Since the 1960s mesothelioma has been gaining interest world-wide as a result of its increasing incidence, related medico-legal issues and poor prognosis. Pleural cancer can rapidly prove fatal, as it has five and ten year relative survival rates of 6.8% and 2.5% respectively. Most mesotheliomas are due to exposure to asbestos, with 80%-85% of cases being attributable to occupational exposure.
It has been estimated that, between 1994 and 2008, age‐adjusted mesothelioma mortality rates increased by 5.37% per year worldwide. Because the asbestos bans and regulations went into effect during different times in different countries, it is expected that mesothelioma rates will follow dissimilar patterns in the next decades. By 1990, the use of asbestos in most industrialized countries had been reduced by at least 75% from the peak asbestos consumption
Mesotheliomas may be caused by environmental exposure, genetic predisposition, or genetic + environmental interaction. Pathogenic germline mutations of BAP1 and, less frequently, of other tumor suppressor genes have been detected in approximately 12% of patients2.
Malignant mesotheliomas are tumours which originate from the mesothelial cells. Most commonly, it originates from the pleura, however, it can originate virtually from any mesothelial structure.
There are 3 histological subtypes: epithelial, sarcomatoid and biphasic. The latter shows characteristics of both and the sarcomatoid is the one with the worse prognosis.
The clinical manifestations are generally subtle and tend to present once disease is already at an advanced stage. The most common symptoms are weight loss, dyspnoea, chest pain and dry cough. On physical examination the patient may show clubbing and signs of pleural effusion.
In patients with MPM an accurate staging is fundamental in order to carefully select patients who will benefit from a radical treatment. In this class we will talk in depth about the minimally invasive staging of MPM.
Multidisciplinary international collaboration will be necessary to improve prevention, early detection, and treatment.
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