Guidelines for the diagnosis and treatment of malignant pleural mesothelioma.

Malignant mesothelioma is an aggressive tumour originating in the serosal membranes that line the thoracic and abdominal cavities. More than 90% of reported mesothelioma cases occur in the pleura. The occurrence of malignant mesothelioma is typically related to exposure to mineral fibres such as asbestos and erionite. The World Health Organization (WHO) has recognised asbestos as one of the most important occupational carcinogens and in 2010 upgraded its global estimate of asbestos-related diseases (ARD) to 107,000 annual deaths. Australia, as one of the largest consumers of asbestos worldwide in the post-World War II period, has one of the highest incidences of malignant mesothelioma. The current epidemic of malignant mesothelioma is closely associated with past occupational exposure. Asbestos, however, persists in our natural and built environments, and it is important that we continue to minimise exposure to it by all reasonable means. There are indications that in Australia the diagnostic and treatment practices for MPM are not equally distributed, with considerable expertise concentrated in some hospitals and lacking in others. Moreover, there are no guidelines that specifically consider diagnosis and treatment of this almost invariably fatal disease in the Australian context. These evidence-based guidelines have been developed by a multidisciplinary team (MDT) of experts (volunteers) that is encouraging improved management of MPM through evidence-based decision making. Guidelines are guides and not rules. A good approach is to be fully aware of appropriate guidelines before making management decisions.