Pleural Mesothelioma

What Is Pleural Mesothelioma?

Pleural mesothelioma is a rare cancer that develops within the pleura, the protective lining encasing the lungs and chest walls. Asbestos exposure is the main cause of mesothelioma.

Pleural mesothelioma is the most common type of mesothelioma cancer, accounting for 70% to 79% of cases. Each year, doctors diagnose more than 3,000 new patients with mesothelioma in the United States.

Symptoms

The most common symptoms of pleural mesothelioma include difficulty breathing, swelling, back pain, and nerve pain. For many people, mesothelioma symptoms are not noticeable until the last stage.

Patients rarely mention weight loss and fatigue during their initial doctor visits. These symptoms may only appear in advanced disease.

Malignant pleural symptoms may reveal a person’s history of asbestos exposure. Research shows that early signs include pleural plaques, effusions and thickening.

Pleural Plaques

Pleural plaques are small areas of thickening on the pleura. These are the most common sign someone has a history of asbestos exposure. Pleural plaques are not cancerous. They usually do not cause symptoms but may exhibit an elevated cancer risk.

Pleural Effusion

Airway irritation can cause excess fluid in the chest. This is known as a pleural effusion. The fluid builds up between the two layers of the pleura. A little fluid between the pleural layers is healthy. Too much puts pressure on the lungs, causing chest pain that worsens when you cough or take deep breaths.

Pleural Thickening

Scarring causes large areas of the pleura to become thicker and stiff. Breathing may become difficult and painful. Pleural thickening around both lungs is often a sign of significant asbestos exposure. Repeated pleural effusions can worsen pleural thickening as scar tissue develops.

Asbestosis

Asbestosis is a progressive scarring of lung tissue caused by asbestos. Patients with asbestosis have a high risk of developing asbestos-related lung cancer. This condition does not affect the pleural lining.

Causes

The primary cause of pleural mesothelioma is asbestos exposure. When someone inhales asbestos, the microscopic fibers become lodged in the pleura and cause irritation.

The sharp and pointed asbestos fibers are like needles that become stuck in the lungs. Over time, asbestos fibers migrate to the pleural lining. The constant irritation causes scar tissue and DNA mutations which lead to cancer.

Who Is Most At Risk?

People at risk of pleural mesothelioma most often include blue-collar workers and veterans. Occupational asbestos exposure is the No. 1 cause of the disease, and several occupations pose a high risk factor.

This cancer usually takes 20 to 60 years to develop after a person’s first exposure to asbestos. Most people receive a diagnosis after age 70 because of the long latency period.

Workers in the past would carry asbestos fibers home on their clothing and tools after exposure to various types of asbestos products and building materials. This oversight led to secondary exposure among their loved ones.

Environmental exposure is a less common exposure pathway but can affect entire communities. The town of Libby, Montana, spent years removing asbestos contamination. The source was an asbestos-contaminated vermiculite mining operation.

Diagnosis

The diagnostic process for pleural mesothelioma begins with symptoms and testing. Doctors order a chest X-ray for chest pain and breathing difficulty. This test can reveal fluid buildup or tumors around a lung.

A primary care physician then refers a patient to a specialist for further testing. A biopsy is necessary to diagnose this disease because it is the only test that detects cancerous tissue in areas such as the lungs or chest wall.

Specialists must use advanced imaging scans and tissue biopsies to confirm a diagnosis. A biopsy reveals tumor cell type, cancer stage and any unique characteristics. Identifying the disease stage and cell type is vital for an effective treatment plan.

Cell Types in the Diagnosis Process

Cell type is vital in determining treatment plans. Doctors distinguish the three different types of tumor cells with a biopsy. Most cases have a high number of epithelial or epithelioid cells. This type responds best to treatment.

The least common mesothelioma cell type is sarcomatoid. It is aggressive and challenging to treat, and most of these cases occur in pleural patients. The biphasic cell type is a blend of these two types. How it responds to treatment depends on the ratio of cells.

Staging

Pleural mesothelioma staging determines disease progression. The stage influences what treatment options doctors prescribe.

The International Mesothelioma Interest Group created the TNM staging system. It is the most used staging system for pleural mesothelioma.

Stages 1 and 2 are early stages and involve localized tumors. Stages 3 and 4 denote the later stages and concern tumor spreading.

Survival Rates of Pleural Mesothelioma

Mesothelioma prognosis is generally poor. The disease has a median survival of eight to 14 months. The five-year survival rate is 20% for early-stage cases with localized tumors. Five-year survival is 12% for all stages combined. With treatment, some patients have lived longer than a decade.

The average pleural mesothelioma prognosis is poor. The disease progresses fast and is resistant to many existing therapies. The life expectancy for pleural mesothelioma is often less than 18 months. Each patient is different, and the prognosis depends on many factors.

Forecasting an individual’s prognosis is challenging because this disease is complex. Every person has a unique response to treatment.

Factors that Affect Your Prognosis for Pleural Cancer

Prognostic factors include personal and disease factors. The can include your age, activity level, cancer stage and cell type.

Certain biomarkers correlate with patient survival, including calcium and platelet count. Talk to your medical team about how these factors may impact your personal prognosis.

Improving Your Prognosis

Taking proactive steps can help patients live longer and better with this condition. Some patients have lived years with almost no symptoms after treatment.

Inspiring stories of mesothelioma survivors reveal ways to confront mesothelioma challenges. Following your physician’s advice is essential. Taking steps toward a healthy lifestyle also improves prognosis and can extend survival.

Treatment Options

Pleural mesothelioma is treated by surgery, radiation therapy or chemotherapy. Doctors often prescribe a combination of these treatments, known as multimodal therapy.

What treatments are available for pleural mesothelioma patients? Dr. Jeffrey Velotta | 0:47

Specialized treatments can improve symptoms and survival. These therapies are available at top cancer centers across the nation. The best treatment centers specialize in pleural mesothelioma.

You may be able to receive experimental therapy through a clinical trial. Some patients may be eligible for emerging treatments through compassionate use programs.

Palliative care controls symptoms to improve quality of life at all stages.

With this disease, finding a specialist is critical. You need someone who really understands it and knows how to treat it aggressively to get the best possible outcome.

Dr. Jacques Fontaine

Pleural mesothelioma surgeon

Top Pleural Mesothelioma Doctors and Specialists in the U.S.

Malignant pleural mesothelioma specialists include many disciplines. They are oncologists, surgeons and other experts with years of mesothelioma experience.

Many specialists offer unique services such as clinical research trials and support resources. Working with a top specialist improves mesothelioma prognosis.

Common Questions About Pleural Mesothelioma

How does asbestos affect the lungs?

Damage to asbestos-containing materials releases asbestos fibers as dust. When inhaled, these fibers become trapped in the pleural lining of the lungs. The asbestos fibers trigger the immune system to launch an inflammatory response. Over the course of decades, this process leads to tissue scarring and DNA damage that causes mesothelioma.

What are the symptoms of pleural mesothelioma?

The symptoms of pleural mesothelioma include shortness of breath, chest pain, dry cough, wheezing, respiratory complications, fever and night sweats. Other symptoms may develop as the disease progresses.

Is pleural mesothelioma curable?

This condition is incurable at all four stages. Clinical trials are providing hope for a cure as they test innovative treatments, including immunotherapy and gene therapy.

How long do pleural mesothelioma patients live?

Most patients have a life expectancy of one year. Patients who are diagnosed early and qualify for aggressive treatment live an average of 22.2 months, and some live for many years.