Mesothelioma Navy Mesothelioma Diagnosis & Treatment 2 — Questions and Answers
Question 1: Which imaging technique is considered the gold standard for detecting pleural thickening and early mesothelioma lesions?
- Chest X-ray
- CT scan of the chest (Correct answer)
- MRI with gadolinium
- PET scan
Correct answer: CT scan of the chest
CT scan of the chest provides the best detail for identifying pleural thickening, nodularity, and fluid that suggest mesothelioma.
Question 2: What is 'pleurodesis' in the context of mesothelioma treatment?
- Surgical removal of the pleura
- A procedure to fuse the pleural layers and prevent fluid reaccumulation (Correct answer)
- A chemotherapy drug injected into the pleural space
- Radiation delivered directly to the pleura
Correct answer: A procedure to fuse the pleural layers and prevent fluid reaccumulation
Pleurodesis involves introducing an irritant (such as talc) between the pleural layers so they adhere, preventing recurrent malignant pleural effusion.
Question 3: Which serum biomarker is most commonly elevated in pleural mesothelioma patients and used to monitor disease progression?
- CEA (carcinoembryonic antigen)
- PSA (prostate-specific antigen)
- Mesothelin (SMRP) (Correct answer)
- AFP (alpha-fetoprotein)
Correct answer: Mesothelin (SMRP)
Soluble mesothelin-related peptide (SMRP/mesothelin) is elevated in most epithelioid mesothelioma cases and correlates with tumor burden.
Question 4: A Navy veteran undergoes thoracoscopy for suspected mesothelioma. Which biopsy approach does thoracoscopy allow that pleural fluid cytology alone cannot reliably provide?
- Detection of asbestos fibers in the tissue
- Adequate tissue architecture for histological subtype classification (Correct answer)
- Real-time genetic sequencing
- Measurement of pleural pressure
Correct answer: Adequate tissue architecture for histological subtype classification
Thoracoscopy provides larger tissue samples with preserved architecture, essential for accurately distinguishing epithelioid, sarcomatoid, and biphasic subtypes.
Question 5: In mesothelioma staging, what does Stage IV specifically indicate?
- Tumor confined to one pleural surface only
- Involvement of ipsilateral lung parenchyma
- Distant metastases to contralateral lung, peritoneum, or remote organs (Correct answer)
- Mediastinal lymph node involvement only
Correct answer: Distant metastases to contralateral lung, peritoneum, or remote organs
Stage IV mesothelioma is characterized by distant spread beyond the chest, including contralateral sites or remote organs, making curative surgery impossible.
Question 6: Which immunohistochemical marker is typically POSITIVE in mesothelioma and helps distinguish it from lung adenocarcinoma?
- TTF-1
- Napsin A
- Calretinin (Correct answer)
- CEA
Correct answer: Calretinin
Calretinin is a mesothelial marker that stains positive in mesothelioma but is typically negative in lung adenocarcinoma.
Question 7: What is the primary purpose of an indwelling pleural catheter (IPC) in mesothelioma management?
- Delivering intrapleural chemotherapy continuously
- Allowing repeated outpatient drainage of malignant pleural effusion (Correct answer)
- Monitoring pleural pressure electronically
- Providing access for radiation seed placement
Correct answer: Allowing repeated outpatient drainage of malignant pleural effusion
An IPC is a tunneled catheter that lets patients or caregivers drain recurrent malignant pleural effusions at home without repeated hospital visits.
Mesothelioma Navy Mesothelioma Diagnosis & Treatment 2
Which imaging technique is considered the gold standard for detecting pleural thickening and early mesothelioma lesions?