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Pleural Mesothelioma

Quick Summary

Pleural mesothelioma is a dangerous cancer that affects the lining of the lungs (the pleura). Its symptoms include chest pain, coughing, and shortness of breath. Patients with malignant pleural mesothelioma have an average life expectancy of 1-2 years.

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What Is Pleural Mesothelioma?

Pleural mesothelioma is a rare type of cancer caused by asbestos exposure. Mesothelioma tumors develop in the pleura, the thin membrane that lines the chest cavity and lungs.

Malignant pleural mesothelioma is the most common type of mesothelioma, making up roughly 80% of all diagnosed cases.

Pleural Mesothelioma Symptoms

Mesothelioma has a latency period of 20-50 years, meaning its development takes a long time. Its symptoms may not appear until decades after a patient is first exposed to asbestos.

Despite the long latency period, the average time from when symptoms appear to diagnosis is 2-3 months.

Common symptoms of pleural mesothelioma include: 

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

Since mesothelioma is not a common form of cancer, many doctors have limited experience with it. Doctors may mistake pleural mesothelioma for more common conditions like lung cancer, pneumonia, bronchitis, or chronic obstructive pulmonary disorder (COPD).

If you have been exposed to asbestos — especially if you are displaying any of the above symptoms of mesothelioma — contact your doctor as soon as possible.

Diagnosing Pleural Mesothelioma

If your doctor suspects mesothelioma after a physical examination, they will often prescribe a series of imaging tests to look for any visual indications of this cancer.

Imaging tests for pleural mesothelioma include:

  • Chest X-ray
  • CT scan
  • PET scan
  • Ultrasound
  • MRI scan
  • PET-CT scan

During these scans, doctors will look for specific signs that may represent potential mesothelioma.

Signs that may indicate malignant pleural mesothelioma include:

  • Calcium Deposits: Calcium deposits on the pleura are the first sign that asbestos has entered the pleural membrane.
  • Pleural Plaques: Asbestos causes noncancerous buildups of collagen (called pleural plaques) on the pleural membrane.
  • Pleural Effusions: Inflammation of the pleural membrane can result in fluid build-up (pleural effusions) in the chest cavity. Pleural effusions occur in over 90% of patients with this form of mesothelioma.

If your doctor detects any abnormalities during imaging tests or other biomarker blood work, they may conduct a biopsy.

Pleural Mesothelioma Biopsy

A biopsy is the collection and examination of tissue (surgical biopsy) or fluid (liquid biopsy) used to test for cancer. Doctors inspect the biopsied sample under a microscope to see if any cancer cells are present.

A biopsy is the only way to confirm a pleural mesothelioma diagnosis.

Pleural Mesothelioma Surgical Biopsy vs Liquid

Many mesothelioma specialists prefer surgical biopsies (collection of tissue) over liquid biopsies (collection of fluid). In most cases, diagnosing pleural mesothelioma using a tissue sample provides less potential for misdiagnosis.

That is not to say that pleural mesothelioma cannot be diagnosed using a liquid biopsy, however.

“Guidelines from several international cytologist bodies have all confirmed that pleural fluid cytology is adequate in diagnosing the majority of cases with epithelioid mesothelioma cells.”

– Y C Gary Lee, Professor of Respiratory Medicine

Many clinicians are inexperienced with mesothelioma cytology (the study of human cells). For this reason, an accurate diagnosis using fluid cells requires the expertise of a pathologist.

Stages of Pleural Mesothelioma

Pleural mesothelioma is the only type of mesothelioma that has an official staging system, called the Tumor Node Metastasis (TNM) system.

There are 4 stages of pleural mesothelioma.

Stage of Pleural Mesothelioma

Description

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 spread to the other side of the chest and body.

 

Pleural mesothelioma typically develops on the lining of only one lung to start with. Over time, tumors can grow and spread to the other lung or other areas in the chest and beyond.

According to Professor of Respiratory Medicine Y C Gary Lee, 60% of pleural mesothelioma cases begin on the right side of the pleural cavity, while 40% begin on the left side.

Early Stage vs Late Stage Pleural Mesothelioma

Early-stage pleural mesothelioma (stages 1 and 2) typically has more treatment options.

Patients with later-stage pleural mesothelioma (stages 3 and 4) may not be capable of undergoing curative surgery.

Pleural Mesothelioma Cell Types

When a patient is given a pleural mesothelioma diagnosis, they will also receive information about the histological classification (cell type) of their tumor.

The 3 major cell types of pleural mesothelioma are outlined in the table below.

Cell TypePrevalencePrognosis
Epithelioid60%Best prognosis
Sarcomatoid10%Poor prognosis
Biphasic (mixed)30%Intermediate prognosis

Pleural Mesothelioma Treatment

The standard treatments for pleural mesothelioma are surgery, chemotherapy, and radiation.

The most successful mesothelioma treatment plans combine more than one treatment method in an approach called multimodal therapy.

Pleural Mesothelioma Surgery

Curative pleural mesothelioma surgery is considered the most effective treatment method for eligible pleural mesothelioma patients. During curative procedures, surgeons remove visible tumors from the lungs and surrounding tissue, disabling and delaying the cancer’s spread.

Extrapleural Pneumonectomy

Extrapleural pneumonectomy (EPP) involves the removal of the entire affected lung and other diseased tissue in the chest cavity.

Pleurectomy With Decortication

Pleurectomy with decortication (P/D) is a surgery that involves the removal of the pleural lining and affected tissue in the lung and chest cavity. It does not include the removal of a patient’s lung.

Top Pleural Mesothelioma Doctors for Veterans

Visit the UCLA Health website to learn more about Dr. Robert Cameron.

Disclaimer

The Mesothelioma Veterans Center has no affiliation with and is not endorsed or sponsored by Dr. Robert B. Cameron. The contact information above is listed for informational purposes only. You have the right to contact Dr. Cameron directly.

Pleural Mesothelioma Chemotherapy

Chemotherapy for pleural mesothelioma involves the use of cancer-killing drugs that circulate through the body. When surgery is no longer possible, chemotherapy is typically the most effective life-extending treatment option.

Mesothelioma specialists may use chemotherapy before, during, or after surgery to prevent cancer cells from spreading and/or reduce the risk that tumors will return.

The most common chemotherapy drugs for treating pleural mesothelioma are pemetrexed (Alimta) plus cisplatin. This drug combination has shown to increase survival time by an average of 3 months longer than cisplatin alone.

New drug combinations and other new treatment methods are currently being tested in clinical trials.

Radiation Therapy

Radiation therapy uses painless, high-energy X-rays to destroy cancer cells.

Historically, radiation was not considered a primary form of pleural mesothelioma treatment because it increased the likelihood of harming nearby healthy tissue.

A 2019 study, however, found that pleural mesothelioma patients who received aggressive radiotherapy were twice as likely to live for at least 2 years.

“Of the patients who received the aggressive radiotherapy treatment, 58% were still alive two years later. In the patients who received the palliative radiotherapy, 28% were still alive two years later.”

– European Society for Radiotherapy and Oncology (ESTRO)

Pleural Mesothelioma Prognosis

A mesothelioma prognosis describes how a patient’s cancer will likely progress and how long they can expect to live.

Median Survival Times for Pleural Mesothelioma
Stage 121 months
Stage 219 months
Stage 316 months
Stage 412 months

Pleural mesothelioma patients survive an average of 12 months after diagnosis, giving them a worse prognosis than those with peritoneal mesothelioma.

Doctors determine a mesothelioma prognosis based on:

  • Cancer stage at diagnosis
  • Mesothelioma cell type
  • Eligibility for life-extending treatments
  • Other factors like age and overall health

Survival rates vary on an individual basis, and some pleural mesothelioma survivors have lived for years past their prognosis.

Cause of Pleural Mesothelioma in Veterans

Asbestos was used heavily in the U.S. military from the 1930s to the early 1980s. In turn, thousands of veterans were exposed to cancer-causing asbestos during their military service.

Some veterans had a military occupational specialty (MOS) that required them to work with asbestos-containing products on a consistent basis. When these products were handled, they often released asbestos fiber into the air where they could be inhaled by those nearby.

Did you know

Military shipyard and construction workers had a severe risk of asbestos exposure because they used asbestos-containing products so often.

When asbestos fibers are inhaled, they can become trapped in the lung lining and cause prolonged irritation. This irritation can harm nearby cells and cause the rapid growth of cancerous tumors. As mesothelioma tumors spread to other areas in the body, they become increasingly more difficult to treat.

Veterans should report their asbestos exposure history and any symptoms of pleural mesothelioma to their doctors as early as possible to get the best treatment outcome.

Access Pleural Mesothelioma Resources for Veterans

Accessing treatment at a top mesothelioma cancer center may help extend your life by months. This treatment can cost hundreds of thousands of dollars, however, so patients and their families are encouraged to explore their compensation options.

The Mesothelioma Veterans Center has compiled information about accessing life-extending treatments, VA benefits, other forms of compensation, and more — all in one place.

Find these helpful resources in our Free Mesothelioma Veterans Packet, or call (877) 450-8973 to speak to a member of our team immediately.

Veterans Support Team
Todd Gersten, MD PhotoReviewed by:Todd Gersten, MD

Double Board-Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Todd Gersten, MD is a double board-certified medical oncologist and hematologist specializing in general adult oncology and hematologic disease. He is a physician partner with the Florida Cancer Specialists and practices in Wellington, Florida.

Dr. Todd Gersten is an independently paid medical reviewer.

Christopher Dryfoos PhotoWritten by:

Contributing Author

Christopher Dryfoos is a journalist and member of the American Medical Writers Association (AMWA). As the grandson of the U.S. Navy’s first forensic pathologist, he aims to help veterans with mesothelioma access needed care.

View 10 Sources
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  8. Marulli, Giuseppe. “Induction chemotherapy vs post-operative adjuvant therapy for malignant Pleural Mesothelioma.” Retrieved from: http://www.tandfonline.com/doi/abs/10.1080/17476348.2017.1338951. Accessed September 8th, 2017.
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