Ovarian cancer

Patients with relapsed ovarian cancer may develop an obstructive nephropathy due to pelvic recurrence. If they are on morphine they may get accumulation of this drug and signs of opiate toxicity superimposed on the signs of renal failure.

Malignant Mesothelioma

Malignant mesothelioma is a pleural malignancy in which there is almost always a history of asbestos contact. No specific treatment has been found to be of benefit, except radiotherapy, which reduces seeding and invasion through percutaneous biopsy sites. Median survival is approximately 12 months. Pleural fluid provides a diagnosis less than 50% of the time, and even multiple pleural biopsies can be negative in some cases due to a florid fibrotic reaction.

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Asbestos exposure is known to be a risk factor for mesothelioma and lung cancer. The relationship with other cancers is not certain. The rate of mesothelioma is increasing. This is mainly due to the long latent period between exposure and the clinical development of the disease. Amosite and crocidolite are more potent carcinogens than chrysotile. Exposure at an early age is another risk factor. Cigarette smoking does not increase the risk of mesothelioma.

The majority of patients with mesothelioma present with advanced disease. Chemotherapy and radiotherapy alone are not helpful. Tri-modality treatment with surgery, chemotherapy and radiotherapy may be helpful in selected cases.