Summary
Definition
History and exam
Key diagnostic factors
- family history
- history of asbestos exposure
- age between 60 and 85 years
- shortness of breath
- diminished breath sounds
- dullness to percussion
Other diagnostic factors
- male sex
- chest pain
- cough
- constitutional symptoms
- abdominal distention and/or pain
Risk factors
- asbestos exposure
- age 60 to 85 years
- asbestos exposure during home maintenance and renovation
- male sex
- radiation exposure
- genetic predisposition
- simian virus 40 (SV-40)
Diagnostic tests
1st tests to order
- CXR
- CT chest and upper abdomen (with contrast)
Tests to consider
- thoracentesis
- PET/CT scan
- pleural biopsy
- video-assisted thoracoscopic surgery (VATS)
- immunohistochemistry
- germline testing
- chest MRI
- cervical mediastinoscopy
- pulmonary function tests
- CBC
- basic metabolic panel
Emerging tests
- diagnostic biomarkers
Treatment algorithm
resectable disease
unresectable or recurrent disease
Contributors
Authors
Hedy Kindler, MD
Professor of Medicine
Associate Dean for Clinical Science Research, Human Subjects
The University of Chicago, Biological Sciences Division
Section of Hematology/Oncology
Chicago
Disclosures
HK declares she has no competing interests.
Acknowledgements
Dr Hedy Kindler would like to gratefully acknowledge Dr Idrees Mian, Dr Jaydira del Rivero, Dr Anish Thomas, Mrs Mary Hesdorffer, Dr Robert Taub, and Dr Chris R. Kelsey, the previous contributors to this topic.
Disclosures
IM, JdR, AT, MH, RT, and CRK declare that they have no competing interests.
Peer reviewers
Marc de Perrot, MD, MSc
Associate Professor of Surgery
University of Toronto
Division of Thoracic Surgery
Toronto General Hospital
Ontario
Canada
Disclosures
MdP is an author of a reference cited in this topic.
Tom Treasure, MD, MS FRCS, FRCP
Professor of Cardiothoracic Surgery (Honorary)
Clinical Operational Research Unit
Department of Mathematics
University College London
London
UK
Disclosures
TT is an author of a reference cited in this topic.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: mesothelioma: pleural [internet publication].Full text
Woolhouse I, Bishop L, Darlison L, et al. British Thoracic Society guideline for the investigation and management of malignant pleural mesothelioma. Thorax. 2018 Mar;73(suppl 1):i1-30.Full text Abstract
Popat S, Baas P, Faivre-Finn C, et al. Malignant pleural mesothelioma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2022 Feb;33(2):129-42.Full text Abstract
Kindler HL, Ismaila N, Bazhenova L, et al. Treatment of pleural mesothelioma: ASCO guideline update. J Clin Oncol. 2025 Mar 10;43(8):1006-38.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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