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 may be available for some cases.

What Is Pleural Mesothelioma?

Malignant 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.

Mesothelioma
Pleura
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.

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Pleural Mesothelioma Causes

The only known pleural mesothelioma cause is asbestos exposure. Asbestos is a naturally occurring mineral once used by many blue-collar industries and the United States military from the 1930s to the early 1980s — until it became known as a cancer-causing substance (carcinogen).

Airborne asbestos fibers can 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 pleural mesothelioma decades later.

Pleural mesothelioma overwhelmingly affects men with working-class and military backgrounds, but anyone who has been exposed to asbestos may be at risk. Those regularly exposed to asbestos (such as through their job) may have a higher chance of getting sick.

Those at higher risk of pleural mesothelioma include:

  • Men over 65 years old
  • Occupational workers
  • People living near asbestos mines or natural deposits
  • Loved ones of those exposed to asbestos (asbestos fibers can be carried home on clothing by workers)
  • Veterans, especially those in the U.S. Navy

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 and too tough to dissolve.
  3. Damage: Over time, the asbestos fibers can cause inflammation, scarring, and genetic damage to nearby cells.
  4. Cancer: After 20 to 50 years, irritation from the fibers causes pleural cells to mutate and grow at an out-of-control rate. The first symptoms of malignant pleural mesothelioma then start to develop.

At this time, researchers are still studying what can cause mesothelioma other than asbestos. There are currently no other known causes of mesothelioma besides asbestos exposure.

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

Getting an early diagnosis is the best way to improve the outlook of mesothelioma. Download our free Mesothelioma Symptoms Checklist to track your symptoms and share with your doctor to get an accurate diagnosis.

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Pleural Mesothelioma Symptoms

The respiratory-related early pleural mesothelioma symptoms often get mistaken for more common and less severe conditions such as pneumonia and emphysema. This can make it hard 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 pleural cancer symptoms may worsen as tumors spread through the body.

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.

Pleural Mesothelioma Diagnosis

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

Doctors will investigate further if symptoms do not resolve and there is reason to believe the patient may have cancer. If a patient thinks they may have been exposed to asbestos in the past, a doctor may order pleural mesothelioma radiology tests to find any signs of cancer.

Tests used to diagnose pleural mesothelioma include:

  • Imaging tests: X-rays, magnetic resonance imaging (MRI) scans, and computerized tomography (CT) scans to look for signs of cancer in and around 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. A biopsy is the only way to confirm a mesothelioma diagnosis.

Pleural Mesothelioma Pathology

After a biopsy, your doctor will determine the type of mesothelioma cells present in the body. The three mesothelioma cell types include epithelioid, sarcomatoid, and biphasic (when tumors have both cell types).

Epithelioid mesothelioma is the most common cell type. It is the easiest cell type to treat and thus patients with these cells often have a better prognosis. Sarcomatoid mesothelioma is more difficult to treat due to its fast growth rate.

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

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Pleural Mesothelioma Stages

Mesothelioma of the pleura is the only type of this cancer 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
Description

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

Treatment

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

Median Life Expectancy

21 months

Stage 2
Description

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.

Treatment

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

Median Life Expectancy

19 months

Stage 3
Description

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

Median Life Expectancy
16 months

Treatment

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

Stage 4
Description

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

Treatment

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. Patients have a median pleural mesothelioma 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. Some patients even can survive pleural mesothelioma.

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 therapies to help patients live long, happy lives. Many researchers hope to one day find a cure for mesothelioma.

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Pleural Mesothelioma Treatment

Mesothelioma treatment aims to increase life expectancy, manage symptoms, relieve pain, and kill cancer cells.

When doctors treat malignant pleural mesothelioma, they will aim to remove as much of the cancer as possible by using 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. Those with late-stage pleural mesothelioma (stages 3 and 4) may be eligible for curative treatment in some cases, 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 to improve your prognosis. It is important to remember that each pleural mesothelioma diagnosis is different and may require unique treatments.

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Surgery

Pleural mesothelioma surgery is one of the most effective ways to treat 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 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 mesothelioma 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

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 as part of a multimodal treatment plan with surgery or radiation.

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 immunotherapy, gene therapy, 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 at 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.

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 esteemed cancer centers in the United States.

  • Dr. Raphael Bueno

    Dr. Raphael Bueno

    Dr. Raphael Bueno is a top thoracic surgeon specializing in mesothelioma research and lung cancer. He is particularly interested in the use of biogenetics to better detect mesothelioma and predict their outcome.

    Dr. Bueno is currently the Chief of the Division of Thoracic and Cardiac Surgery at Brigham and Women’s Hospital in Boston, MA, as well as co-director of the BWH Lung Center. He is also affiliated with Dana-Farber Cancer Institute, Women’s Faulkner Hospital, and Carney Hospital.

  • Dr. Marcelo DaSilva

    Dr. Marcelo DaSilva

    Dr. Marcelo DaSilva helped pioneer the application of heated chemotherapy for pleural mesothelioma, called intraoperative heated chemotherapy (IOHC). This procedure has improved survival rates for many patients with the condition.

    Dr. DaSilva is currently the Chief of Thoracic Surgery Services and Medical Director at the AdventHealth Cancer Institute in Orlando, FL.

  • Dr. Avi Lebenthal

    Dr. Avi Lebenthal

    Dr. Avi Lebenthal is a renowned pleural mesothelioma surgeon with a focus in minimally invasive thoracic surgery. He performs procedures such as EPPs and P/Ds with VATs and robotic-assisted technology.

    Dr. Lebenthal is currently based out of Brigham and Women’s Hospital in Boston, MA, and in the VA Boston Healthcare System.

  • Dr. Taylor Ripley

    Dr. Taylor Ripley

    Dr. Taylor Ripley is an accomplished thoracic surgeon specializing in minimally invasive robotic surgery, surgical oncology, and cancer profiling research.

    Dr. Ripley is currently the Director of the Mesothelioma Treatment Center at Baylor College of Medicine’s Lung Institute in Houston, TX. Dr. Ripley was personally selected by Dr. David Sugarbaker, a world-renowned mesothelioma specialist, to be his successor as director.

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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.

You should not be responsible for paying for a condition caused by the negligence of large asbestos companies. Manufacturers of asbestos-based products knew the dangers of their products and chose to continue to profit while millions of individuals suffered from exposure.

Thankfully, there are several financial support options for victims of pleural mesothelioma to help them get the treatment they deserve and hold these corrupt companies accountable.

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 that may help you live a long, happy life.

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

Pleural Mesothelioma FAQs

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. Mark Levin

Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Mark Levin, MD has nearly 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 also 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.

Mesothelioma Hope was founded by a team of passionate health advocates to educate people about this aggressive form of cancer. Mesothelioma affects thousands of people each year. Our team works tirelessly to give hope to those impacted by mesothelioma. Learn more about operating principles and our Editorial Guidelines.

12 References
  1. American Society of Clinical Oncology. (2019). Mesothelioma: Risk Factors. Retrieved July 7, 2021, from https://www.cancer.net/cancer-types/mesothelioma/risk-factors

  2. American Society of Clinical Oncology. (2019). Mesothelioma: Statistics. Retrieved July 7, 2021, from https://www.cancer.net/cancer-types/mesothelioma/statistics

  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 https://jtd.amegroups.com/article/view/1428

  4. Cleveland Clinic medical professional. (2016). Pleural Mesothelioma. Retrieved July 7, 2021, from https://my.clevelandclinic.org/health/diseases/15044-pleural-mesothelioma

  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 https://www.tandfonline.com/doi/full/10.1586/ers.11.1

  6. How is MALIGNANT MESOTHELIOMA DIAGNOSED? (n.d.). Retrieved July 07, 2021, from https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/how-diagnosed.html#:~:text=Chest%20x%2Dray&text=Findings%20that%20might%20suggest%20mesothelioma,a%20result%20of%20asbestos%20exposure

  7. Malignant mesothelioma STAGES. (n.d.). Retrieved July 07, 2021, from https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/staging.html

  8. Mayo Clinic Staff. (2019). Mesothelioma. Retrieved July 7, 2021, from https://www.mayoclinic.org/diseases-conditions/mesothelioma/symptoms-causes/syc-20375022

  9. Mayo Clinic Staff. (2018). Radiation therapy. Retrieved July 7, 2021, from https://www.mayoclinic.org/tests-procedures/radiation-therapy/about/pac-20385162

  10. National Organization for Rare Disorders. (2017). Mesothelioma. Retrieved July 2, 2021, from https://rarediseases.org/rare-diseases/mesothelioma/

  11. Penn Medicine. (n.d.). Prognosis. Retrieved July 7, 2021, from https://www.pennmedicine.org/cancer/types-of-cancer/mesothelioma/prognosis

  12. The American Cancer Society medical and editorial content team. (2018). Risk Factors for Malignant Mesothelioma. Retrieved July 7, 2021, from https://www.cancer.org/cancer/malignant-mesothelioma/causes-risks-prevention/risk-factors.html

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