What Is Pleural Mesothelioma?
Malignant pleural mesothelioma is a type of cancer that develops in the pleura, which is the thin lining of tissue surrounding the lungs.
It is the most common form of malignant mesothelioma, accounting for about 80% of all diagnoses.
- Approximately 2,400 Americans are diagnosed with pleural mesothelioma each year.
- The only known cause of this cancer is asbestos exposure.
- Pleural mesothelioma is the only type of mesothelioma with its own formal staging system.
- Men make up 80% of pleural mesothelioma patients, according to Cancer Therapy Advisor.
Learn more about pleural mesothelioma — and the most effective ways to treat it — in our Free Mesothelioma Guide.
Pleural Mesothelioma Symptoms
Symptoms of pleural mesothelioma usually appear 10-50 years after initial asbestos exposure.
- Chest pain
- Difficulty breathing and shortness of breath
- Dry, chronic cough
- Fatigue
- Fever
- Night sweats
- Pain or tightness in the chest
- Unexplained weight loss
Symptoms of pleural mesothelioma tend to worsen as the cancer spreads through the body.
Lining of lungs
It is important to talk to your doctor if you are experiencing 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.
Some patients may also have additional asbestos-related conditions due to their exposure. Learn about these diseases below.
Asbestosis
Asbestosis is a noncancerous disease that occurs when asbestos fibers get stuck in the lungs. The asbestos causes the lungs to stiffen, leading to breathing problems and pain. Asbestosis gets worse over time and can be fatal.
Pleural Effusions
One of the early symptoms of pleural mesothelioma are pleural effusions. These fluid buildups in the pleura can be painful and interfere with breathing.
Pleural Plaques
Pleural plaques are accumulations of a protein called collagen in the lung lining. They cause no symptoms and are harmless. People won’t know they have pleural plaques until doctors identify them on imaging scans.
Pleural Thickening
Pleural hardening and thickening can occur due to irritation from asbestos fibers. Pleural thickening can lead to mild breathing problems.
Pleural Mesothelioma Causes
The only known cause of this cancer is asbestos exposure. Asbestos is a naturally occurring mineral once used by many industries and the U.S. military from the 1930s to the early 1980s until it became widely known as a cancer-causing substance (carcinogen).
How Asbestos Causes Pleural Mesothelioma
- Exposure: Someone inhales or swallows airborne asbestos fibers through direct or secondhand exposure.
- 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.
- Damage: Over time, asbestos fibers cause inflammation, scarring, and genetic damage to nearby cells.
- Cancer: After 10-50 years, irritation from the fibers causes pleural cells to mutate and grow at an out-of-control rate. The first symptoms of cancer then start to develop.
Risk Factors
Pleural mesothelioma primarily affects older men with working-class and/or military backgrounds. That said, anyone who has been regularly exposed to asbestos may also be at risk.
High-risk groups include:
- Anyone exposed to asbestos at their jobs
- Family members of workers who carried asbestos home on their clothes
- Men over the age of 65
- Veterans, especially those who served in the U.S. Navy
Diagnosing Mesothelioma of the Pleura
A mesothelioma diagnosis often starts with a patient reporting flu-like symptoms. If a doctor thinks the patient may have cancer after a basic exam, they’ll order tests to confirm a diagnosis.
Tests used to diagnose this cancer include:
- Imaging tests: X-rays, magnetic resonance imaging (MRI) scans, and computerized tomography (CT) scans can help doctors look for signs of cancer in and around the lungs.
- Biopsies: If imaging tests show signs of cancer, biopsies are ordered to extract tissue and/or fluid to test for cancer cells. A biopsy is the only way to confirm a pleural mesothelioma diagnosis.
Getting an early diagnosis is the best way to improve your health outlook. If you’re diagnosed before the cancer spreads, you’ll have more treatment options and may be able to live longer.
For help getting diagnosed and treated, use our Free Doctor Match to find top mesothelioma specialists in your area.
Pleural Mesothelioma Misdiagnosis
A health care provider may sometimes misdiagnose pleural mesothelioma symptoms as a more common and less severe condition like pneumonia.
Other patients may not have any symptoms at first. This can make it hard to accurately diagnose mesothelioma.
For these reasons, getting a second opinion from an experienced mesothelioma specialist is important to prevent misdiagnosis.
Pleural Mesothelioma Cell Types
After a biopsy, your doctor will determine the type of mesothelioma cell(s) present in your body. The three mesothelioma cell types are epithelioid, sarcomatoid, and biphasic (when tumors have both cell types).
- Epithelioid mesothelioma is the most common cell type and is the easiest to treat. Patients with this cell type often have a better health outlook.
- Sarcomatoid mesothelioma is more difficult to treat because of how aggressively it spreads.
- Biphasic mesothelioma tumors are easier to treat if more epithelioid cells are present.
Pleural Mesothelioma Stages
There are four stages of pleural mesothelioma. Each stage refers to how much cancer is in your body and how far it has spread. Which stage you have will play a big role in the treatments you receive.
Doctors typically use the tumor-node-metastasis (TNM) staging system to classify the stages of pleural mesothelioma.
The earliest stage. Cancer is only in the pleura.
Treatments like surgery may improve life expectancy by several months or years.
21 months
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 treatment options to increase life expectancy.
19 months
The cancer has reached nearby tissues, organs, or lymph nodes.
Some patients can get life-extending treatments, but others will only qualify for pain-relieving care.
16 months
The final stage. Cancer has reached distant areas of the chest and the rest of the body.
Treatments are focused exclusively on easing pain.
12 months
Download our Free Questions to Ask Your Doctor Checklist to get the answers you need no matter which stage of this cancer you have.
Malignant Pleural Mesothelioma Prognosis
A prognosis is the projected outcome of a disease. Mesothelioma prognosis is typically measured using survival rate (percentage of patients still alive after a set period of time) and life expectancy (average length of time people live after a diagnosis, usually measured in months).
The average mesothelioma prognosis is generally poor, with few patients still alive 5 years after being diagnosed. But some patients may live longer depending on the unique factors of their case.
Pleural Mesothelioma Life Expectancy
Pleural mesothelioma patients have an average life expectancy of 18 months after diagnosis. However, many patients go on to live far longer than this average.
Treatment is the most effective way to improve your life expectancy.
Pleural Mesothelioma Survival Rates
Pleural mesothelioma survival rates vary depending on factors such as the stage of the disease, the patient’s age, and the type of treatment received.
| Time After Diagnosis | Survival Rates* |
|---|---|
| 1 year | 73% |
| 3 years | 29% |
| 5 years | 17% |
*Data accounts for stage I-IIIA patients. Source: JAMA Network (2023)
While these survival rates are low, it’s possible to become a pleural mesothelioma survivor. John Stahl was diagnosed with stage 4 pleural mesothelioma in 2019 but is still alive today thanks to chemotherapy treatments. Watch John’s story of survival below, which is also featured in our Free Survivors Guide.
Mesothelioma survivor John Stahl was diagnosed with stage 4 pleural mesothelioma in 2019. More than four years later, he's still enjoying his golden years with his wife, Dee. Call us today at (866) 608-8933 to get the medical help you need to become a survivor. View Transcript.
Duration: 2 min 59 sec
Dee Stahl:
The day started out fine. We got up and John, which is unusual for him, just came out of the bedroom and just sat down, and he said, “I just don’t feel good.” And I knew something was wrong because John doesn’t complain. And I said, “Well, I think we should probably go to the ER.” They found out that there was over two liters of fluid on his left lung, and they were amazed that he was even able to breathe, period. They did a CAT scan, and that’s when he just said, “You have stage four mesothelioma, John.”
John Stahl:
I was kind of blank. I didn’t know what to think. I didn’t realize that my job had exposed me to this.
Dee Stahl:
We’re the Stahls. I’m Dee, and this is my husband, John.
John Stahl:
My name is John Stahl. I was first exposed to asbestos poisoning through the construction business, through Sheetrock®, through gaskets, and piping all through my career. And I worked 43 years in the construction business. If you don’t work, you don’t get paid. The first treatment was with chemotherapy, and I went every two weeks. It didn’t take long, an hour or so, but it would take me seven to 10 days to recover. That was hard for me because I’m a pretty active person. At first, it didn’t really sink in. The longer I thought about it, it’s gonna end my life eventually, but I’m gonna live it…as well as I can.
Dee Stahl:
Being with John through this, I’m glad I was here for him. He’s got a lot of support. He’s got a lot of friends and family that really care for him. But to be there, John made it easy because he was so positive. I’m just glad I was here for him. He held me up, really.
John Stahl:
Having Dee with me going through this was indescribable. It’s important for people to understand that there’s help and there’s people that are willing to help them.
Dee Stahl:
I think John’s positive attitude has kept him going like he has, having John so halfway healthy. I mean, he’s able to do things and be happy. John’s a very positive guy. He makes you happy.
Pleural Mesothelioma Treatment
Mesothelioma treatment aims to increase life expectancy, manage symptoms, and kill cancer cells. Commonly used treatments include surgery, chemotherapy, and radiation therapy.
Patients with early-stage mesothelioma are more likely to qualify for aggressive treatments like surgery to remove tumors. Treatment for late-stage patients is often more focused on relieving pain.
We can help find the best mesothelioma treatments for you or a loved one. Call (866) 608-8933 now.
Pleural Mesothelioma Surgery
Pleural mesothelioma surgery is one of the most effective ways to treat this cancer.
The two most common types of surgeries include:
- Extrapleural pneumonectomy (EPP): An EPP removes the lung closest to the mesothelioma tumors and the lung lining. Patients live for over 35 months on average with this surgery.
- Pleurectomy with decortication (P/D): A P/D leaves the lungs intact but removes the lung lining and tumors. Patients treated with this surgery live for 34 months on average. They usually have a lower risk of complications and shorter recovery times when compared to those treated with an EPP.
According to a 2023 study published in Cancer Medicine, patients treated with surgery live for nearly 1 year longer on average than those who do not.
Surgeries are typically only performed on early-stage patients who are strong enough to fully recover from them.
Chemotherapy
Chemotherapy circulates through the body and destroys cancer cells. The most common chemotherapy drugs used to treat pleural mesothelioma are cisplatin and pemetrexed.
The 2023 Cancer Medicine study revealed that pleural mesothelioma patients treated with chemotherapy live for an average of 14 months. Patients typically lived for nearly 22 months when surgery and chemotherapy were combined.
Patients may get chemotherapy alone or in conjunction with other treatments like surgery and radiation.
Radiation
Radiation therapy treats mesothelioma with intense beams of energy. It is often used to reduce the symptoms of late-stage pleural mesothelioma. It may also be used alongside chemotherapy or surgery to kill cancer cells and extend a patient’s life.
The typical life expectancy for pleural mesothelioma patients treated with radiation is 12 months, according to Cancer Medicine.
Learn from 7 mesothelioma patients who surpassed their life expectancy in our Free Survivors Guide.
Immunotherapy
Immunotherapy boosts the body’s immune response to mesothelioma. Mesothelioma cells sometimes escape detection by the immune system otherwise, and as a result, grow and spread rapidly.
Cancer Medicine noted that pleural mesothelioma patients treated with immunotherapy had an average life expectancy of nearly 16 months.
The U.S. Food and Drug Administration (FDA) approved two immunotherapy drugs — Opdivo® and Yervoy® — to treat this cancer in 2020. Additional immunotherapy therapies are currently being tested in clinical trials and may be approved as mesothelioma treatments in the future.
TTFields
Tumor treating fields (TTFields) allow doctors to stop or slow the spread of mesothelioma. Pads that attach to the patient’s chest produce a low-grade electrical field that disrupts the division of cancer cells without hurting the patient.
The FDA approved TTFields to treat pleural mesothelioma in 2019. All patients using TTFields also receive chemotherapy.
Emerging Treatments
Medical professionals are currently developing many new mesothelioma treatment options and studying them in clinical trials.
Emerging treatments include:
- Gene therapy
- Photodynamic therapy
- Virus therapy
These and other promising treatments offered in clinical trials can bring hope to patients whose cancer has stopped responding to standard therapies.
Palliative Care for Pleural Mesothelioma Patients
Late-stage pleural mesothelioma patients who cannot undergo life-extending treatments can still access therapies to live with less pain. This is known as palliative care.
Palliative care options for mesothelioma include:
- Partial pleurectomy: This prevents fluid buildup and relieves symptoms by removing part of the pleura.
- PleurX™ catheter: This device helps patients drain pleural effusions at home.
- Talc pleurodesis: Using video-assisted thoracoscopic surgery (VATS), doctors insert medical grade-talc into the pleura to prevent fluid buildup.
- Thoracentesis: This removes extra fluid from the pleura to make breathing easier.
Talk to a mesothelioma doctor to learn which palliative care options may be right for you.
Top Pleural Mesothelioma Doctors
While it’s scary to know you have a rare and very aggressive cancer like pleural mesothelioma, there are many specialists available nationwide who may be able to help you.
Top doctors who treat this type of mesothelioma include:
Dr. Raphael Bueno
Pleural MesotheliomaChairman of the Department of Thoracic Surgery at Mount Sinai Medical Center in New York
Dr. Marcelo DaSilva
Pleural MesotheliomaChief of Thoracic Surgery Services and Medical Director at the Cancer Institute at AdventHealth in Orlando, FL
Dr. Anne Tsao
Pleural MesotheliomaDirector of the Mesothelioma Program at the University of Texas MD Anderson Cancer Center
Dr. Taylor Ripley
Pleural MesotheliomaDirector of the Mesothelioma Treatment Center at Baylor College of Medicine’s Lung Institute in Houston
Get help connecting with pleural mesothelioma specialists near you using our Free Doctor Match.
Financial Support for Pleural Mesothelioma Patients
If you’ve been diagnosed with pleural mesothelioma, financial aid may be available. Makers of asbestos-based products knew the hazards of asbestos for decades, yet allowed millions to still be exposed.
Thankfully, it’s now possible to get compensation from the companies that might have caused you to develop this cancer.
Financial support options for mesothelioma include:
- Mesothelioma Lawsuits
Mesothelioma patients or their families can file a lawsuit to pursue financial compensation. Mesothelioma lawsuits typically pay out $1 million or more.
- Asbestos Trust Funds
Many asbestos companies declared bankruptcy to avoid being sued. However, the U.S. court system forced these companies to put money in trust funds to help victims. More than $30 billion is available in asbestos trust funds right now.
- VA Benefits and Health Care
Military veterans with mesothelioma can file for benefits offered by the U.S. Department of Veterans Affairs (VA). These benefits include monthly payouts worth nearly $4,000 a month in many cases and medical care from the VA health care system.
Order your Free Mesothelioma Guide now to learn more about financial and medical benefits that may be available to you.
Pleural Mesothelioma FAQs
Can you survive pleural mesothelioma?
Possibly, yes. Though rare, you may be able to become a long-term survivor with medical care from top doctors.
Treatment options such as surgery, chemotherapy, and radiation can improve your prognosis and extend your life.
What are common symptoms of pleural mesothelioma?
The most common signs and symptoms of mesothelioma include difficulty breathing, dry coughing, chest tightness, shortness of breath, and fluid buildup in the lungs.
These symptoms are associated with other respiratory illnesses, so it is important to be seen by a doctor to get a correct diagnosis.
How is pleural mesothelioma diagnosed?
Mesothelioma is diagnosed by assessing a patient’s symptoms and asbestos exposure history, then ordering diagnostic tests.
According to the American Cancer Society (ACS), doctors will often order a chest X-ray to look for signs of mesothelioma in the lungs, lung lining, and chest wall. Other imaging tests may be used as well depending on the situation.
Doctors will then order biopsies to test tissue/fluid to see if there are cancerous cells present. Only a biopsy can officially confirm a diagnosis.
Is pleural mesothelioma curable?
No, but some mesothelioma patients may live for 20 years or more after being diagnosed with this cancer. The key is to get medical care from top mesothelioma doctors.
Patients also have a better chance of living longer if they’re diagnosed before the cancer spreads.
