What Is Pleural Mesothelioma?
Pleural mesothelioma is an incurable type of cancer that develops in the pleura, a thin layer of tissue surrounding the lungs.
It is the most common form of malignant mesothelioma, accounting for around 80% of all diagnoses.
What Causes Pleural Mesothelioma?
Pleural mesothelioma is caused by exposure to asbestos.
Asbestos is a naturally occurring mineral made up of flexible and extremely durable fibers that can become stuck in the lung lining if inhaled or swallowed. Over time, these fibers cause irritation and, in some cases, cancer.
Who Is at Risk?
Most risk factors for mesothelioma directly relate to increased exposure to asbestos.
Groups at higher risk for asbestos exposure include:
- Blue-collar workers
- Veterans, especially those in the U.S. Navy
- Loved ones of individuals exposed to asbestos
- People living near asbestos mines or natural deposits
- Men over 65 years old
Pleural mesothelioma overwhelmingly affects men with working-class and military backgrounds. From the 1930s to the late 1970s, asbestos was heavily used in many blue-collar industries and in the United States military.
How Pleural Mesothelioma Develops
- Exposure: A person inhales loose asbestos fibers while working, through secondhand exposure, or other means.
- Buildup: The asbestos fibers, which are too small to cough up and too strong to dissolve, become stuck in the lining of the lungs.
- Damage: Over time, the asbestos fibers can cause inflammation, scarring, and genetic damage to nearby cells.
- Cancer: Over the course of decades, this genetic damage can cause uncontrolled pleural cell division. After that, the first symptoms of malignant pleural mesothelioma start to develop.
It takes 20-50 years or more for pleural mesothelioma to develop after initial asbestos exposure. This long latency period means patients are often diagnosed late in life.
It may also increase the risk of misdiagnosis if a patient doesn’t remember if or how they were exposed to asbestos decades ago.
Pleural Mesothelioma Symptoms
Pleural mesothelioma symptoms are often difficult to effectively diagnose. The cancer’s respiratory-related symptoms often get mistaken for more common, less severe conditions, such as pneumonia or emphysema.
Common signs and symptoms of pleural mesothelioma include:
- Difficulty breathing and shortness of breath
- Fluid buildup in the lungs (pleural effusions)
- Night sweats
- Pain or tightness in the chest
- Persistent, dry cough
- Unexplained weight loss
Patients with pleural mesothelioma most commonly report chest pain and chronic cough. As the cancer progresses, patients may develop additional, or more severe, symptoms.
Pleural Mesothelioma Diagnosis
Most pleural mesothelioma diagnoses begin with the patient reporting flu-like symptoms.
If these symptoms do not go away, or if there is reason to suspect cancer or another serious condition, doctors will investigate further using imaging tests and a biopsy. Often, it is a patient’s asbestos exposure history that prompts doctors to test for mesothelioma.
If you are experiencing symptoms of mesothelioma, even if you don’t know whether you were exposed to asbestos, it is important to talk to your doctor about getting tested.
Imaging tests are used to look for tell-tale signs of pleural mesothelioma, such as thickening of the pleural lining, pleural effusions, and tumors growing around the lung area. Doctors may choose to perform a chest X-ray, CT scan, MRI, or another diagnostic test to look for cancer.
If imaging tests show signs of pleural mesothelioma, doctors will order a biopsy, which is a sample of tissue or fluid used to diagnose cancer and determine how far it has spread.
A biopsy is the only way to confirm a pleural mesothelioma diagnosis.
Getting a Second Opinion
An accurate pleural mesothelioma diagnosis is a critical part of treatment. However, most oncologists are not experienced with diagnosing pleural mesothelioma, and the illness is commonly misdiagnosed.
To lower the risk of misdiagnosis, get a second opinion from an experienced mesothelioma specialist.
Pleural Mesothelioma Stages
Pleural mesothelioma is the only type of mesothelioma with four distinct stages, which describe how much cancer is in a patient’s body and how much it has spread. Doctors typically use the Tumor Node Metastasis (TNM) Staging System to classify the stages of pleural mesothelioma.
Staging also helps doctors determine which treatments will be most effective at removing mesothelioma tumors and managing symptoms.
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.
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.
The cancer has reached tissues, organs, or lymph nodes nearby.
Most patients are no longer eligible for curative treatments but can undergo palliative options.
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.
Pleural Mesothelioma Prognosis
A pleural mesothelioma prognosis describes the way the cancer is expected to progress.
Because the cancer spreads rapidly, patients with pleural mesothelioma have a median life expectancy of 1-2 years after diagnosis. However, this only describes the average outcome, and many patients go on to live far longer than the average.
A mesothelioma prognosis is not one-size-fits-all, and there are many factors that influence it, including cell type, cancer stage, and overall health.
In most cases, treatment is the most effective way to improve prognosis. Doctors and researchers are constantly working to refine current treatments and develop new methods to help cancer patients live longer, more comfortable lives.
Pleural Mesothelioma Treatment
Treatment options for pleural mesothelioma are used to increase life expectancy and/or to relieve symptoms.
The primary types of treatment for pleural mesothelioma are:
Patients with early-stage cancer (stages 1 and 2) are more likely to be eligible for curative surgeries. During the later stages of pleural mesothelioma (stages 3 and 4), curative options may be available, but treatments are often more focused on relieving pain and discomfort.
Mesothelioma surgery is the most effective way to manage malignant pleural mesothelioma and prevent it from spreading. During surgery, pleural mesothelioma doctors physically remove visible tumors from the chest cavity and, in some cases, the surrounding tissues or organs.
There are two main surgical procedures for pleural mesothelioma: extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D).
EPP involves removal of the diseased lung, while its counterpart pleurectomy with decortication is “lung-sparing,” meaning patients keep both lungs.
Surgery is typically only performed on patients who are strong enough to endure and recover from the operation. Patients with advanced cancer, older patients, and those in poor health may have different treatments available to them.
During this treatment, patients are given several rounds of chemotherapy drugs that circulate through the body and kill cancer cells. The most common chemotherapy medications for mesothelioma are a combination of cisplatin and pemetrexed.
Patients may undergo chemotherapy alone, but it is most effective when combined with surgery or radiation therapy in a multimodal treatment plan.
Radiation therapy treats cancer by using intense beams of energy to destroy mesothelioma cells.
Radiation has few side effects and 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 and help extend a patient’s life.
Emerging Treatments for Pleural Mesothelioma
Medical professionals are developing many promising cancer treatment options for pleural mesothelioma. Clinical trials test these new treatments with the goal of increasing patient lifespans and quality of life — and, ultimately, curing the 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 remaining standard treatment options and help expand available treatments for future patients.
Late-stage pleural mesothelioma patients who can no longer undergo curative surgeries still have options for reducing pain and discomfort.
Palliative treatment options include:
- Chemotherapy/Radiation: These options may help reduce the size of tumors, easing symptoms like chest pain
- Thoracentesis: This procedure involves removing extra fluid from the pleura, making it easier to breathe
- Video-Assisted Thoracoscopic Surgery (VATS) Talc Pleurodesis: In this procedure, the pleural space is sealed to prevent repeated fluid buildup
- 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 pleural effusions from home
Both palliative and curative treatments are best performed by a cancer care team with specialized experience treating mesothelioma.
Pleural Mesothelioma Treatment Centers
Brigham & Women’s Hospital
Dr. Raphael Bueno
Support Options for Pleural Mesothelioma Victims
Receiving life-extending treatment from a mesothelioma specialist usually costs hundreds of thousands of dollars. Patients and loved ones affected by pleural mesothelioma have several financial support options to help cover treatment expenses.
Click the icons below to learn more about the compensation options that may be available for victims and families.
Despite the grave challenges of a pleural mesothelioma diagnosis, it is not a hopeless situation.
To learn more about promising treatments for pleural mesothelioma and how to afford them, download our free Mesothelioma Guide.