Written By: Devin Golden
Pleural mesothelioma is a type of cancer that forms in the lining of the lungs. It is the most common type of mesothelioma, and patients have an average prognosis of 1-2 years. Exposure to asbestos is the only cause of pleural mesothelioma.
Medically reviewed for accuracy by
Dr. Abraham Lebenthal
Mesothelioma Thoracic Surgeon
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Everything You Need to Know About Pleural Mesothelioma
Pleural mesothelioma is a type of mesothelioma, which is a rare and aggressive cancer that forms in certain tissue linings in the body. Pleural mesothelioma forms in the lining of the lungs. This lining is called the pleura.
Approximately 75%–80% of mesothelioma cases are pleural mesothelioma. An estimated 2,000 people in the U.S. are diagnosed each year. The only cause of pleural mesothelioma is exposure to asbestos.
The pleura is the thin lining that surrounds the lungs. The pleura has two tissue linings with a fluid space between them. This space is called the pleural cavity.
The pleura is a buffer that allows the lungs to expand freely against the chest wall. The lungs need to expand to enable the proper exchange of oxygen and carbon dioxide in the blood.
Malignant pleural mesothelioma is a cancer that is actively spreading. The term malignant means the disease is aggressive, invasive and can spread to other parts of the body.
This is different from benign tumors, which are not actively spreading. Most diagnosed cases of pleural mesothelioma are malignant.
Symptoms of pleural mesothelioma include shortness of breath, chest pain and persistent coughing. These are the most noticeable early symptoms.
Pleural effusion is a common symptom of pleural mesothelioma. It is the buildup of fluid in the lining of the lungs (pleura). The fluid builds up in pockets within the pleural cavity as tumors form and take up the limited space. This excess fluid causes pressure against the lungs and chest wall, leading to discomfort and difficulty breathing.
A study published in ScienceDirect reports that 60% of people with pleural mesothelioma experience pleural effusions.
Pleural thickening is a common symptom of pleural mesothelioma. It is thickening of tissue of the lining surrounding the lungs (pleura). The thickening is the result of asbestos fibers getting stuck in tissue linings, causing chronic inflammation and scarring.
A study published in ScienceDirect reports that 88% of people with pleural mesothelioma experience pleural thickening.
Asbestos exposure is the only known cause of pleural mesothelioma. People are exposed to asbestos through work, from a loved one carrying asbestos on their clothes, or from using a product containing asbestos.
Products with asbestos include industrial, household or cosmetic products. They can be made with asbestos for insulation or contaminated from mining for talc.
Asbestos causes pleural mesothelioma when microscopic asbestos fibers are inhaled and get stuck in body tissues containing mesothelial cells.
Embedded asbestos fibers create chronic inflammation of mesothelial cells in the lining of the lungs (pleura). These cells mutate as the asbestos fibers remain stuck. The altered cells multiply quickly and become a growing cluster of cells, which is called a tumor.
Asbestos fibers are inhaled through the nose or ingested through the mouth.
The fibers get stuck in the lining of the lungs (pleura).
Fibers cause chronic inflammation and genetic damage to tissue cells, which multiply uncontrollably and form a tumor.
Asbestos fibers are sharp, which causes them to get lodged in the tissue lining of the lungs. They are also difficult for the body to expel.
The people most at risk of developing pleural mesothelioma are older men. The average age for diagnosed pleural mesothelioma patients is 72, and 80% are men.
Asbestos is a fire-resistant mineral that corporations used during the 20th century to prevent overheating and fires in factories, homes and other buildings. Men are most likely to have worked jobs involving asbestos exposure. Construction workers, electrical workers, roofers, boiler technicians, carpenters and firefighters would work with and near asbestos products and materials.
Treatment of pleural mesothelioma includes surgery, immunotherapy, chemotherapy, radiation and emerging options such as gene therapy and oncolytic viruses. Treatment is the best way to fight this cancer and extend survival. Doctors at cancer centers believe combining therapies is the best approach against pleural mesothelioma.
Surgery for pleural mesothelioma can remove most or all visible tumors from the body. Since the tumors first appear in the lining of the lungs (in the thoracic region of the body), the surgeries for pleural mesothelioma are called thoracic procedures.
The two main surgeries for pleural mesothelioma are extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D).
Extrapleural pneumonectomy surgery is an operation to remove pleural mesothelioma tumors. Doctors remove the entire affected lung, the lining of the lungs (pleura) and any other diseased tissue in the chest cavity.
Extrapleural pneumonectomy is often shortened to “EPP” surgery. Since EPP involves removing one of the patient’s lungs, the operation can affect breathing and quality of life.
Pleurectomy/decortication surgery is an operation used to remove pleural mesothelioma tumors. The surgery is often called “P/D” surgery.
P/D surgery is a “lung-sparing surgery” since neither lung is removed. Doctors take out the pleura by stripping the lining off of the lung and chest wall, which removes tumors in the lining and on the surface of the lung.
In addition to removing the pleura, mesothelioma doctors often remove part or all of the diaphragm and the sac around the heart (pericardium). This version is called “extended P/D surgery” or “radical P/D surgery.”
Immunotherapy for mesothelioma helps the immune system fight cancer and stop the growth of tumors. Immunotherapy drugs activate the immune system to fight mesothelioma or teach the immune system how to look for and destroy cancer cells.
Chemotherapy for mesothelioma uses cancer-killing medication to stop tumors from growing and spreading. The FDA approved the chemotherapy drugs pemetrexed and cisplatin for pleural mesothelioma. The two are best used together as a chemotherapy combination.
Chemotherapy drugs are usually delivered into the bloodstream, where they travel through the body searching for cancer cells. Chemotherapy interferes with the cell cycle – which is how cells grow and multiply – and prevents cancer cells from reproducing and spreading.
An alternative type of chemotherapy for pleural mesothelioma is heated intrathoracic chemotherapy (HITHOC). This type of chemotherapy treatment delivers drugs directly into the chest cavity during pleural mesothelioma surgery.
Radiation therapy sends high doses of radiation through the body to kill cancer cells or slow their growth. A machine sends the concentrated radiation beams to the site of the disease. For pleural mesothelioma, the target of radiation is the chest cavity.
Tumor treating fields send electromagnetic waves through the body to fight cancer. The waves disrupt the cancer cells’ ability to divide and grow.
The FDA approved a tumor treating fields device called Optune Lua for unresectable pleural mesothelioma. Patients wear the Optune Lua device all day, sending continuous magnetic waves through their body.
This treatment is non-invasive. Patients can go about their normal activities while wearing the device and receiving treatment.
Palliative therapy for pleural mesothelioma focuses on quality of life. Palliative care for mesothelioma manages symptoms and side effects to increase patient comfort. This should be a priority during all stages of cancer and throughout the pleural mesothelioma treatment process.
Palliative care for pleural mesothelioma may include a procedure called a thoracentesis to drain fluid from around the lungs. When fluid builds up around the lungs, it can cause pain and difficult breathing. A thoracentesis can minimize these symptoms.
Other examples of palliative care for pleural mesothelioma are:
Clinical trials are an important first step in the development of new therapies, diagnostic testing, and ways to prevent cancer altogether. For the rare cancer mesothelioma, clinical trials test new and emerging therapies and treatment options for safety and effectiveness.
Clinical trials for pleural mesothelioma test new drug combinations and emerging medical advancements that offer mesothelioma patients hope in their fight against this aggressive cancer.
Some of the emerging treatment options currently in clinical trials for pleural mesothelioma include:
Finding a mesothelioma specialist is a crucial step after receiving a diagnosis of mesothelioma. Look for a doctor for pleural mesothelioma with experience treating this cancer and compassion working with patients. Many cancer doctors do not have knowledge to effectively treat this rare disease.
Find a mesothelioma cancer center with a team of medical professionals equipped to treat pleural mesothelioma. The top pleural mesothelioma centers have a multidisciplinary team of oncologists, surgeons and other experts who have experience fighting this cancer.
Diagnosing pleural mesothelioma involves meetings with doctors, imaging tests, and a biopsy. The first step is identifying symptoms and reporting them to a doctor. The next step will likely involve an imaging test, such as a chest X-ray or CT scan, to look for and evaluate any abnormalities near the lungs.
If there are any abnormal findings in the imaging tests, your doctor may recommend a biopsy. They will likely refer you to a surgeon or pulmonologist to perform the biopsy if they are not skilled to do it themselves.
During a biopsy for pleural mesothelioma, the doctors usually take out small pieces of tissue. The tissue samples are sent to a lab where a pathologist examines them under a microscope and determines if cancer cells are present.
There are four stages of pleural mesothelioma. Stage 1 is the earliest stage, and stage 4 is the last and most advanced stage.
Tumors are contained to the pleura, where the cancer started. Detection at this stage is key for giving patients the most treatment options and best prognosis.
Tumors are contained mostly to the pleura, but some may have reached nearby lymph nodes or the surface of the lung. Most treatment options, including surgery, should be available.
This is a more advanced stage of mesothelioma. Tumors may have spread to the lungs, the diaphragm, lymph nodes, and possibly the space between the lungs. Surgery, chemotherapy or immunotherapy may all be considered as treatment options.
Tumors may have spread to the lungs, heart, major blood vessels, and possibly even the brain or spine. Treatment is more limited, and the prognosis is poor.
The prognosis of pleural mesothelioma is typically 1-2 years of survival. Life expectancy can be longer for select patients depending on several factors:
Pleural mesothelioma survival rates are the percentage of people who live for a set amount of time after being diagnosed. According to the Moffitt Cancer Center, the survival rates for pleural mesothelioma are:
The survival rates improve for people diagnosed with mesothelioma in early stages. According to the American Cancer Society, the 5-year survival rates for each stage are:
There are several survivors of pleural mesothelioma who have outlived their prognosis and are still enjoying life today. They are inspirations for people currently fighting this cancer and examples that the disease can be defeated.
Financial assistance is crucial for people affected by pleural mesothelioma. Financial resources help families cover medical bills, overcome lost wages due to an inability to work, pay for life-extending treatment, and provide peace of mind and future security.
Many people rely on financial help to fight this aggressive cancer and receive treatment. Financial compensation also protects the surviving loved ones if the patient passes away.
Pleural mesothelioma is aggressive and can severely hurt patients’ quality of life. The disease is also life-ending for most people, which takes away precious time to spend with friends and family.
People diagnosed with pleural mesothelioma do not need to face these challenges on their own. Speak with a Mesothelioma Guide patient advocate to learn more about the financial resources available. Email registered nurse and patient advocate Karen Ritter at karen@mesotheliomaguide.com or fill out an official contact form to get the information you need.
Each year, there are hundreds of veterans with mesothelioma in the United States. Approximately one-third of people with mesothelioma are military veterans and an estimated 75%-80% of them will have pleural mesothelioma.
The U.S. Department of Veterans Affairs (VA) provides free benefits and support services to veterans with pleural mesothelioma. VA benefits for mesothelioma include financial help to veterans and their families – such as VA Disability Compensation and VA Pension – plus free health care.
Treatment for veterans with pleural mesothelioma is available through the VA. Veterans with VA health care can receive this treatment for free from a VA medical center.
There are two VA medical centers with mesothelioma programs. Veterans with pleural mesothelioma can visit the Michael E. DeBakey VA Medical Center (Houston, Texas) or the West Los Angeles VA Medical Center.
Contact the Mesothelioma Guide veterans staff for help. Carl Jewett is a retired navy commander and has helped countless veterans apply for VA benefits, file VA claims, get VA healthcare and so much more. Email Carl at cjewett@mesotheliomaguide.com or request his assistance by filling out an official contact form.
The cause of pleural mesothelioma is exposure to asbestos. People who are exposed to asbestos can develop pleural mesothelioma from loose, sharp strands of asbestos getting stuck in the tissue lining covering their lungs. This lining is called the pleura. Asbestos fibers often cannot be expelled by the body, leading to cells mutating and turning into cancer.
Five of the most common signs and symptoms of pleural mesothelioma are shortness of breath, chest pain, coughing, loss of appetite, and nausea. Other symptoms are lower back pain, swelling of the face or arms, and night sweats.
Pleural mesothelioma is treated with surgery, immunotherapy, chemotherapy and radiation. There are two surgeries for pleural mesothelioma: extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D). Ask your doctor if you’re a candidate for surgery.
Immunotherapy and chemotherapy are approved for pleural mesothelioma. The FDA approved the immunotherapy drugs Keytruda, Opdivo and Yervoy. The agency also approved the chemotherapy combination pemetrexed and cisplatin (Alimta).
The survival rate of pleural mesothelioma is 73% for one year, 23% for three years, and 12% for five years. The survival rate for pleural mesothelioma improves when patients receive treatment such as surgery or immunotherapy.
Yes. Many people have survived pleural mesothelioma and remain alive today enjoying their lives. Gary Maxwell, for example, has survived for more than 10 years since his initial diagnosis in 2014. Marilyn Landin has survived for more than 20 years since her diagnosis in 2000. These survivors are inspirations and offer hope to people facing this rare cancer.
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