d li 2nd line chemo - h pemetrexed

Common Common missteps missteps • Pleural effusion • Intercostal drainag • No CECT • Difficulty in achiev Difficulty in achiev diagnosis • Palliative chemotherapy h th

The Shor The Shor rtcomings rtcomings • No Mesothelioma Registry • Hospital based reg gistries may not reflect the actual fi fl t th t l fi gures • Delayed diagnosis s/Misdiagnosis • Lack of multidiscip plinary teams

Solu Solu ution ution • Implement a ban o • Implement a ban o on Asbestos on Asbestos • Mesothelioma Reg • Mesothelioma Reg gistr gistry • High index of susp • Hi h i d f picion for those i i f th occupationally exp occupationally exp posed posed • Dedicated Multidis Dedicated Multidis sciplinary team for sciplinary team for management g

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