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Pleural vs. Peritoneal Mesothelioma

Mesothelioma is a cancer that begins in the lining surrounding most internal organs (called the mesothelium). It is caused by exposure to asbestos and most commonly develops in the lining of the lungs (pleura) or abdomen (peritoneal). Learn about the differences between pleural and peritoneal mesothelioma and get help for you or a loved one.

Medically reviewed by: Mark Levin, MD

Last updated:

Pleural vs. Peritoneal Mesothelioma: What’s the Difference?

Mesothelioma is a cancer caused by asbestos exposure that affects the lining of certain organs. The terms pleural and peritoneal describe the location in which the cancer develops.

Pleural and Peritoneal infographic

Pleural mesothelioma begins in the pleura, or the lining of the lungs. It is the most common type of mesothelioma, accounting for 80% of all mesothelioma diagnoses.

Peritoneal mesothelioma develops in the peritoneum, which is the lining of the abdomen. It is the second most common type of mesothelioma, with 10 to 20% of diagnosed cases.

Quick Facts on Pleural vs. Peritoneal Mesothelioma

Pleural Mesothelioma

Peritoneal Mesothelioma

Part of the body it affects: Pleura (the lining of the lung) Peritoneum (the lining of the abdomen)
Symptoms: Shortness of breath, unexplained weight loss, coughing, chest pains, night sweats Pain in abdomen, fluid buildup in the abdomen (ascites), bloating, nausea, vomiting, diarrhea, constipation, loss of appetite
Surgical treatments: Extrapleural pneumonectomy (EPP), pleurectomy with decortication (P/D), thoracentesis, talc pleurodesis Cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC), peritonectomy, omentectomy, paracentesis
Other treatments: Heated chemotherapy (HITHOC), standard chemotherapy, radiation therapy, immunotherapy, palliative care Chemotherapy, immunotherapy, radiation therapy, targeted therapy, palliative care

Learn more about the different types of mesothelioma and symptoms, diagnosis, and treatment for them in our Free Mesothelioma Guide. Your comprehensive welcome kit will be shipped overnight.

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Pleural vs. Peritoneal Mesothelioma Symptoms

Pleural mesothelioma and peritoneal mesothelioma affect different parts of the mesothelium. As such, they cause different symptoms.

Symptoms of malignant pleural mesothelioma may include:

  • Chest pain
  • Fatigue
  • Fever
  • Lower back pain
  • Night sweats
  • Persistent coughing fits
  • Shortness of breath
  • Swollen arms and face
  • Unexpected weight loss

Symptoms of malignant peritoneal mesothelioma may include:

  • Abdominal pain
  • Constipation or diarrhea
  • Fluid buildup in the abdomen (ascites)
  • Loss of appetite
  • Nausea
  • Vomiting

Causes of Pleural vs. Peritoneal Mesothelioma

Pleural and peritoneal mesothelioma are both caused by exposure to asbestos. Asbestos is durable and heat-resistant, so it was used extensively in many building and industrial projects dating back to the 1930s.

When asbestos fibers are inhaled, they can lodge in the lining of either the pleura or peritoneum and cause inflammation. Over time, there is a change in the DNA of the mesothelial cells, and cancer develops as a result.

Who’s at Risk of Pleural and Peritoneal Mesothelioma?

Anyone who was exposed to asbestos in their lifetime may be at risk of developing mesothelioma. Many people were exposed due to certain occupations or military service, and others don’t know how they were exposed.

People who may be at higher risk of mesothelioma include:

Additionally, family members of someone who was exposed to asbestos may be at risk of developing mesothelioma. This is known as “take-home” exposure and can happen when asbestos fibers become lodged in the clothing or hair of someone working around the material.

How to Diagnose Peritoneal vs. Pleural Mesothelioma

Doctors may use various methods to diagnose pleural and peritoneal mesothelioma. However, a biopsy is the only definitive way to diagnose either type of mesothelioma.

Other tests may be used to distinguish mesothelioma from other conditions or to identify cancer spread or cell type.

Some of the most common diagnostic tests include:

  • Biopsies (fluid or tissue)
  • Blood chemistry tests
  • Complete blood count (CBC) tests
  • Computed tomography (CT) scans
  • Magnetic resonance imaging (MRI) scans
  • X-rays

Some doctors also use lung function tests to diagnose pleural mesothelioma.

If you’re experiencing possible symptoms of mesothelioma, our Free Doctor Match can get you in touch with a mesothelioma specialist for a diagnosis or second opinion.

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Pleural vs. Peritoneal Mesothelioma Stages

Oncologists use different staging systems for pleural vs. peritoneal mesothelioma. Determining the stage of cancer can help your health care team determine an effective treatment plan.

Pleural mesothelioma is staged according to the Tumor-Node-Metastasis (TNM) system, which has four stages:

  1. Stage 1: The cancer is still localized to the place it originated and hasn’t spread to other parts of the body.
  2. Stage 2: The mesothelioma tumors have spread to nearby lymph nodes and potentially started to affect other organs nearby.
  3. Stage 3: The cancer has spread extensively and affected adjacent organs and lymph nodes.
  4. Stage 4: The cancer has migrated to other parts of the body, including the other side of the lung and body. By this stage, the condition is called metastatic pleural mesothelioma.

On the other hand, peritoneal mesothelioma is usually staged using the peritoneal cancer index (PCI).

This system evaluates 13 regions within the abdomen, with a score from 0 to 3 based on tumors found in these regions. Doctors calculate the PCI by adding the scores for all 13 regions — the higher the score, the greater the extent of cancer spread.

Prognosis for Pleural vs. Peritoneal Mesothelioma

Prognosis is another name for the expected outcome of pleural or peritoneal mesothelioma, including life expectancy.

Your prognosis depends on several factors, such as your age, mesothelioma cell type, overall health, and treatment plan. Your medical provider can explain how these factors shape your prognosis.

“Getting a mesothelioma diagnosis can be very scary. So many people go on Google and find either misinformation or information that doesn’t apply to their individual situation. Mesothelioma is not a guaranteed death sentence — there are options that you have.”

- Quote from Dr. Raja Flores, pleural mesothelioma specialist

Survival Rate & Life Expectancy of Pleural vs. Peritoneal Mesothelioma

Life expectancy and survival rates vary by the type of mesothelioma, cell type (epithelioid vs. sarcomatoid), subtype (i.e., adenomatoid, cystic, and papillary), treatment, and other factors.

Average Pleural and Peritoneal Life Expectancy With Treatment
  • Peritoneal: 53 months
  • Pleural: 18 months
Sources: Frontiers in Oncology, Cancer Therapy Advisor, Cancer Management and Research

For instance, if your pleural or peritoneal mesothelioma tumor consists of epithelioid or epithelial mesothelioma cells or epithelioid-dominant biphasic mesothelioma cells, you may have a better overall survival rate and life expectancy compared to sarcomatoid mesothelioma cells.

The 5-year survival rate for pleural mesothelioma is 12%, and the average life expectancy is 18 months after diagnosis.

On the other hand, the 5-year survival rate for peritoneal mesothelioma patients is 65%, and the average life expectancy is 53 months after diagnosis if they undergo cytoreductive surgery with HIPEC.

Survival rates and life expectancy numbers are averages based on many patients with vastly different medical histories — your situation may be different, and new treatments are being tested all the time that may help you live longer.

The medical treatment you receive can have a significant impact on your prognosis. Get our Free Checklist of Questions to Ask Your Doctor to help guide your conversations around treatment.

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Treatment Options for Pleural vs. Peritoneal Mesothelioma

There are many treatment options for people with pleural or peritoneal mesothelioma, including surgery, chemotherapy, radiation, immunotherapy, and emerging therapies accessed through clinical trials.

A mesothelioma doctor can help you determine the right treatment plan for your or your loved one’s unique diagnosis.


Surgeries involve removing cancerous tissue. Various surgeries can be used to help increase life expectancy and manage symptoms from both pleural and peritoneal mesothelioma.

Surgeries for pleural mesothelioma include:

  • Extrapleural pneumonectomy (EPP) removes the visceral and parietal pleura, part of the diaphragm, the lung on the side where the mesothelioma developed, and the lymph nodes in the chest.
  • Pleurectomy and decortication (P/D) removes the visceral and parietal pleural and mesothelioma. It does not remove the lung.
  • Palliative surgeries such as debulking surgery for removing as much of the mesothelioma tumor as possible, thoracentesis for draining air or fluid around the lungs, and pleurodesis for sealing the visceral and parietal pleural together so there is no space between them.

Surgeries for peritoneal mesothelioma include:

  • Cytoreductive surgery with HIPEC removes as much of the cancer as possible from the abdomen. Doctors then bathe the area with chemo drugs after the surgery (intraperitoneal chemotherapy) to kill the remaining cancer cells.
  • Paracentesis drains excess fluid from the abdominal cavity using a tube or hollow needle to help manage ascites, one of the main symptoms of peritoneal mesothelioma.


Chemotherapy uses drugs to kill mesothelioma cancer cells.

For pleural mesothelioma, chemotherapy can be used systemically (drugs travel through the bloodstream to kill cancer cells throughout the body) or regionally (injected into a specific area of the body).

Common chemo drug combinations for pleural mesothelioma include:

  • Cisplatin and pemetrexed (Alimta®)
  • Cisplatin and raltitrexed (Tomudex®)
  • Pemetrexed and carboplatin (Paraplatin®, Paraplatin AQ®)

Some procedures involve hyperthermic intrathoracic chemotherapy (HITHOC), in which the chemo is applied directly to the chest wall after surgery to kill any remaining cancer cells.

Chemotherapy for peritoneal mesothelioma is typically regional and injected directly into the peritoneal cavity. This is called intraperitoneal chemotherapy.

Sometimes doctors heat the drugs before putting them into the body. This process is called hyperthermic intraperitoneal chemotherapy, or HIPEC.

Common chemotherapy drugs for peritoneal mesothelioma include:

  • Cisplatin
  • Doxorubicin (Adriamycin®)
  • Mitomycin (Mutamycin®)

Peritoneal mesothelioma doctors may combine cisplatin with doxorubicin or mitomycin.


Radiation therapy may be used to relieve pain or control the symptoms of advanced peritoneal and pleural mesothelioma. This is called palliative treatment.

For curative treatment (treatment done to cure or fight against a condition), researchers have discovered that giving radiation therapy before surgery for pleural mesothelioma can significantly boost survival time.

However, radiation therapy is not used after surgery for peritoneal mesothelioma. This is because many organs in the abdomen can be damaged by radiation.


Immunotherapy uses drugs to support the body’s own immune system to fight cancer. These drugs are usually given through an IV infusion.

Currently, ipilimumab (Yervoy®) and nivolumab (Opdivo®) are approved for pleural mesothelioma patients who are not eligible for surgery and have tumors that have spread throughout the body.

Research is still being done on immunotherapy for peritoneal mesothelioma. However, there have been promising results in clinical trials.

According to a study published in Cancer Discovery, testing bevacizumab (Avastin®) plus atezolizumab (Tecentriq®), the 1-year survival rate was 85%, and 61% of peritoneal mesothelioma patients did not experience cancer spread.

Clinical Trials

Clinical trials are research studies that test new treatments for mesothelioma. Past clinical trials have led to the development of standard chemotherapy, vaccines, and other cancer treatments that exist today.

Some current and upcoming clinical trials for pleural mesothelioma include:

  • A phase I trial for studying how well combination and nivolumab (Opdivo®) chemo before surgery works in treating pleural mesothelioma patients with tumors that can be removed by surgery (also called resectable tumors).
  • A phase I trial looking for the best dose of intensity-modulated pleural radiation therapy to see its effect when given with pembrolizumab in treating pleural mesothelioma patients with unresectable tumors.
  • A phase II study that looks at the side effects of nivolumab (Opdivo®) with or without ipilimumab (Yervoy®) before surgery in patients with stage I to III resectable pleural mesothelioma.

Some current and upcoming clinical trials for peritoneal mesothelioma include:

  • A phase II trial comparing additional chemo (carboplatin or pemetrexed and cisplatin) given directly into the abdominal area versus an IV.
  • A phase II trial comparing the usual treatment for peritoneal mesothelioma against atezolizumab immunotherapy plus the usual treatment for peritoneal mesothelioma.
  • A phase I trial testing the side effects, safety, and best dose of paclitaxel-loaded tumor penetrating microparticles (TPM) in people with abdominal cancer that has spread to the membrane surrounding the abdominal organs who have no other standard treatment options available.

Cost of Treatment for Pleural vs. Peritoneal Mesothelioma

The cost of treatment for pleural and peritoneal mesothelioma varies depending on several factors, such as your medical insurance, treatment plan, age, and veteran status.

The total cost of pleural and peritoneal mesothelioma treatment can reach $500,000 or more. This includes appointments, tests, various treatments, medications, travel, and other expenses.

Your medical provider can help you better understand what you can expect to pay once your treatment plan is finalized.

Get Help for Mesothelioma Today

For over 20 years, Mesothelioma Hope has provided pleural and peritoneal mesothelioma patients and their loved ones with free mesothelioma resources and medical, financial, and supportive care.

Our team can help you:

  • Get an accurate diagnosis or second opinion
  • Find a mesothelioma specialist for treatment
  • Identify ways to pay for your medical expenses
  • Connect with a support group or peer mentor

Call (866) 608-8933 or fill out our contact form today to get started. We are standing by to help however we can.

Pleural vs. Peritoneal Mesothelioma FAQs

What is the life expectancy of a pleural and peritoneal mesothelioma patient?

The life expectancy of a pleural or peritoneal mesothelioma patient can vary greatly depending on several factors, including the stage of the cancer, the patient’s overall health, age, and the effectiveness of various treatment options.

On average, pleural mesothelioma patients have a life expectancy of 18 months, while peritoneal mesothelioma patients have a life expectancy of 53 months.

Can pleural mesothelioma spread to peritoneal mesothelioma?

Yes, but very rarely. Pleural mesothelioma that becomes metastatic, or spreading, can affect other parts of the body beyond the lung lining. Typically, the cancer will spread to the lymph nodes and other internal organs.

Although it’s not impossible, most people with pleural mesothelioma will not also be diagnosed with peritoneal mesothelioma.

What’s the difference between pleural and peritoneal mesothelioma?

Both peritoneal and pleural mesothelioma are caused by exposure to asbestos. Pleural mesothelioma develops in the pleura, or the lining of the lungs. Peritoneal mesothelioma develops in the peritoneum, or the lining of the abdomen.

Because of the different locations of the cancer, each has slightly different symptoms and treatment options.

Where in the body does mesothelioma develop?

Mesothelioma primarily develops in the lining of the lungs (pleural mesothelioma), but it can also affect the lining of the abdomen (peritoneal mesothelioma), heart (pericardial mesothelioma), or testicles (testicular mesothelioma), although these cases are much rarer.

Dr. Mark LevinReviewed by:Mark Levin, MD

Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Mark Levin, MD, has over 30 years of experience in academic and community hematology and oncology. In addition to serving as Chief or Director at four different teaching institutions throughout his life, he is still a practicing clinician, has taught and designed formal education programs, and has authored numerous publications in various fields related to hematology and oncology.

Dr. Mark Levin is an independently paid medical reviewer.

  • Board Certified Oncologist
  • 30+ Years Experience
  • Published Medical Author
Jenna TozziWritten by:

Director of Patient Advocacy

Jenna Tozzi, RN, is the Director of Patient Advocacy at Mesothelioma Hope. With more than 15 years of experience as an adult and pediatric oncology nurse navigator, Jenna provides exceptional guidance and support to mesothelioma patients and their loved ones. Jenna has been featured in Oncology Nursing News and is a member of the Academy of Oncology Nurse & Patient Navigators & the American Nurses Association.

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  1. American Cancer Society. Risk Factors for Malignant Mesothelioma. Accessed on March 11, 2024.
  2. Canadian Cancer Society. Chemotherapy. Accessed on March 11, 2024.
  3. Canadian Cancer Society. Diagnosis of mesothelioma. Accessed on March 11, 2024.
  4. Canadian Cancer Society. Pleural Mesothelioma. Accessed on March 11, 2024.
  5. Canadian Cancer Society. Radiation Therapy. Accessed on March 11, 2024.
  6. Canadian Cancer Society. Staging of mesothelioma. Accessed on March 11, 2024.
  7. Cleveland Clinic. Peritoneal Mesothelioma. Accessed on March 11, 2024.
  8. Cleveland Clinic. Pleural Mesothelioma. Accessed on March 11, 2024.
  9. Moffitt Cancer Center. Mesothelioma Survival Rates. Accessed on March 11, 2024.
  10. National Library of Medicine. (2017). Intra-abdominal manifestations of pleural mesothelioma. Retrieved on March 11, 2024, from,initial%20diagnosis%20of%20pleural%20disease.
  11. Raghav, Kanwal et al. American Association for Cancer Research. (November 2021). Efficacy, Safety, and Biomarker Analysis of Combined PD-L1 (Atezolizumab) and VEGF (Bevacizumab) Blockade in Advanced Malignant Peritoneal Mesothelioma. Accessed on March 11, 2024.
  12. Zishou, Hu. et al.Cancer. (April 2021). Malignant Mesothelioma: Advances in Immune Checkpoint Inhibitor and Mesothelin Targeted Therapies. Accessed on March 11, 2024.
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