Mesotheliomas

Pathology

Malignant mesothelioma is a rare cancer, more common in men, closely linked to exposure toasbestos, a material widely used in construction and industry especially between the 1970s and 1980s.

This tumor originates from mesothelial cells, which line the major serous cavities of the body:

  • Pleura (membrane lining the lungs): 60-70% of cases
  • Peritoneum (membrane lining the abdominal organs): 30-35% of cases
  • pericardium (membrane lining the heart): very rare form.

Benign tum ors can also develop from the mesothelium (e.g., adenomatoid tumors, benign cystic mesothelioma), which are usually treated with surgery alone and without the need for further therapy.

The numbers in Italy

In 2024, according to the AIRTUM registry (Italian Association of Cancer Registries), mesothelioma in Italy recorded about 1,779 new diagnoses (1,328 men and 451 women).

Symptoms

Pleural mesothelioma

In most cases, initial symptoms are related to the presence of pleural effusion (accumulation of fluid in the pleural cavity) and include:

  • shortness ofbreath (dyspnea)
  • persistent cough
  • Pain in one side of the chest or in the lower back
  • general symptoms, such as muscle weakness and weight loss, may also appear.

Peritoneal mesothelioma

It manifests most frequently with:

  • abdominal pain
  • weight loss
  • nausea and vomiting
  • in some cases, the abdomen may increase in volume due toaccumulation of fluid in the peritoneum(ascites).

Risk factors

The main cause of pleural mesothelioma isexposure to asbestos (asbestos). The increase in cases in recent decades is mainly related to the widespread use of this material, which has been introduced since the 1950s in building construction, shipyards, the production of car brakes and clutches, and for making textiles and papers. The time between exposure and disease onset(latency) is typically 40-50 years. In Italy, the marketing of products containing asbestos has been prohibited since 1994.

The risk of developing mesothelioma varies according to:

  • Fiber type (higher for crocidolite)
  • duration of exposure
  • fiber size

About 70 percent of inhaled fibers are eliminated naturally through the respiratory or intestinal tract. Those that remain can seep into the tissues, accumulate in the lower part of the lung, and reach the visceral pleura (the layer in direct contact with the lungs). Here, over time, pleural hyaline plaques can form, which in some cases evolve into mesothelioma.

To date, there are no screening tests that can diagnose pleural mesothelioma early.

Diagnosis and examination

Pleurectomy and Lung Decortication

This surgery is used to treat pleural mesothelioma, which affects the membrane lining the inner wall of the chest wall and lungs (parietal and visceral pleura).

During pleurectomy, the surgeon removes all of the pleura and surrounding tissue affected by the cancer.

This surgery aims to remove the tumor without removing the underlying lung in order to relieve associated symptoms, such as chest pain and fluid accumulation in the chest (pleural effusion).

Pleurectomy can sometimes be enlarged by removing neighboring organs involved in the disease.

Excision of the diaphragm

Pleurectomy may be expanded to the diaphragmatic muscle in some cases because mesothelioma can spread and infiltrate this anatomical structure that separates the thoracic and abdominal cavities. Surgical excision involves excision of part or all of the diaphragm and its reconstruction with or without prosthetic replacement.

Pericardiectomy

If mesothelioma spreads to the pericardium (the membrane that surrounds the heart), surgical removal of the affected pericardium and its replacement by synthetic or biological prostheses may be necessary.

Pneumonectomy

In very advanced cases of pleural mesothelioma in which the tumor significantly involves one lung, it may be necessary to remove the entire affected lung surgically.

Hyperthermic intraperitoneal cytoreduction (HITOC)

This procedure can be performed in conjunction with pleurectomy. After surgical removal of the tumor, a chemotherapy solution heated to 41°/42° for about 60 minutes is circulated directly into the chest cavity to produce the death of any remaining cancer cells. Surgical treatment of mesothelioma is usually part of a multimodal approach, that is, combined with other forms of therapy, such as chemotherapy and radiation therapy, to improve the overall effectiveness of treatment and to manage the disease more comprehensively. The choice of treatment depends on several factors, including the stage of the tumor, the patient’s overall health, and personal preference. Surgical treatment of mesothelioma depends on the staging of the disease and its extent.

Types of pleural mesothelioma

Based on cell characteristics, mesothelioma can be divided into four histotypes:

  • Epithelioid: the most common (70-85% of cases) and with the best prognosis;
  • Sarcomatoid or fibrous: about 10% of cases;
  • Mixed or biphasic: 10-25% of cases;
  • Desmoplastic: less than 2% of cases, the most difficult to diagnose.

Therapies

In selected cases, pleural mesothelioma can be treated with a combination of drugs, surgery, and radiation therapy.

Drug treatment remains the main therapy for all patients.

Pleurectomy and Lung Decortication

This surgery is used to treat pleural mesothelioma, which affects the membrane lining the inner wall of the chest wall and lungs (parietal and visceral pleura).

During pleurectomy, the surgeon removes all of the pleura and surrounding tissue affected by the cancer.

This surgery aims to remove the tumor without removing the underlying lung in order to relieve associated symptoms, such as chest pain and fluid accumulation in the chest (pleural effusion).

Pleurectomy can sometimes be enlarged by removing neighboring organs involved in the disease.

Excision of the diaphragm

Pleurectomy may be expanded to the diaphragmatic muscle in some cases because mesothelioma can spread and infiltrate this anatomical structure that separates the thoracic and abdominal cavities. Surgical excision involves excision of part or all of the diaphragm and its reconstruction with or without prosthetic replacement.

Pericardiectomy

If mesothelioma spreads to the pericardium (the membrane that surrounds the heart), surgical removal of the affected pericardium and its replacement by synthetic or biological prostheses may be necessary.

Pneumonectomy

In very advanced cases of pleural mesothelioma in which the tumor significantly involves one lung, it may be necessary to remove the entire affected lung surgically.

Hyperthermic intraperitoneal cytoreduction (HITOC)

This procedure can be performed in conjunction with pleurectomy. After surgical removal of the tumor, a chemotherapy solution heated to 41°/42° for about 60 minutes is circulated directly into the chest cavity to produce the death of any remaining cancer cells. Surgical treatment of mesothelioma is usually part of a multimodal approach, that is, combined with other forms of therapy, such as chemotherapy and radiation therapy, to improve the overall effectiveness of treatment and to manage the disease more comprehensively. The choice of treatment depends on several factors, including the stage of the tumor, the patient’s overall health, and personal preference. Surgical treatment of mesothelioma depends on the staging of the disease and its extent.

Surgery

Surgical treatment of mesothelioma is usually part of a multimodal approach, that is, combined with other forms of therapy, such as chemotherapy and radiation therapy, to improve the overall effectiveness of treatment and to manage the disease more comprehensively. The choice of treatment depends on several factors, including the stage of the tumor, the patient’s overall health, and personal preference. Surgical treatment of mesothelioma depends on the staging of the disease and its extent.

Pleurectomy and Lung Decortication

This surgery is used to treat pleural mesothelioma, which affects the membrane lining the inner wall of the chest wall and lungs (parietal and visceral pleura).

During pleurectomy, the surgeon removes all of the pleura and surrounding tissue affected by the cancer.

This surgery aims to remove the tumor without removing the underlying lung in order to relieve associated symptoms, such as chest pain and fluid accumulation in the chest (pleural effusion).

Pleurectomy can sometimes be enlarged by removing neighboring organs involved in the disease.

Excision of the diaphragm

Pleurectomy may be expanded to the diaphragmatic muscle in some cases because mesothelioma can spread and infiltrate this anatomical structure that separates the thoracic and abdominal cavities. Surgical excision involves excision of part or all of the diaphragm and its reconstruction with or without prosthetic replacement.

Pericardiectomy

If mesothelioma spreads to the pericardium (the membrane that surrounds the heart), surgical removal of the affected pericardium and its replacement by synthetic or biological prostheses may be necessary.

Pneumonectomy

In very advanced cases of pleural mesothelioma in which the tumor significantly involves one lung, it may be necessary to remove the entire affected lung surgically.

Hyperthermic intraperitoneal cytoreduction (HITOC)

This procedure can be performed in conjunction with pleurectomy. After surgical removal of the tumor, a chemotherapy solution heated to 41°/42° for about 60 minutes is circulated directly into the chest cavity to produce the death of any remaining cancer cells. Surgical treatment of mesothelioma is usually part of a multimodal approach, that is, combined with other forms of therapy, such as chemotherapy and radiation therapy, to improve the overall effectiveness of treatment and to manage the disease more comprehensively. The choice of treatment depends on several factors, including the stage of the tumor, the patient’s overall health, and personal preference. Surgical treatment of mesothelioma depends on the staging of the disease and its extent.

Radiotherapy

To date, the main indication is palliative, in the presence of localized pain symptoms. Only in highly selected cases (based on elle general condition, comorbidities, extent of disease and histology) is treatment proposed in order to improve disease control and reduce any loco-regional recurrence.

Ongoing support

At our institute, we ensure constant support before, during and after treatment to accompany each patient throughout the entire course of treatment and recovery.

Pleurectomy and Lung Decortication

This surgery is used to treat pleural mesothelioma, which affects the membrane lining the inner wall of the chest wall and lungs (parietal and visceral pleura).

During pleurectomy, the surgeon removes all of the pleura and surrounding tissue affected by the cancer.

This surgery aims to remove the tumor without removing the underlying lung in order to relieve associated symptoms, such as chest pain and fluid accumulation in the chest (pleural effusion).

Pleurectomy can sometimes be enlarged by removing neighboring organs involved in the disease.

Excision of the diaphragm

Pleurectomy may be expanded to the diaphragmatic muscle in some cases because mesothelioma can spread and infiltrate this anatomical structure that separates the thoracic and abdominal cavities. Surgical excision involves excision of part or all of the diaphragm and its reconstruction with or without prosthetic replacement.

Pericardiectomy

If mesothelioma spreads to the pericardium (the membrane that surrounds the heart), surgical removal of the affected pericardium and its replacement by synthetic or biological prostheses may be necessary.

Pneumonectomy

In very advanced cases of pleural mesothelioma in which the tumor significantly involves one lung, it may be necessary to remove the entire affected lung surgically.

Hyperthermic intraperitoneal cytoreduction (HITOC)

This procedure can be performed in conjunction with pleurectomy. After surgical removal of the tumor, a chemotherapy solution heated to 41°/42° for about 60 minutes is circulated directly into the chest cavity to produce the death of any remaining cancer cells. Surgical treatment of mesothelioma is usually part of a multimodal approach, that is, combined with other forms of therapy, such as chemotherapy and radiation therapy, to improve the overall effectiveness of treatment and to manage the disease more comprehensively. The choice of treatment depends on several factors, including the stage of the tumor, the patient’s overall health, and personal preference. Surgical treatment of mesothelioma depends on the staging of the disease and its extent.

Interdisciplinary Group

Every cancer requires, in all phases of disease management, a multidisciplinary approach that at the Candiolo Institute is guaranteed by a team of different specialists, belonging to the various clinical and surgical departments of the Institute: this team is called GIC (Interdisciplinary Care Group). The GIC ensures that each patient is taken care of throughout the diagnostic-therapeutic process, including prescribing and booking examinations and communicating with the patient and his or her family members. The GIC defines and shares a personalized care pathway for each patient, based not only on the type and stage of the tumor, but also on the patient’s own characteristics. The goal is to ensure that he or she has the best outcome both oncologically and functionally and the maintenance of a good quality of life.The Group also works closely with researchers at the Institute to ensure that patients have rapid access to the latest research-produced innovations in screening, diagnosis and treatment.

Clinical divisions

The diagnostic-therapeutic pathway for mesothelioma at Candiolo involves several clinical divisions, including:

Why choose us

At the Candiolo IRCCS Institute, every mesothelioma patient is followed in a highly specialized manner, thanks to the synergistic work of a dedicated Interdisciplinary Care Group (ICG) .

Clinical experience and tailored approach

Due to the high number of cases treated each year, the Candiolo Institute is a national reference for taking care of esophageal cancer. Our experience enables us to deal with even the most complex situations, always with a personalized approach built on the clinical and personal profile of each patient.

Imaging technologies and advanced diagnostics

Establishing the treatment plan always starts with an accurate and timely diagnosis. Patients have access to state-of-the-art imaging technologies that allow accurate assessment of the extent of the disease.

In addition, the Institute offers advanced and sophisticated laboratory investigations, including molecular and genomic analyses, which are critical for identifying biological features of cancer and guiding therapeutic decisions.

Minimally invasive surgical techniques and multidisciplinarity

When indicated, surgery is performed with minimally invasive techniques (laparoscopic or thoracoscopic), which reduce operative trauma, promote faster recovery, and improve postoperative quality of life. Every treatment choice is defined within the GIC, ensuring a consistent and integrated approach.

Clinical research and access to trials

As an IRCCS, the Candiolo Institute combines clinical practice with a strong vocation for scientific research. Patients can be evaluated for inclusion in active clinical trials, which represent a real chance to access innovative therapies not yet available in standard practice. Collaboration between care and research is a distinctive value that translates into concrete opportunities for the patient.

Care and support every step of the way

The Interdisciplinary Care Group takes care of the person at every stage: from diagnosis to treatment to follow-up, with attention to nutritional support, psychological health, and reintegration into daily life. The organization of checkups, visits and treatment is designed to ensure continuity and serenity, always valuing the human dimension of care.