Exclusive Content
Dr. Jacques Fontaine: Dr. Jacques Fontaine - What are the differences between mesothelioma and lung cancer?
Differences Between Mesothelioma & Lung Cancer Development
Mesothelioma and lung cancer develop in very different ways. Pleural mesothelioma starts as nodules, merges and grows as a sheet over time that coats the lining around the lung. Lung cancer grows as discrete tumor masses, individual lumps like marbles, that grow outward.
Because the most common type of mesothelioma develops in the lining of the lung, it’s sometimes mistakenly referred to as “mesothelioma lung cancer.” But mesothelioma isn’t a type of lung cancer.
Doctors diagnose about 226,650 Americans with lung cancer each year, compared with roughly 3,000 mesothelioma cases. As thoracic surgeon Dr. Jacques Fontaine of Moffitt Cancer Center tells us, “For every mesothelioma case we diagnose, we diagnose 95 lung cancers.”
| Mesothelioma | Lung Cancer | |
|---|---|---|
| Where it forms | Lining around the lungs, abdomen, heart and testes | Inside lung tissue |
| U.S. cases per year | About 3,000 | About 226,650 (ACS, 2025) |
| Primary cause | Asbestos exposure | Smoking causes about 80% of cases; asbestos causes about 4% |
| Latency period | 20 to 60 years after asbestos exposure | 15 or more years after asbestos exposure |
| 5-year survival rate | 12% | 28% |
| Cell types | Epithelioid, sarcomatoid and biphasic | Non-small cell and small cell |
| Common symptoms | Chest pain, shortness of breath and pleural effusion | Persistent cough, chest pain and blood in sputum |
How Smoking and Asbestos Together Raise Lung Cancer Risk
Asbestos exposure causes nearly all mesothelioma cases and 4% of lung cancer cases, whereas smoking only causes lung cancer. It doesn’t cause mesothelioma. When smoking is combined with asbestos exposure, the risk increases dramatically. A person who smokes and has worked with asbestos is roughly 50 to 90 times more likely to develop lung cancer than someone with neither exposure.
Asbestos fibers get stuck in tissues in the body, causing chronic inflammation and scarring. Smoking introduces dozens of cancer-causing chemicals. Quitting smoking after asbestos exposure substantially lowers the risk of lung cancer, but it doesn’t eliminate it entirely.
Similarities Between Mesothelioma and Lung Cancer
Mesothelioma and lung cancer are different cancers, but they share some features that can make them seem similar at first. Both are asbestos-related cancers that can develop after many years and may cause the same kinds of symptoms. Looking at how they overlap can help people better understand what makes each unique.
How Lung Cancer and Mesothelioma Are Similar
- Diagnosis and treatment: Imaging scans and biopsies help diagnose both mesothelioma and lung cancer. Treatments for both may include surgery, chemo, radiation and immunotherapy.
- Incidence and mortality: Incidence for lung cancer is mostly tied to smoking rates. But like mesothelioma, areas with histories of heavy asbestos use also have higher lung cancer incidence. Death rates are similar between the two cancers as well.
- Similar symptoms: Mesothelioma and lung cancer share symptoms like chest pain, coughing, trouble breathing, fatigue and weight loss.
- Time to develop: Both cancers often have long latency periods. Lung cancer can take 15 to 30 years, and mesothelioma can take 20 to 60 years to develop after asbestos exposure.
In the U.S., lung cancer caused about 124,730 deaths in 2025. Mesothelioma causes roughly 2,500 to 3,000 deaths each year, according to the CDC.
Mesothelioma and lung cancer’s shared features help explain why they’re sometimes discussed together. While these two cancers share some similarities, each has its own behavior.
Get answers about treatment, top doctors, and financial support from the nation’s most trusted mesothelioma resource.
Get Your Free GuideDiagnosing Mesothelioma and Lung Cancer
Diagnosing mesothelioma and lung cancer involves similar steps: a physical exam is done, then imaging tests such as X-rays, CT or PET scans and then a biopsy to confirm the diagnosis. Your doctor may perform a biopsy via a bronchoscopy, needle aspiration or thoracoscopic surgery.
Biopsies to Diagnose Lung Cancer or Mesothelioma
- Antibody staining: Pathologists apply special stains to biopsy tissue to identify mesothelioma cells. This process, called immunohistochemistry or IHC, is the standard test for confirming a mesothelioma diagnosis.
- Bronchoscopy: Your doctor inserts a tiny camera down your throat and airways to detect abnormalities like tumors. They may collect and test a cell sample for cancer.
- Needle biopsy: Done under local anesthesia, it involves placing a small needle into the tumor. An ultrasound machine or a CT scan can visualize it.
- Thoracoscopic surgery: A solid tissue sample is collected using a small camera inserted between your ribs. Fluid buildup is suctioned out for testing, but this isn’t a reliable way to confirm a diagnosis.
Doctors often misdiagnose mesothelioma as adenocarcinoma first, a type of lung cancer. These cancers can look similar on imaging and under a basic microscope. But pathologists use antibody stains to identify proteins specific to each disease.
Most people with pleural mesothelioma will either show pleural thickening or effusion. Pleural thickening is extensive scarring in the chest cavity lining. Pleural effusion is fluid buildup in the chest cavity. Pleural thickening may not appear in lung cancer, but both exhibit pleural effusion.
Why Mesothelioma Is Frequently Misdiagnosed
Early mesothelioma symptoms overlap with lung cancer, pneumonia and pleurisy, and its cells can look like adenocarcinoma under a microscope. Patients who suspect asbestos exposure should ask their doctor about a second review with a pathologist experienced with mesothelioma using IHC before starting treatment.
Treating Mesothelioma and Lung Cancer
Mesothelioma and lung cancer share 4 core treatment categories: surgery, chemotherapy, radiation and immunotherapy. However, the FDA has approved more than 10 times as many drug treatments for lung cancer than for mesothelioma. Clinical trials often test similar therapies for both cancers, like gene therapy, photodynamic therapy and cryotherapy.
The 2020 FDA approval of Opdivo (nivolumab) combined with Yervoy (ipilimumab) was the first immunotherapy approval for pleural mesothelioma in 16 years. The current first-line chemo for the disease is Alimta (pemetrexed) combined with cisplatin or carboplatin.
Lung cancer surgery may include a lobectomy that removes the cancerous lobe of the lung. Mesothelioma surgery often involves a pleurectomy and decortication that removes the pleural lining. Dr. Fontaine tells us, “The fundamental difference is the fact that mesothelioma starts in the lining around the lung. It’s more technically challenging and difficult for us to surgically remove the cancer in mesothelioma compared to lung cancer.”
Radiation may be slightly less effective for lung cancer treatment than for mesothelioma. A 2021 study found 76% of recurring mesothelioma tumors remained under control a year after radiation. But 74% of recurring lung cancer tumors remained under control a year after radiation.
Randy Boudreaux
Keytruda Helped Survivor of Mesothelioma and Lung Cancer
When Boudreaux was diagnosed with mesothelioma in 2014, he wasn’t a surgical candidate because of a previous surgery for non-small cell lung cancer. He had a piece of lung removed the year before on the opposite side of the chest from where the mesothelioma was found.
Randy Boudreaux
Prognosis for Mesothelioma vs. Lung Cancer
While mesothelioma and lung cancer are both serious cancers, mesothelioma tends to have a poorer outlook. However, an individual’s outlook depends on many factors, including age at diagnosis, responsiveness to treatment and overall health.
The 5-year relative survival rate is 28% for lung cancer and 12% for mesothelioma. About 53% of people diagnosed with mesothelioma and 55% of people diagnosed with lung cancer survive at least 1 year after diagnosis. Both prognoses improve substantially with early-stage diagnosis and treatment with a specialist.
The higher incidence of lung cancer cases means more widespread access to specialized treatment centers and doctors. Mesothelioma is much rarer, leaving people diagnosed with it fewer options to improve their prognosis. People diagnosed with mesothelioma who receive care at specialized mesothelioma treatment centers tend to live significantly longer than those who see general oncologists.
Discover financial assistance programs, insurance guidance, and veteran benefits to help cover your mesothelioma treatment expenses.
Get Financial HelpCommon Questions About Mesothelioma Vs. Lung Cancer
- Is mesothelioma a form of lung cancer or considered non-small cell lung cancer?
-
No. Mesothelioma isn’t non-small cell lung cancer or any other form of lung cancer. They share similarities, but are distinct cancers. A detailed pathology report will confirm the type of cancer someone has. Request a pathologist who has experience with mesothelioma if you are at risk for it.
As Anna Nowak, internationally renowned asbestos researcher and mesothelioma advocate, tells us, “No, mesothelioma is not the same as lung cancer. Mesothelioma is a cancer of the pleura, which is the lining around the lungs. However, because both lung cancer and mesothelioma arise within the chest cavity (thorax), mesothelioma is sometimes incorrectly called a ‘lung cancer.’ Adding to the confusion, many lung cancer specialists also treat mesothelioma and vice versa.”
- Can mesothelioma be misdiagnosed as lung cancer?
-
Yes. Doctors often misdiagnose mesothelioma as adenocarcinoma first, a type of non-small cell lung cancer, because they can look identical on chest imaging and similar under a basic microscope. Pathologists confirm a mesothelioma diagnosis with antibody staining to detect specific proteins. People with known or suspected asbestos exposure should request a second pathology review at a specialty mesothelioma center before starting treatment.
- Can you have both mesothelioma and lung cancer at the same time?
-
Yes. People with heavy asbestos exposure can develop both cancers at the same time or one after the other. Doctors may diagnose them simultaneously during imaging or biopsy. A thoracic oncologist typically coordinates treatment for both cancers and addresses the more aggressive cancer first.
- Should you see a mesothelioma specialist if you have asbestos-related lung cancer?
-
Yes. A thoracic specialist who regularly treats asbestos-related cancers can confirm whether a tumor is lung cancer or mesothelioma, since the 2 are easy to confuse. Specialty centers also offer access to clinical trials and treatment plans that community hospitals often don’t. A second pathology review at a specialty center is recommended before any patient with known asbestos exposure starts treatment.
