Over the past 40 years MPM has been linked to asbestos exposure worldwide. Recently, however, a new theory on the carcinogenesis of this tumor has been proposed with the isolation of a simian virus 40-like gene sequence in mesothelioma tumor cells. The clinical presentation of MPM is variable, although most patients typically present with dyspnea, chest pain, or pleural effusion. Obtaining a diagnosis of MPM has been assisted by surgery and the use of immunohistochemistry and electron microscopic techniques which help to distinguish MPM from other tumor pathologies such as adernocarcinoma. In the past decade, advances have been made on several fronts that may improve the quality and quantity of life for patients with MPM. New chemotherapy drugs may provide symptomatic relief and clinical/radiological responses to patients with advanced disease. Radiation therapy is useful for palliation of localized symptoms as well as for prophylaxis against chest wall implantation. Multimodality treatment programs that combine surgical cytoreduction with radiation therapy and more effective less toxic chemotherapeutic agents may offer significant increases in survival for certain subgroups of MPM patients.Experimental treatments such as PDT, immunotherapy, and gene therapy present a window of hope for all patients with mesothelioma, even if application of these modalities in a routine fashion is years away.