When people think of mesothelioma, they typically picture an older adult who has been exposed to asbestos. Yet this disease can, in rare cases, also strike children. Because the prognosis is poor, doctors need to carefully diagnose mesothelioma in their youngest patients.
Doctors don’t know what causes mesothelioma in children. Although a high number of adults with the disease have a history of asbestos exposure, this isn’t the case in children. “The latent period of asbestos exposure in mesothelioma patients can be many years,” explains Cesar A. Moran, MD, professor of Pathology in the Department of Pathology at MD Anderson Cancer Center in Houston, Texas. “Children have not lived long enough to be in that ballpark.”
Dr. Moran and his colleagues recently published a study in the journal, Histopathology, in which they looked at the cases of eight children with mesothelioma. All of the children had cancer in the abdominal cavity lining (peritoneal mesothelioma). Most adults with the disease have pleural mesothelioma, which affects the lining of the lung.
Because this cancer is so rare in children, it can be challenging to diagnose. “For most physicians, the diagnosis of mesothelioma [in children] is low on the list,” Dr. Moran says. Children with mesothelioma tend to complain of the same symptoms: pain, bloating, and fluid build-up in the abdomen. Moran says that it is important to rule out other types of lesions in this location before making an unequivocal diagnosis of mesothelioma in a child.
In this study, all of the children had a biopsy (removing a sample of tissue for examination) to determine the type and severity of their cancer. Diagnosing mesothelioma also typically involves radiological scans of the abdomen, as well as immunohistochemical studies, in which the cells are examined to look for specific cancer markers. “You have to do immunohistochemical tests to make sure you aren’t dealing with another tumor that has metastasized [spread] into the peritoneum,” according to Dr. Moran.
Treating mesothelioma presents another challenge to doctors. No standard therapy exists, even for adults with the disease. Surgery and chemotherapy may be used in adult patients. Similar treatments may be tried in children, but regardless of which treatment is used, the outlook is generally poor.
Currently there is very limited research on peritoneal mesothelioma in children to guide doctors in diagnosis and treatment, and what little research does exist is conflicting. Because this cancer is so rare in children, additional research should be done in adult patients to learn more about this disease, says Dr. Moran. “From adults, we can make more meaningful conclusions, and the results may be applied to the pediatric population,” he says.
Moran CA, Albores-Saavedra J, Suster S. Primary peritoneal mesotheliomas in children: a clinicopathological and immunohistochemical study of eight cases. Histopathology. 2008;52:824-830.