Mesotelioma pleural

Abstract

Pleural mesothelioma is the main malignant pleural tumor. Most cases are associated with inhalation of asbestos fibers. The most frequent manifestations are dyspnea and chest pain in patients in pleural effusion and/or nodular pleural thickening. The diagnosis is histological, distinguishing between three big subgroups: epithelioid, sarcomatoid, and biphasic. The most used staging is based on the TNM staging system and proposed by the International Association for the Study of Lung Cancer (IASLC). The principal prognostic factors, in addition to TNM stage, are the histological type, age, and the patient's overall condition. In select patients, surgery may be indicated as part of multimodal treatment. In order to determine which patients are candidates for surgery, in addition to the epithelial histological type, an adequate cardiopulmonary reserve, an extension study with a computed tomography scan of the chest and abdomen, magnetic resonance imaging, positron emission tomography, and an examination of the mediastinum with endobronchial ultrasound or mediastinoscopy should be taken into account. In patients who are not candidates for surgery, chemotherapy in a platinum/pemetrexed regimen and/or symptomatic treatment that includes pleurodesis and control of pain and dyspnea should be considered.