Pleural Mesothelioma

Pleural mesothelioma affects the lining of the lungs (pleura) and is the most common form of this rare cancer. Symptoms may include chest pain, chronic cough, and shortness of breath. The average life expectancy for pleural mesothelioma after diagnosis is about 1-2 years, but specialized life-extending treatments are available.

What Is Pleural Mesothelioma?

Pleural mesothelioma is a type of cancer that develops in the thin lining of tissue surrounding the lungs, called the pleura.

It is the most common form of malignant mesothelioma, accounting for about 80% of all diagnoses. Pleural mesothelioma is the only type of mesothelioma with its own formal staging system.

Lining of lungs
Asbestos Fibers
Mesothelioma Cell
A person may develop pleural mesothelioma after breathing in asbestos fibers. Over time, these fibers can damage healthy cells, leading to malignant mesothelioma of the pleura.

Pleural Mesothelioma Causes

The only known cause of pleural mesothelioma is asbestos exposure. Asbestos is a naturally occurring mineral once used for decades in thousands of products before it was known as a carcinogen (cancer-causing material).

Airborne asbestos fibers attach themselves to the lining of the lungs once inhaled or swallowed. The fibers then cause irritation and scarring that can lead to the development of malignant pleural mesothelioma decades later.

Anyone who has been exposed to asbestos may be at risk of developing pleural mesothelioma. Those with repeated exposure may have a higher chance of getting sick.

Those at higher risk for asbestos exposure and pleural mesothelioma include:

  • Blue-collar workers
  • Loved ones of individuals exposed to asbestos
  • Men over 65 years old
  • People living near asbestos mines or natural deposits
  • Veterans, especially those in the U.S. Navy

Pleural mesothelioma overwhelmingly affects men with working-class and military backgrounds. From the 1930s to the early 1980s, asbestos was heavily used in many blue-collar industries and in the United States military.

How Malignant Pleural Mesothelioma Develops

  1. Exposure: An individual inhales or swallows airborne asbestos fibers through direct or secondhand exposure.
  2. Buildup: Microscopic asbestos fibers become stuck in the lining of the lungs since they are too small to cough up or dissolve.
  3. Damage: Over time, the asbestos fibers can cause inflammation, scarring, and genetic damage to nearby cells.
  4. Cancer: Over the course of decades, this genetic damage causes pleural cells to mutate and grow at an out-of-control rate. The first symptoms of malignant pleural mesothelioma then start to develop.

It can take 20 to 50 years or more for pleural mesothelioma to develop after someone is exposed to asbestos. The long latency period (time between exposure and symptoms) of mesothelioma often causes patients to be diagnosed later on in their lives.

Pleural Mesothelioma Symptoms

The respiratory-related symptoms of pleural mesothelioma often get mistaken for more common and less severe conditions such as pneumonia and emphysema. This can make it difficult to accurately diagnose mesothelioma.

The most commonly reported symptoms of pleural mesothelioma include chest pain and a dry, chronic cough.

Other common signs and symptoms of pleural mesothelioma include:

  • Difficulty breathing and shortness of breath
  • Fatigue
  • Fever
  • Fluid buildup in the lungs (pleural effusions)
  • Night sweats
  • Pain or tightness in the chest
  • Unexplained weight loss

These symptoms may increase in severity as the cancer progresses.

It is important to talk to your doctor if you are experiencing pleural mesothelioma symptoms even if you are unsure if you were exposed to asbestos. Early detection is the best way to treat malignant pleural mesothelioma before it spreads.

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Pleural Mesothelioma Diagnosis

Most times, a pleural mesothelioma diagnosis begins with the patient reporting flu-like symptoms.

If these symptoms do not resolve themselves, or if there is reason to suspect cancer, doctors will investigate further. If a patient indicates they may have been exposed to asbestos in the past, a doctor may order tests to see if mesothelioma tumors are present.

Doctors will determine a pleural mesothelioma diagnosis by ordering:

  • Imaging tests: X-rays, magnetic resonance imaging (MRI), and computerized tomography (CT) scans to look for signs of cancer in the lungs.
  • Biopsies: If imaging tests show signs of cancer, biopsies are ordered to extract tissue or fluid through a needle to test for cancer cells.

Determining an accurate pleural mesothelioma diagnosis can help you get treatment faster and may improve your prognosis. For this reason — and since this cancer is so rare — getting a second opinion from an experienced mesothelioma specialist can prevent a misdiagnosis.

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Pleural Mesothelioma Stages

Mesothelioma of the pleura is the only type of the condition with a formal staging system. These four distinct stages describe how much cancer is in the patient’s body and how far it has spread. Staging can also help doctors determine effective treatments to remove a patient’s tumors and manage their symptoms.

Doctors will typically use the Tumor Node Metastasis (TNM) Staging System to classify the stages of pleural mesothelioma.

Stage 1

The earliest stage of pleural mesothelioma. Cancer is localized to the layers of the pleura.


Curative treatments like surgery may improve life expectancy by several months or years.

Median Life Expectancy

21 months

Stage 2

The cancer has spread just past the pleura and may have reached nearby lymph nodes. It has not reached the other side of the chest.


Patients still have many curative treatment options to increase life expectancy.

Median Life Expectancy

19 months

Stage 3

The cancer has reached tissues, organs, or lymph nodes nearby.


Most patients are no longer eligible for curative treatments but can undergo palliative options.

Median Life Expectancy

16 months

Stage 4

The final stage of pleural mesothelioma. Cancer has reached distant areas of the chest and the rest of the body.


Treatments are focused exclusively on palliative care.

Median Life Expectancy

12 months

Pleural Mesothelioma Prognosis

A mesothelioma prognosis is the projected outcome of the cancer’s progression. Since pleural mesothelioma spreads so rapidly, patients have a median life expectancy of 1-2 years after diagnosis.

However, it is important to note that many patients go on to live far longer than this average.


Not every patient will have the same pleural mesothelioma prognosis. Factors such as cell type, cancer stage, and overall health can greatly impact an individual’s prognosis.

Treatment is often the most effective way to improve a malignant pleural mesothelioma prognosis.

Researchers around the globe are continuously working to perfect current treatments and develop new treatment methods to help patients live long, happy lives. Many researchers hope to one day find a cure for mesothelioma.

Pleural Mesothelioma Treatment

Treatments for mesothelioma aim to increase life expectancy, manage symptoms, relieve pain, and kill cancer cells.

When doctors treat malignant pleural mesothelioma, they’ll try to remove as much of the cancer as possible. To do so, they’ll likely use a combination of different treatment options.

The three primary types of pleural mesothelioma treatment include:

  • Chemotherapy
  • Radiation
  • Surgery

Patients with early-stage mesothelioma (stages 1 and 2) are more likely to be eligible for surgery to remove tumors in the lining of the lungs. Late-stage mesothelioma (stages 3 and 4) patients may be eligible for curative treatment, but treatment is often more focused on relieving pain and discomfort.

Your cancer care team will be able to determine which method can be most effective in your case. It is important to remember that each pleural mesothelioma diagnosis is different and may require unique treatments.


Mesothelioma surgery is one of the most effective ways to treat malignant pleural mesothelioma and prevent the spread of cancer. Pleural mesothelioma doctors will physically remove visible tumors from the chest cavity and/or surrounding tissues or organs during surgery.

The two main surgeries to treat malignant pleural mesothelioma are an extrapleural pneumonectomy (EPP) and a pleurectomy with decortication (P/D).

An EPP removes the lung closest to the mesothelioma tumors as well as the lung lining, while a P/D leaves the lung intact and simply removes the lining and tumors.


According to a study from the Journal of Thoracic Disease, patients who underwent EPP have a median survival time of up to 27 months – three times the average life expectancy of most patients.

Surgery is typically only performed on patients who are strong enough to undergo and recover from the operation. Older people, those with advanced cancer, and patients in poor health may require different treatments.


Chemotherapy involves giving patients several rounds of cancer-killing drugs that circulate through the body and destroy cancer cells.

The most common chemotherapy medications for pleural mesothelioma are a combination of cisplatin and pemetrexed. These medications are typically given intravenously (through the vein).

Pleural mesothelioma patients may get chemotherapy alone, but it is generally most effective in a multimodal treatment plan with surgery or radiation.


Radiation therapy treats malignant pleural mesothelioma with intense beams of energy aimed to destroy cancer cells in the lining of the lungs.

Radiation is often used to reduce the symptoms of late-stage pleural mesothelioma. It may also be used alongside chemotherapy or surgery to kill remaining cancer cells to help extend a patient’s life.

Emerging Treatments

Medical professionals are currently developing many promising cancer treatment options for pleural mesothelioma. Clinical trials test new treatments with the goal of increasing patient lifespans and quality of life, as well as finding a cure for cancer.

Promising new treatments for pleural mesothelioma include gene therapy, immunotherapy, and photodynamic therapy. These and other emerging mesothelioma treatments offer hope to patients with no other choices and help expand available options for future patients.

Palliative Care

Late-stage pleural mesothelioma patients who are unable to undergo life-extending surgery still have plenty of options for reducing their pain and discomfort and improving their quality of life.

Palliative care treatment options for pleural mesothelioma include:

  • Chemotherapy/Radiation
    These options may help reduce the size of tumors, easing symptoms like chest pain
  • Partial Pleurectomy
    This procedure helps prevent the buildup of fluid and relieves symptoms by removing part of the pleura
  • PleurX™ Catheter
    This device helps patients drain any pleural effusions from home to reduce pain
  • Thoracentesis
    This procedure removes extra fluid from the pleura to make it easier for the patient to breathe
  • Video-Assisted Thoracoscopic Surgery (VATS) Talc Pleurodesis
    In this procedure, the pleural space is sealed with medical-grade talc to prevent repeated fluid buildup

Both palliative and curative treatments are best performed by a cancer care team with specialized experience treating mesothelioma.

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Top Pleural Mesothelioma Doctors

Because mesothelioma is so rare — affecting roughly 3,000 people every year — most family doctors or primary care physicians don’t have experience diagnosing and treating it. As such, it’s important to see a cancer specialist that has treated pleural mesothelioma in the past.

Thankfully, there are many pleural mesothelioma specialists available to patients around the country. To learn about accessing treatment and connecting to mesothelioma specialists in your area, fill out our Doctor Match form today.

Below is a list of some of the top pleural mesothelioma doctors that work at prestigious cancer centers in the United States.

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Support Options for Pleural Mesothelioma Patients

Many patients may feel confused, lost, or scared when diagnosed with mesothelioma. Families may worry about how they are going to pay for costly treatment.

Asbestos manufacturers knew the dangers of their products and chose to continue to profit while millions of individuals suffered from exposure.

You should not be responsible for paying for a condition caused by the negligence of large asbestos companies. Thankfully, there are several financial support options for victims of pleural mesothelioma to help you get the treatment you deserve.

These support options include:

It is important to stay hopeful and positive during your battle with pleural mesothelioma. There are many life-extending treatments available to help you live a long, happy life.

Download our free Mesothelioma Symptom Checklist today to share any signs of disease with your doctor to get an accurate and early diagnosis.

Common Questions About Pleural Mesothelioma

Can you survive pleural mesothelioma?

Yes. Although the prognosis for pleural mesothelioma is often poor, there are many individuals who have lived years past their prognosis. Early detection and treatment can help improve your prognosis.

What are common symptoms of pleural mesothelioma?

The most common signs and symptoms of pleural mesothelioma include difficulty breathing, dry coughing, chest tightness, shortness of breath, and fluid buildup in the lungs.

These symptoms can often be associated with other respiratory illnesses, so it is important to be seen by a doctor to get a diagnosis.

Can a chest X-ray show pleural mesothelioma?

Yes. According to the American Cancer Society (ACS), doctors will often order a chest X-ray to look for pleural thickening, calcium deposits in the pleura, fluid in between the lungs and chest wall, or changes in the lungs themselves due to asbestos exposure.

Doctors will then order biopsies to test tissue to see if there are cancerous cells in the lining of the lungs.

Are there treatment options for pleural mesothelioma?

Yes. There are several treatment options available for pleural mesothelioma including surgery, chemotherapy, radiation, and more to destroy cancer cells in the pleura. There are also other palliative care options for patients with late-stage pleural mesothelioma to help manage symptoms and relieve pain.

Reviewed by:Dr. Assuntina Sacco

Board-Certified Oncologist

  • Fact-Checked
  • Editor

Assuntina Sacco, MD is an Associate Professor of Internal Medicine at the University of California, San Diego (UCSD) Moores Cancer Center, where she also serves as the Medical Director of Infusion Services. She is a board-certified medical oncologist trained to treat all solid tumor types, with the use of chemotherapy, immunotherapy, targeted therapy, and clinical trials.

Dr. Assuntina Sacco is an independently paid medical reviewer.

Mesothelioma Hope was founded by a team of advocates to educate people about this aggressive form of cancer. Mesothelioma affects thousands of people each year. We help give hope to those impacted by mesothelioma.

12 references
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  3. Bedirhan, M., Cansever, L., Demir, A., Ceyhan, S., Akın, H., Ürer, H., . . . Dinçer, İ. (2013, August 22). Which type of surgery should become the preferred procedure for malignant pleural mesothelioma: Extrapleural pneumonectomy or extended pleurectomy? Retrieved July 12, 2021, from
  4. Cleveland Clinic medical professional. (2016). Pleural Mesothelioma. Retrieved July 7, 2021, from
  5. Friedberg, J. S. (2014). Photodynamic therapy for malignant pleural mesothelioma: the future of treatment?, Expert Review of Respiratory Medicine, 5:1, 49-63. Retrieved July 7, 2021, from
  6. How is MALIGNANT MESOTHELIOMA DIAGNOSED? (n.d.). Retrieved July 07, 2021, from,a%20result%20of%20asbestos%20exposure
  7. Malignant mesothelioma STAGES. (n.d.). Retrieved July 07, 2021, from
  8. Mayo Clinic Staff. (2019). Mesothelioma. Retrieved July 7, 2021, from
  9. Mayo Clinic Staff. (2018). Radiation therapy. Retrieved July 7, 2021, from
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  11. Penn Medicine. (n.d.). Prognosis. Retrieved July 7, 2021, from
  12. The American Cancer Society medical and editorial content team. (2018). Risk Factors for Malignant Mesothelioma. Retrieved July 7, 2021, from

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