Malignant mesothelioma.

INTRODUCTION: Mesothelioma is a malignant tumour of the pleura or peritoneum caused by asbestos. It is increasing in frequency and the prognosis remains grim, with average survival around 1 year.

SOURCES OF DATA: Medical literature and personal experience.

AREAS OF AGREEMENT: Amphibole fibres are far more potent than chrysotile in causing mesothelioma.

AREAS OF CONTROVERSY: A minority view suggests that mesotheliomas in those exposed to chrysotile are caused only by tremolite (an amphibole) which contaminates chrysotile. There is a hypothesis, for which evidence is weakening, that Simian virus 40 may cause mesothelioma.

GROWING POINTS: There is emerging evidence of genetic variation in susceptibility to fibre carcinogenesis. There are developments in treatment, particularly chemotherapy with pemetrexed and cisplatin which prolongs survival and helps symptoms.

AREAS TIMELY FOR DEVELOPING RESEARCH: Targeted agents for treatment are under investigation and may improve the outlook. The role of radical and palliative surgery requires clarification.