mesotheelioma - flying uflying under thender the...
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MesotheMesotheFlying uFlying u
Rad
Dr.George KC lt t ThConsultant,Th
Tata Memo
elioma -elioma nder thender the dar
Karimundackalh i S ihoracic Servicesorial Hospital
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BackgBackg
• M li t l• Malignant neoplaspleural or peritonepleural or peritone
• 75-80% arise in th75-80% arise in th
• Peritoneum pericaPeritoneum, perica
groundground
i i f thsm arising from the al surfaceal surface
e pleurae pleura
ardiumardium
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•• Strong co-relationasbestosasbestos
• First established i• First established i
• Most common in I• Most common in I
• Fi t d l ti• First degree relati
•• Rare without asbe
n with exposure to
in 1960(South Africa)in 1960(South Africa)
Industrial workersIndustrial workers
l ff t dves also affected
estos exposure
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IncidIncid
US figures
enceence
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UK figures
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The TMThe TM
•• 127 cases (1985 -
• 116 pleural mesoth
• 11 peritoneal meso
• Male : Female - 91
• 50% in the age ran
H StoryH Story
2008)
helioma
othelioma
1: 36
nge 40 - 60
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The lyears(200years(200
• 36 cases
• Male : Female - 2
• Median Age - 46
ast 5 03-2008)03 2008)
4 : 12
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TreTre
Lung Cancer
ndsnds
Mesothelioma
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Lung Cancer Mesothelioma
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Statedi t ibdistrib
• Maharashtra - 14
• Madhyapradesh -y p
• Rajasthan - 3Rajasthan 3
• Bihar - 2Bihar 2
• Gujarat - 2Gujarat - 2
• Orissa 3• Orissa - 3
wise b tibution
4
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ExpoExpo
•Only 3 / 36 patientsOnly 3 / 36 patients of exposure.p
•May be a reflectionMay be a reflection capture mechanism
osureosure
had definite historyhad definite history
of the poor dataof the poor data m
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ManagManag
• N id• No consensus guid
• Surgery - integral ptreatmenttreatment
• Broadly based on• Broadly based on Cardiopulmonary rCardiopulmonary rPerformance statu
gementgement
d lidelines
part of curative
StageStage, reserve and reserve and
us.
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StagStaggingging
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TreatmentTreatment • Early Stage y g• Surgery followed bg y
chemotherapy and• Neoadjuvant chem
surgery and radiatisurgery and radiati• Advanced DiseaseAdvanced Disease• Palliative chemoth• Palliative chemoth
ModalitiesModalities
by adjuvant y jd radiationmotherapy followed by ionioneeerapyerapy
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SurgicalSurgical
• Extrapleural pneum
• Decortication
OptionsOptions
monectomy
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In TIn T
• 4 / 36 patients und
• 3 - Extrapleural pn
• 1- Decortication
• Remaining - palliachemotherapy/bes
TMHTMH
derwent surgery
neumonectomy
ative st supportive care
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CasCas• 55 year old maley
• Factory workerFactory worker
• BilaspurBilaspur
• h/o recent onset dyh/o recent onset dyeffusion aspirated p
• Pleural fluid cytoloy
• TMH review Epith
se 1se 1
yspnoea and pleuralyspnoea and pleural multiple timesp
ogy - adenocagy
heloid mesothelioma
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Localized disease
Underwent left t l lextrapleural
pneumonectomy
Adjuvant chemotherapy and radiation
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Cas
1 year old male
Office worker
hane
Sarcomatoid th limesothelioma
NACT - Pemetrexed
se 2
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CasCas51 year old male51 year old male
T d iTreated as metastatic adenoca with palliative chemotherapy.
TMH review - mesothelioma
Contralateral metastases at time of re evaluationtime of re evaluation
2 d li h2nd line chemo -pemetrexed
se 3se 3
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CommonCommon misstepsmissteps• Pleural effusion
• Intercostal drainag
• No CECT
• Difficulty in achievDifficulty in achievdiagnosis
• Palliative h thchemotherapy
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The ShorThe Shor
• No Mesothelioma
• Hospital based regfl t th t l fireflect the actual fi
•• Delayed diagnosis
• Lack of multidiscip
rtcomingsrtcomings
Registry
gistries may not gures
s/Misdiagnosis
plinary teams
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SoluSolu
• Implement a ban o• Implement a ban o
• Mesothelioma Reg• Mesothelioma Reg
• Hi h i d f• High index of suspoccupationally expoccupationally exp
• Dedicated MultidisDedicated Multidismanagementg
utionution
on Asbestoson Asbestos
gistrgistry
i i f thpicion for those posedposed
sciplinary team forsciplinary team for
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ThankThankk youk you