Malignant pleural mesothelioma (MPM) is a rare tumour but with increasing incidence and a poor prognosis. In 2008, the European Respiratory Society/European Society of Thoracic Surgeons Task Force brought together experts to propose practical and up-to-dated guidelines on the management of MPM.To obtain an earlier and reliable diagnosis of MPM, the experts recommend performing thoracoscopy, except in cases of pre-operative contraindication or pleural symphysis. The standard staining procedures are insufficient in ,10% of cases. Therefore, we propose using specific immunohistochemistry markers on pleural biopsies. In the absence of a uniform, robust and validated staging system, we advice use of the most recent TNM based classification, and propose a three step pre-treatment assessment. Patient's performance status and histological subtype are currently the only prognostic factors of clinical importance in the management of MPM. Other potential parameters should be recorded at baseline and reported in clinical trials. MPM exhibits a high resistance to chemotherapy and only a few patients are candidates for radical surgery. New therapies and strategies have been reviewed.Because of limited data on the best combination treatment, we emphasise that patients who are considered candidates for a multimodal approach should be included in a prospective trial at a specialised centre.

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M esothelioma is attributable to asbestos exposure, usually in the workplace. In spite of the increasing incidence of the disease and increased health and safety legislation, public and in some cases health professionals' knowledge of mesothelioma is poor. The issues around causal attribution are complex and patients may develop coping styles and strategies in order to minimise emotional distress. As a consequence of mesothelioma being a 'prescribed disease', patients and their families are frequently engaged in time-consuming, exhausting and worrying medicolegal procedures at a time when they are attempting to adjust to living with a terminal disease and coping with the burden of symptoms and medical interventions. Bereavement is complicated by the Coroner's investigation of the death and on-going benefit and compensation claims which may continue for years -all delaying resolution and adding to anger and resentment. Psychosocial distress in patients with cancer and their families is well documented; in mesothelioma, the specific non-clinical issues explored in this paper add a significant load to the burden of suffering.

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