EPIDEMIOLOGY of MESOTHELIOMA THE ROLE OF ASBESTOS
Massimo Menegozzo Roberto Pasetto Simona Menegozzo and Pietro Comba
Campania Regional Operating Center (COR) of the National Mesothelioma Registry (ReNaM),
Experimental Medicine Department, Second University of Naples, Naples, Italy Department of
Environment and Primary Prevention, Istituto Superiore di Sanita, Rome, Italy
ABSTRACT
Mesothelioma is a rare but lethal disease. This chapter provides an explanation of the disease and
descriptive epidemiological data: incidence, mortality, survival, temporal trends and geographical
distribution. It also presents etiological data on asbestos and asbestos-type fibers and delves into the
effects of the duration and intensity of exposure and the dose-response relation. It describes the
context of occupational risk in general terms, details on exposure and the risks associated with specific
work sectors, the report then goes on to illustrate multiple scenarios of environment exposure. Finally, it
elaborates on the contribution of the epidemiology of mesothelioma to public health initiatives
environmental reclamation, identification of groups at risk and the prevention of asbestos related
pathologies in developing countries.
Definition
Malignant Mesothelioma is a rare and very severe form of cancer of the serous membrances of
mesothelial origin, with an unfortunate prognosis and a highly limited survival time.
Malignant mesothelioma attacks the serous membrane origination from the embrynonical mesodermal
folium and has the following clinical manisfestation.
* Pleural mesothelioma
*Peritoneal mesothelioma
*pericardial mesothelioma
Mesothelioma of the tunica Vaginalis testis
From a histological perspective, it appears in the primary forms:
Epithelial
Sarcomatoid
Biphasic or mixed
This classification is approximate as the availability of wide ranging samples of mesothelioma
determines a significant variability of the histological picture.
Nevertheless, classification in the three istotypes is sufficiently correlated both with the prognosis and
with the evaluation criteria for surgery: epitheliomorphic mesotheliomas have a better prognosis and
are susceptible to a therapeutic approach with an improved probability of survival.
Diagnosis of a malignant pleural mesothelioma involves numerous difficulties relating to possible
superimposition of such clinical contextas carcinoma of the lung in a juxtapleural location pleural
metastasis of the extra-pulmunary primary carcinomas, reactive pleuritis.
Peritoneal mesothelioma is also associated with problems of differential diagnostics relative to
peritoneal metastasis of primary carcinomas, with peritoneal localization of TBC.
Mesotheliomas of th pericardium and of the tunica vaginalis testis are rare:
The Principal etiological agent of malignant mesothelioma is asbestos [4,5,6], although other agents
cannot be excluded for a limited percentage of cases, such as environmental exposure to other types of
complex silicates found in nature [7,8] and previous exposure to ionizing radiation.
Diagnosis of mesothelioma is currently based on several basic parameters:
(a) Patients clinical history: ( work anamnesis with special regard to evaluation of a previous
exposure to asbestos, clinical outcome, course of the illness, temporal evolution up to exitus);
(b) Imunohistochemical assessment: based on the availability of a set of markers that allow for a
differential diagnosis between pleural mesothelioma and pulmonary adencarcinoma. The best
set of :
Positive biomarkers per MM: calretinina and cytokeratine 5/6 and WT I;
Negative biomarkers per MM: CEA and MOC -31
(c) Image diagnostic using standard chest xrays (I.L.O. ‘ 80) and new imaging
TC [11]
PET [12]
Magnetic Resonance [13]
(d) Serum marker capabale of acting as precocious biomarkers for the onset of mesothelioma
SMRP (Serum Mesothelin-Related Protein [14]
Auto Antibodies P53 [15]
N-ERC/mesothelin [16]
Ostopotina [17]
(e) Profile of gene expression: [18,19,20]
Numerous studies have been conducted since 1999 to assess the presence of any specific profiles of
gene expression (micro array analysis) to define the criteria for differential diagnostic between pleural
mesothelioma and lung cancer. A set of genes has consequently been identified that accompany the
transformation of the mesothelioma cell into a cancerous cell by modifying its activity by means of gene
over-expression for some and of under expression for other. The study of gene expression has proven
useful not only for differential diagnosis of pleural mesothelioma, but also for an evaluation of prognosis
Massimo Menegozzo Roberto Pasetto Simona Menegozzo and Pietro Comba
Campania Regional Operating Center (COR) of the National Mesothelioma Registry (ReNaM),
Experimental Medicine Department, Second University of Naples, Naples, Italy Department of
Environment and Primary Prevention, Istituto Superiore di Sanita, Rome, Italy
ABSTRACT
Mesothelioma is a rare but lethal disease. This chapter provides an explanation of the disease and
descriptive epidemiological data: incidence, mortality, survival, temporal trends and geographical
distribution. It also presents etiological data on asbestos and asbestos-type fibers and delves into the
effects of the duration and intensity of exposure and the dose-response relation. It describes the
context of occupational risk in general terms, details on exposure and the risks associated with specific
work sectors, the report then goes on to illustrate multiple scenarios of environment exposure. Finally, it
elaborates on the contribution of the epidemiology of mesothelioma to public health initiatives
environmental reclamation, identification of groups at risk and the prevention of asbestos related
pathologies in developing countries.
Definition
Malignant Mesothelioma is a rare and very severe form of cancer of the serous membrances of
mesothelial origin, with an unfortunate prognosis and a highly limited survival time.
Malignant mesothelioma attacks the serous membrane origination from the embrynonical mesodermal
folium and has the following clinical manisfestation.
* Pleural mesothelioma
*Peritoneal mesothelioma
*pericardial mesothelioma
Mesothelioma of the tunica Vaginalis testis
From a histological perspective, it appears in the primary forms:
Epithelial
Sarcomatoid
Biphasic or mixed
This classification is approximate as the availability of wide ranging samples of mesothelioma
determines a significant variability of the histological picture.
Nevertheless, classification in the three istotypes is sufficiently correlated both with the prognosis and
with the evaluation criteria for surgery: epitheliomorphic mesotheliomas have a better prognosis and
are susceptible to a therapeutic approach with an improved probability of survival.
Diagnosis of a malignant pleural mesothelioma involves numerous difficulties relating to possible
superimposition of such clinical contextas carcinoma of the lung in a juxtapleural location pleural
metastasis of the extra-pulmunary primary carcinomas, reactive pleuritis.
Peritoneal mesothelioma is also associated with problems of differential diagnostics relative to
peritoneal metastasis of primary carcinomas, with peritoneal localization of TBC.
Mesotheliomas of th pericardium and of the tunica vaginalis testis are rare:
The Principal etiological agent of malignant mesothelioma is asbestos [4,5,6], although other agents
cannot be excluded for a limited percentage of cases, such as environmental exposure to other types of
complex silicates found in nature [7,8] and previous exposure to ionizing radiation.
Diagnosis of mesothelioma is currently based on several basic parameters:
(a) Patients clinical history: ( work anamnesis with special regard to evaluation of a previous
exposure to asbestos, clinical outcome, course of the illness, temporal evolution up to exitus);
(b) Imunohistochemical assessment: based on the availability of a set of markers that allow for a
differential diagnosis between pleural mesothelioma and pulmonary adencarcinoma. The best
set of :
Positive biomarkers per MM: calretinina and cytokeratine 5/6 and WT I;
Negative biomarkers per MM: CEA and MOC -31
(c) Image diagnostic using standard chest xrays (I.L.O. ‘ 80) and new imaging
TC [11]
PET [12]
Magnetic Resonance [13]
(d) Serum marker capabale of acting as precocious biomarkers for the onset of mesothelioma
SMRP (Serum Mesothelin-Related Protein [14]
Auto Antibodies P53 [15]
N-ERC/mesothelin [16]
Ostopotina [17]
(e) Profile of gene expression: [18,19,20]
Numerous studies have been conducted since 1999 to assess the presence of any specific profiles of
gene expression (micro array analysis) to define the criteria for differential diagnostic between pleural
mesothelioma and lung cancer. A set of genes has consequently been identified that accompany the
transformation of the mesothelioma cell into a cancerous cell by modifying its activity by means of gene
over-expression for some and of under expression for other. The study of gene expression has proven
useful not only for differential diagnosis of pleural mesothelioma, but also for an evaluation of prognosis
