Pleural Mesothelioma

What is Pleural Mesothelioma?

Pleural mesothelioma is the most common type of mesothelioma. The overwhelming majority of veterans diagnosed with mesothelioma have pleural mesothelioma. It’s caused by inhaling asbestos fibers. Many veterans were exposed to asbestos in the military and in their occupations following their service.

When someone inhales asbestos dust, the tiny needle-like fibers get trapped in the lining of the lungs, known as the pleura. These fibers are difficult or impossible to cough up. Over time, the needles migrate farther into the pleura, remaining lodged up to 60 years in some cases.

The median survival for pleural mesothelioma patients is 12 to 21 months. Survival time depends on factors such as age and disease stage at the time of diagnosis. It’s important to remember that these statistics aren’t based on patients who are currently living with the disease.

Many people have survived long beyond the median survival times.

Facts about Pleural Mesothelioma

• It is caused by the inhalation of asbestos fibers
• It occurs commonly in veterans exposed to asbestos in military construction and naval shipyards
• It is the most common type of mesothelioma
• Family members of asbestos workers can get mesothelioma too
• Changes in the pleura of the lung don’t occur for at least ten years
• Calcium deposits are the first sign that asbestos has infiltrated the pleural membrane
• Pleural plaques (inflamed tissue) put you at a higher risk of having mesothelioma later in life
• Pleural mesothelioma is aggressive, often metastasizing within one year after diagnosis

Symptoms of Pleural Mesothelioma

Common symptoms of pleural mesothelioma include:

• Persistent cough
• Unexplained weight loss
• Chest pain
• Lumps noticed on the skin of the chest wall
• Chronic shortness of breath

Pleural mesothelioma symptoms are nonspecific. Several conditions have the same symptoms as this type of cancer. Patients with pleural mesothelioma may think they just have a chest infection, pleurisy or pneumonia. If your symptoms do not go away after several weeks of coughing and chest pain, or if you notice lumps beneath the skin of the chest area, you may need to get tested for mesothelioma.

Mesothelioma is very rare. So doctors will often ask about your asbestos exposure history before testing for mesothelioma.

Diagnosing Pleural Mesothelioma

An X-ray, CT scan or MRI scan of the chest can show thickening of the lining of the lungs. This can be an indication that you have asbestos plaques on your pleural tissue. Some of these plaques may be cancerous. To get a proper diagnosis, you need to get a biopsy from the affected area. A biopsy is a tissue sample used to test for cancer. It’s the only conclusive way to diagnose pleural mesothelioma.

If the Diagnosis of Mesothelioma is Positive

If you are diagnosed with pleural mesothelioma, you’ll want to see one of the top doctors who treat mesothelioma. Some of the best mesothelioma specialists in the country are at VA medical centers in:

• Los Angeles – The West Lost Angeles VA Medical Center
• Boston – The Boston VA Hospital

Some top pleural mesothelioma doctors to contact include:

• Dr. Avi Lebenthal (Boston VA)
• Dr. Robert Cameron (Los Angeles VA)
• Dr. David Sugarbaker (Baylor St. Luke’s Medical Center)

Stages of Pleural Mesothelioma

Pleural mesothelioma has four stages. These stages are either early or advanced. They help explain how far the mesothelioma has spread in the body. There are more treatments available for patients with early-stage disease. However, disease stage alone isn’t the only factor when doctors prescribe treatment. Late-stage patients often qualify for radical treatments that can prolong their lives.

Here is a simple description of each stage of pleural mesothelioma:

Stage 1 – Tumors are confined to the lining of one lung.

Stage 2 – Tumors have spread to other parts of the lung or diaphragm.

Stage 3 – Lymph nodes and other organs contain signs of cancer.

Stage 4 – Cancer has finally spread to the other side of the chest.

 

Treating Pleural Mesothelioma

Treating pleural mesothelioma requires more than one treatment method. The most successful patients receive a combination of surgery, chemotherapy, radiation and experimental therapy if possible. This kind of treatment requires not only a mesothelioma specialist but a team of specialists.

The authors of a report reviewing the treatment of mesothelioma stress the importance of picking the right cancer center:

“The growing complexity of treatment protocols mandates that [mesothelioma] patients be referred to specialized centers,” said the authors. They continue saying that “every component of the interdisciplinary team can provide the necessary expertise and quality of care.”

Surgery

Surgery is the best treatment to extend your life. Patients with early-stage mesothelioma are usually eligible for surgery. Late stage patients may also be eligible depending on the opinion of the surgeon. In some cases, the benefits of surgery may not apply to late-stage patients. This is because pleural mesothelioma often metastasizes (spreads) to other body areas in later stages. Common areas of metastasis are the lymph nodes, diaphragm and abdominal organs.

If your mesothelioma specialist thinks that surgery will work for you, there are two major surgeries they may consider.

Surgeries for pleural mesothelioma include:

• Extrapleural pneumonectomy (EPP). Patients with localized disease may be eligible for the extrapleural pneumonectomy (EPP). This a radical surgery that removes the entire affected lung. During an EPP, parts of the pericardium, the diaphragm and the pleural tissue are removed along with the cancerous lung.
• Pleurectomy with decortication (P/D). During this procedure, doctors carefully remove tumors along with any other areas of the affected lung. Some mesothelioma specialists prefer this surgery because it is less radical of a procedure than the EPP.

The type of surgery that is right for you depends on your unique situation. Many doctors will start with a P/D in mind. However, if the affected lung is overrun with pleural plaques, an EPP may provide a better chance at removing all of the tumor masses.

Chemotherapy

Chemotherapy is the most common treatment for mesothelioma. It’s used at all stages of pleural mesothelioma, often combined with surgery or radiation.

Chemotherapy is often the best option if the mesothelioma has already spread to other tissues at the time of diagnosis.

There have been many types of chemotherapy used in clinical studies. Currently, only a combination of Alimta (pemetrexed) and cisplatin are approved by the U.S. Food and Drug Administration. Going through chemotherapy can be difficult but the process has shown to shrink tumors caused by mesothelioma.

Radiation Therapy

Radiation therapy is used to treat some cases of pleural mesothelioma. It is often combined with other treatments, like chemotherapy or surgery. Radiation uses painless X-ray waves that destroy parts of the tumor. Radiation can shrink the tumors but is not considered a curative measure on its own. Oftentimes, doctors prescribe radiation before surgery. Shrinking the tumors first may make surgery more successful.

Alternative Therapy

Alternative therapies have become popular in the treatment of mesothelioma pain and symptoms. These therapies include reflexology, acupuncture, or massage. Most of these treatments help mesothelioma patients feel better and less anxious. Patients using alternative therapies may tolerate the stress of having chemotherapy and radiation better than patients who do not.

It’s important to speak with your doctor first before trying alternative therapy. According to the American Cancer Association, “Although some of these methods might be helpful in relieving symptoms or helping you feel better, many have not been proven to work. Some might even be dangerous.”

Prognosis

Your doctor has probably given you a mesothelioma prognosis based on the stage of your disease. A prognosis is the likely outcome of your disease, or how fast it will progress. It’s also discussed in terms of survival time.

According to the American Cancer Association, the median survival times for pleural mesothelioma are:

Stage 1 – 21 months

Stage 2 – 19 months

Stage 3 – 16 months

Stage 4 – 12 months

Remember that every patient is different. Survival times are more dependent on the treatments you receive. Furthermore, survival times vary drastically on an individual basis. Some pleural mesothelioma patients have lived years and years with the disease.

Taking Control of Your Prognosis

Research for pleural mesothelioma is advancing rapidly for such a rare disease. There are many experimental treatments currently showing promise. Some of these include gene therapy and immunotherapy, which alter a patient’s genetics or immune system to fight mesothelioma. These treatments are in clinical stages. It goes to show that no matter your diagnosis, there are options available for every patient.

Points to remember:

• Pleural mesothelioma patients are living longer than ever
• New treatments are worth discussing with your doctor
• You can outlive your prognosis

You can learn more about your treatment and support options in our free Mesothelioma Veterans Guide.