History and exam
Key diagnostic factors
common
family history
Family history of mesothelioma and other cancers, including uveal melanoma, renal cell carcinoma, and cutaneous melanoma, may suggest an underlying germline BAP1 mutation.[20][21]
Germline mutations in the gene encoding BRCA1-associated protein-1 (BAP1) can predispose carriers to mesothelioma.[16][26]
history of asbestos exposure
Exposure to asbestos is the principal risk factor; about 80% of patients have a history of asbestos exposure.[8][9][10][29][30]
Occupational history regarding the type of work performed (e.g., naval shipboard service; ship building; construction; maintenance; vehicle brake mechanic; production of asbestos products including asbestos cement, insulation, tiles, shingles, gaskets, brakes, or textiles) may provide some clues.
age between 60 and 85 years
shortness of breath
Increasing shortness of breath, typically due to a large pleural effusion or trapped lung, is the most common symptom. Moderate or severe dyspnea occurs in about 40% of patients.[55]
diminished breath sounds
Usually a result of pleural effusion, trapped lung, or bronchial obstruction.
dullness to percussion
Suggests presence of a pleural effusion on the affected side.
Other diagnostic factors
common
male sex
Male to female ratio in the US is approximately 3:1, likely reflecting occupational exposure to asbestos.[4]
chest pain
Although mesothelioma does not commonly invade the chest wall, chest pain is a common symptom, occurring in about 25% of patients.[55]
cough
Usually dry and nonproductive.
constitutional symptoms
Include nonspecific findings such as fatigue, fever, sweats, and weight loss.
Moderate or severe fatigue occurs in about 30% of patients.[55]
uncommon
abdominal distention and/or pain
Uncommon, but can occur as a consequence of extension to the abdominal cavity with resultant ascites; often a late presentation of disease. It is more often seen as a presenting symptom of peritoneal mesothelioma.
Risk factors
strong
asbestos exposure
Exposure to asbestos is the principal risk factor; about 80% of patients have a history of asbestos exposure.[8][9][10][29][30]
Occupational history regarding the type of work performed (e.g., naval shipboard service; ship building; construction and maintenance; vehicle brake mechanic; production of asbestos products such as cement, insulation, tiles, shingles, gaskets, brakes, or textiles) may provide some clues.
weak
asbestos exposure during home maintenance and renovation
male sex
Male to female ratio is approximately 3:1, likely reflecting occupational exposure to asbestos.[4]
radiation exposure
Case reports and epidemiologic studies suggest that radiation exposure may be associated with the development of mesothelioma. This includes patients treated with radiation therapy for other malignancies or benign conditions, as well as patients treated with the contrast medium thorotrast, which contains radioactive thorium dioxide.[14][33][34][35]
Patients with radiation-associated mesothelioma may be younger than patients with asbestos-associated mesothelioma.[36]
genetic predisposition
Germline mutations in the gene encoding BRCA1-associated protein-1 (BAP1) can predispose carriers to mesothelioma.[16][26]
Other cancers, in particular uveal and cutaneous melanomas, basal cell carcinomas, and renal cell carcinomas, have been described in individuals with mutation of the BAP1 gene.[20][21]
simian virus 40 (SV-40)
SV-40 DNA sequences have been detected in human mesotheliomas.[17][18] And sera from patients with mesothelioma has tested positive for immunoglobulin G (IgG) antibodies against SV-40 large T antigen (SV-40 Tag).[19]
SV-40 Tag mRNA was, however, absent in a large series of cases of asbestos-exposed malignant pleural mesotheliomas in the UK population.[37]
The role, if any, SV-40 plays in the pathogenesis of malignant pleural mesothelioma remains unclear.
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