Understanding Malignant Pleural Mesothelioma
Of the types of mesothelioma, pleural mesothelioma is the most common. It makes up approximately 75 to 80 percent of mesothelioma diagnoses and affects between 2,500 to 3,000 patients in the United States annually.
Though pleural mesothelioma is an aggressive and severe form of cancer, it is also treatable. Studies have shown that the two pleural mesothelioma surgical treatments (extrapleural pneumonectomy and pleurectomy with decortication) can extend your life expectancy after diagnosis. These treatments increase survival rates significantly, with nearly a third of patients living past 3 years.
Researchers are developing and testing treatment options in order to improve the quality of life and extend the life expectancy of pleural mesothelioma patients.
Pleural Mesothelioma Causes
Pleural mesothelioma is directly linked to asbestos exposure. When inhaled, microscopic asbestos fibers can get lodged in the lining of the lungs. Over time, these fibers cause irritation and inflammation in the lungs. Long-term irritation triggers cellular mutations that lead to the growth of cancer cells. Cancer cells by nature will continue to divide and replicate themselves quickly until they form into tumors. Tumors are masses of cancerous tissue that grow and spread the disease.
If left untreated, tumors will take over the body’s organs and systems. Treatment can remove or shrink tumors, kill cancer cells, and in some cases, send pleural mesothelioma into remission.
Pleural Mesothelioma Symptoms
Pleural mesothelioma affects the lungs and chest. This means that most pleural mesothelioma symptoms are respiratory issues. In the early stages, pleural mesothelioma symptoms are difficult to detect and are often confused with other respiratory conditions, such as pneumonia or asthma.
Common pleural mesothelioma symptoms include:
- Shortness of breath or difficulty breathing
- Chest tightening
- Pain under the rib cage
- Painful, persistent cough
- Lumps forming under the skin around the chest
- Fluid buildup in the lung linings (pleural effusions)
- Difficulty swallowing
- Husky sounding voice
- Weight loss
- Loss of appetite
Pleural mesothelioma starts out with a progressive thickening of the pleura (the lining of the lungs and chest cavity). This causes subtle symptoms like a persistent cough and shortness of breath. As pleural mesothelioma progresses, these symptoms may worsen or become more persistent. Continued progression of pleural mesothelioma leads to chronic fatigue, weight loss and further difficulty breathing.
Uncomfortable symptoms can be controlled and reduced with treatment. Doctors can ease a patient’s pain by removing pleural mesothelioma tumors. Tumors cause pain as they grow and create pressure inside the pleura. This pressure leads to difficulty breathing and a tightening in the chest. Palliative surgery helps remove these tumors and relieve the pressure.
It’s important to pay close attention to your pleural mesothelioma symptoms and communicate any changes with your health care team. Symptoms are a strong indicator of treatment efficacy and disease progression.
Pleural Mesothelioma Diagnosis
After noticing symptoms that may indicate pleural mesothelioma, doctors will work with patients to reach a diagnosis. Obtaining a full diagnosis is critical for doctors to prescribe treatments that can extend life expectancy and improve quality of life.
To diagnose pleural mesothelioma, doctors follow three main steps:
1. Assess Symptoms
Reviewing symptoms and performing a physical examination is the first step in reaching a diagnosis. Doctors will ask about symptoms, lifestyle and any history of asbestos exposure. This helps doctors weigh the likelihood that their patient has pleural mesothelioma. Because pleural mesothelioma is rare, doctors may suspect other respiratory diseases first.
2. Perform Chest X-Rays and Imaging Scans
If your doctor suspects pleural mesothelioma based on your symptoms and personal history, he or she will request chest X-rays or other imaging scans to determine if tumors are present.
These tests are important because they help doctors rule out other potential diseases and determine if pleural mesothelioma tumors are present. X-rays and imaging scans also show doctors if the tumors have spread from the lungs to other systems or surrounding areas.
3. Conduct Biopsies
If X-rays or imaging scans indicate abnormalities in the pleura, then your doctor will order a biopsy. During a biopsy, doctors take samples of tissue cells from the pleura and test them to see if mesothelioma cells are present.
Doctors reach a pleural mesothelioma diagnosis if the biopsy results reveal the presence of mesothelioma cells. A biopsy is the final and most conclusive way to reach a pleural mesothelioma diagnosis.
Pleural Mesothelioma Stages
After doctors have reached a pleural mesothelioma diagnosis, they will determine what stage the cancer is in. Stages indicate the degree to which the mesothelioma has spread.
- Stage1: Mesothelioma is found either in the inner or outer layer of the pleura of one lung.
- Stage 2: Mesothelioma is in both the inner and outer layers of the pleura and has formed a tumor. It may also have spread to the diaphragm or the lung tissue in this stage.
- Stage 3: Tumors have spread to the chest wall, the pericardium (heart covering) or the lymph nodes on the same side of the chest.
- Stage 4: Tumors have spread into multiple surrounding areas, such as the chest wall, the other side of the chest, the peritoneum (abdomen lining), the lymph nodes on the other side of the chest or to other parts of the body.
No matter which stage your pleural mesothelioma is at, there are treatment options. Treatment may include surgery, chemotherapy or radiation. Doctors provide treatments to slow down the spread of the cancer, shrink tumors and alleviate as many painful symptoms as possible. All treatment options aim to extend life expectancy and improve your quality of life.
Pleural Mesothelioma Prognosis
Once you’ve been diagnosed with pleural mesothelioma, your doctor will provide you with a prognosis. A prognosis is the likely progression the disease will take. Based on this expected progression, doctors also provide their patients with their life expectancy, either in the number of months or years a patient can expect to survive with their disease. Because pleural mesothelioma is rare and each person responds differently to treatment, giving an accurate prognosis can be challenging.
Doctors consider many factors before they give a prognosis, the most important being the disease stage at the time of diagnosis. A patient with advanced pleural mesothelioma will have a poorer prognosis than one diagnosed in the early stages. This is due to limited treatment options for advanced stage pleural mesothelioma.
A patient’s age and overall health level are also important to look at because generally younger, healthier people will respond to and recover from treatment better.
The average life expectancy of patients with pleural mesothelioma is between 9 and 12 months. Many patients live well beyond this thanks to emerging treatments. Regardless of your disease stage, age or health level there are treatment options for everybody.
Pleural Mesothelioma Treatment
A patient’s prognosis can significantly improve with the right treatment plan. Every pleural mesothelioma patient is placed on a personalized treatment plan tailored to their unique case. The treatment plan takes into consideration the patient’s disease stage and their overall health level. Four primary pleural mesothelioma treatment options currently exist. Depending on the case, one or more of these may be combined in a multimodal treatment plan.
Pleural mesothelioma treatments include:
- Radiation therapy
- Palliative therapy
Chemotherapy and radiation therapy are often used with surgery in early stages. On their own, chemotherapy and radiation therapy can control the spread of mesothelioma, but they are far more effective when combined with surgery.
There are two notable surgical procedures for pleural mesothelioma: extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D). Doctors decide which surgical procedure is best based on individual patient factors. Both have proven to increase survival rates in pleural mesothelioma patients. One study showed that nearly half of patients who underwent an EPP were still alive two years later.
Palliative therapy, such as thoracentesis and pleurodesis, are surgical procedures used to remove fluid buildup in the pleura. These procedures help improve the patient’s ability to breathe. They are generally used during the final stages of pleural mesothelioma, though they can benefit patients in early stages as well.
Talk to your health care team about all available treatment options so you can increase your life expectancy, improve your quality of life and continue to enjoy an active lifestyle.