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

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

Sep 06, 2023 219 likes •505 views

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

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SLIDE 1

Mesothe Mesothe Flying u Flying u Rad

Dr.George K C lt t Th Consultant,Th Tata Memo

elioma - elioma nder the nder the dar

Karimundackal h i S i horacic Services

  • rial Hospital
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SLIDE 2

Backg Backg

  • M li

t l

  • Malignant neoplas

pleural or peritone pleural or peritone

  • 75-80% arise in th

75-80% arise in th

  • Peritoneum perica

Peritoneum, perica

ground ground

i i f th sm arising from the al surface al surface e pleura e pleura ardium ardium

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SLIDE 3
  • Strong co-relation

asbestos asbestos

  • 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 workers Industrial workers l ff t d ves also affected estos exposure

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SLIDE 4

Incid Incid

US figures

ence ence

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SLIDE 5
slide-6
SLIDE 6

UK figures

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SLIDE 7

The TM The TM

  • 127 cases (1985 -
  • 116 pleural mesoth
  • 11 peritoneal meso
  • Male : Female - 91
  • 50% in the age ran

H Story H Story

2008) helioma

  • thelioma

1: 36 nge 40 - 60

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SLIDE 8

The l years(200 years(200

  • 36 cases
  • Male : Female - 2
  • Median Age - 46

ast 5 03-2008) 03 2008)

4 : 12

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SLIDE 9

Tre Tre

Lung Cancer

nds nds

Mesothelioma

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SLIDE 10

Lung Cancer Mesothelioma

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SLIDE 11

State di t ib distrib

  • Maharashtra - 14
  • Madhyapradesh -

y p

  • Rajasthan - 3

Rajasthan 3

  • Bihar - 2

Bihar 2

  • Gujarat - 2

Gujarat - 2

  • Orissa

3

  • Orissa - 3

wise b ti bution

4

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SLIDE 12

Expo Expo

  • Only 3 / 36 patients

Only 3 / 36 patients

  • f exposure.

p

  • May be a reflection

May be a reflection capture mechanism

  • sure
  • sure

had definite history had definite history

  • f the poor data
  • f the poor data

m

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SLIDE 13

Manag Manag

  • N

id

  • No consensus guid
  • Surgery - integral p

treatment treatment

  • Broadly based on
  • Broadly based on

Cardiopulmonary r Cardiopulmonary r Performance statu

gement gement

d li delines part of curative Stage Stage, reserve and reserve and us.

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SLIDE 14

Stag Stag ging ging

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SLIDE 15
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SLIDE 16

Treatment Treatment

  • Early Stage

y g

  • Surgery followed b

g y chemotherapy and

  • Neoadjuvant chem

surgery and radiati surgery and radiati

  • Advanced Disease

Advanced Disease

  • Palliative chemoth
  • Palliative chemoth

Modalities Modalities

by adjuvant y j d radiation motherapy followed by ion ion e erapy erapy

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SLIDE 17

Surgical Surgical

  • Extrapleural pneum
  • Decortication

Options Options

monectomy

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SLIDE 18

In T In T

  • 4 / 36 patients und
  • 3 - Extrapleural pn
  • 1- Decortication
  • Remaining - pallia

chemotherapy/bes

TMH TMH

derwent surgery neumonectomy ative st supportive care

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SLIDE 19

Cas Cas

  • 55 year old male

y

  • Factory worker

Factory worker

  • Bilaspur

Bilaspur

  • h/o recent onset dy

h/o recent onset dy effusion aspirated p

  • Pleural fluid cytolo

y

  • TMH review

Epith

se 1 se 1

yspnoea and pleural yspnoea and pleural multiple times p

  • gy - adenoca

gy heloid mesothelioma

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SLIDE 20
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SLIDE 21

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

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SLIDE 22

Cas

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

se 2

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SLIDE 23

Cas Cas

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

se 3 se 3

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SLIDE 24

Common Common missteps missteps

  • Pleural effusion
  • Intercostal drainag
  • No CECT
  • Difficulty in achiev

Difficulty in achiev diagnosis

  • Palliative

h th chemotherapy

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SLIDE 25

The Shor The Shor

  • No Mesothelioma
  • Hospital based reg

fl t th t l fi reflect the actual fi

  • Delayed diagnosis
  • Lack of multidiscip

rtcomings rtcomings

Registry gistries may not gures s/Misdiagnosis plinary teams

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SLIDE 26

Solu Solu

  • Implement a ban o
  • Implement a ban o
  • Mesothelioma Reg
  • Mesothelioma Reg
  • Hi h i d

f

  • High index of susp
  • ccupationally exp
  • ccupationally exp
  • Dedicated Multidis

Dedicated Multidis management g

ution ution

  • n Asbestos
  • n Asbestos

gistr gistry i i f th picion for those posed posed sciplinary team for sciplinary team for

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SLIDE 27

Thank Thank k you k you