Introduction

Mesothelioma is a challenging disease for patients, relatives and doctors. It is strongly linked to exposure to asbestos and, despite a ban on the use of asbestos in the 1960s in the UK, its incidence is continuing to rise because of the long latent period between exposure and development of the disease. The incidence of mesothelioma is expected to peak around 2020 (Peto et al., 1995). High-quality clinical research evidence to guide treatment decisions is lacking, and there is an urgent need to identify and evaluate new chemotherapeutic agents and treatment strategies.

Of all mesotheliomas, 94.5% affect the pleura, 5.1% affect the peritoneum and 0.4% affect the pericardium (Yates et al., 1997). Mesotheliomas may also arise in the tunica vaginalis.

Types of pleural tumour

The most common tumours affecting the pleura are metastatic from other sites. Table 29.1 shows the types of tumour that affect the pleura.

Anatomy of the pleurae

The pleurae surround both lungs and each is divided into two parts. The parietal pleura lines the cavity bounded by the thoracic wall, diaphragm and lateral mediastinum. The visceral pleura covers the surface of the lungs and extends into the interlobular fissures. The two layers are separated by a small amount of pleural fluid, which reduces friction during respiration.

The parietal pleura is divided into regions: cervical, costal, diaphragmatic and mediastinal. The costal pleura is supplied by intercostal nerves and is sensitive to pain and touch.