Takehome
- The British Thoracic Society (BTS) has recently published an updated guideline for malignant pleural mesothelioma (MPM).
- A mesothelioma is a tumour of mesothelial cells which generally occurs in the pleura (rarely a mesothelioma may occur in the peritoneum or other organs).1
- The recommendations in this summarised version of the guideline have been restricted to GPs.
History
- For suspected patients, take a thorough occupational history covering all occupations throughout life. Sources of possible non-occupational exposure must also be considered while taking history.
Risk factors for MPM
- Male gender with respect to occupational exposure.
- High-risk occupations, including the production of asbestos sheets, brake and clutch linings, construction/demolition jobs, dock and shipyard work, electricians, plumbers, and launderers.
- Low risk of para exposure via a relative or partner, residing in the vicinity of an asbestos factory, and environmental exposure.
Clinical signs and symptoms
- There is a paucity of evidence exploring clinical features specific for MPM.
- Chest pain and dyspnoea are the most common presenting symptoms, the less common ones being weight loss, fever, and sweating.
- Pleural effusion is a commonly observed clinical sign, other signs such as palpable lymph nodes being variable.
- Smoking and finger clubbing are more appropriate when suspecting lung cancer rather than mesothelioma.
- However, a diagnosis of MPM should not be ruled out on the basis of symptoms and examination findings alone.
- Urgent chest X-ray should be offered to suspected MPM cases as per the NICE Guideline on Investigation and Referral for Suspected Cancer.
- If chest X-ray is suggestive of MPM, consider the patient urgently for referral (via the 2-week wait suspected cancer pathway in England and Wales).
- If chest X-ray is normal but the patient has persistent symptoms and history of asbestos exposure, consider referral for further investigation.
This summary is reviewed by Prof. Rishabh Prasad MBBS, MA, MSC, FRCGP FRSA
Please read linked summary of NICE guidance on "
References
References
