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Mesothelioma is mainly linked to asbestos exposure, with a latency period of 20 to 40 years.
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The gold standard for diagnosis is thoracoscopy or thoracotomy. Chest radiograph, computed tomography, positron emission tomography, and serum mesothelin–related protein are useful clinical adjuncts.
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Surgical treatment is preferred for operable candidates—extrapleural pneumonectomy is better for locoregional control compared with pleurectomy/decortication, but both have similar overall rates of survival.
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Multimodality Treatment of Pleural Mesothelioma
Section snippets
Key points
Surgery
Surgery remains the gold standard for diagnosis and treatment of mesothelioma but is only performed in 22% of American patients.2 Thoracoscopic diagnostic biopsy is less invasive and preferred to thoracotomy. Talc pleurodesis can most often be performed to treat dyspnea secondary to pleural effusion simultaneously with obtaining diagnostic tissue. This practice makes it possible to revert to the previous state should resection be contemplated and may provide significant palliation if further
Biomarkers
The utility of biomarkers in MPM has been evaluated for both diagnostic and prognostic purposes. These tests are noninvasive and are theorized to help diagnose mesothelioma early as well as to stratify patients effectively into clinical trial algorithms. Biomarker panels are likely more effective than individual markers and are being investigated as additions to multimodal trials.
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Mesothelin—Serum mesothelin, formerly known as soluble mesothelin-related protein, is the most commonly assayed and
Summary
The multimodal paradigm for the detection and treatment has changed the quality as well as the length of survival for MPM. Although US epidemiologic data suggest that the disease has already reached its highest incidence in 2000, international data suggest that MPM is on the rise in many undeveloped and developing countries, which corresponds to great multi-institutional interest in optimizing diagnostic and therapeutic modalities.
Patients diagnosed with mesothelioma benefit from receiving care
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Funding Sources: Dr Liptay: Consultant, Covidien; Consultant, Neomend; Dr Shersher: None.
Conflict of Interest: None.