Written By: Karen Selby, RN, Last modified: March 18, 2021

What Is Pleural Mesothelioma?

Malignant pleural mesothelioma (MPM) is a cancer that develops in the lungs. Almost 75% of diagnosed mesothelioma cases form in the pleura, making it the most common of the four types.

The cause of pleural mesothelioma is exposure to asbestos fibers, which are inhaled into the lungs. It usually takes from 20 to 50 years for mesothelioma to develop after a person’s first exposure to asbestos. Because of this latency period, the disease usually affects people older than 75.

The average life expectancy for pleural mesothelioma is often less than 18 months, but it depends on many factors.

Although there is no cure for mesothelioma, some patients live much longer with treatments. Combining several treatments, such as surgery, chemotherapy and radiation therapy, has helped some people live for years. Clinical trials offer access to new treatments such as immunotherapy.

Pleural Mesothelioma Facts

  • Most common type of mesothelioma
  • Forms on soft tissue covering the lungs
  • Symptoms: Shortness of breath, chest pain, dry cough and fatigue
  • Diagnostic Tools: Imaging scans and tissue biopsies
  • Treatments: Chemotherapy, surgery, radiation therapy, immunotherapy and experimental therapies
  • Life Expectancy: About 40% live at least one year

What Causes Pleural Mesothelioma?

Asbestos causes pleural mesothelioma. After inhaling the mineral’s needle-like fibers, they tend to lodge in the lungs and gradually migrate into the pleural lining.

Over a long period of time, these fibers cause irritation, chronic inflammation and genetic changes that turn cells cancerous.

These cancerous cells grow fast and uncontrollably, threatening the organs around them.

Plaque forming on the pleura after decades of asbestos exposure

Two layers make up the pleural lining. The outer layer lines the entire inside of the chest cavity (inside the ribs), and the inner layer covers the lungs.

A malignant tumor can develop on either layer and quickly spread to the other layer. As tumors develop on the pleural surface, they grow to form a mass around the affected lung. They also cause pleural fluid to accumulate in the chest cavity.

The combination of tumor mass on the lung and collection of pleural fluid prevents the lung from expanding, which causes breathing difficulties.

Symptoms of Pleural Mesothelioma

For many people, mesothelioma symptoms are not noticeable until the cancer is in a later stage.

  • Shortness of breath
  • Chest pain or painful breathing
  • Persistent dry or raspy cough
  • Coughing up blood
  • Difficulty swallowing
  • Pain in the lower back or rib area
  • Unexplained weight loss and fatigue
  • Swelling of the face or arms
  • Night sweats or fever
  • Lumps under the skin on the chest

Patients rarely mention weight loss and fatigue during their initial doctor visit. These symptoms may show if the cancer is advanced. Some patients develop swelling of the face or arms, back pain or nerve pain.

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Pleural Mesothelioma Treatment Options

Standard pleural mesothelioma treatment options can include surgery, radiation therapy and chemotherapy.

Chemotherapy is the most common type of pleural treatment. A combination of treatments can be used, which is known as multimodal therapy, if a patient is diagnosed early. These treatments can improve symptoms, such as chest pain and breathing difficulties, and improve survival.

Patients can access these therapies at top cancer centers across the nation that specialize in pleural mesothelioma treatment.

Dr. David Sugarbaker video on pleural mesothelioma treatment options.

Watch: Pleural Mesothelioma Expert Dr. David Sugarbaker explains the best treatment options available for mesothelioma.

Chemotherapy

The most common pleural mesothelioma treatment is chemotherapy. It uses one or more drugs, usually a combination of cisplatin or carboplatin and pemetrexed (Alimta), to kill cancer cells or prevent them from reproducing. Recent advances have improved how well patients respond to chemotherapy, but success rates remain low overall.

Surgery

Pleural mesothelioma patients diagnosed in the early stages benefit the most from surgery. The goal of surgery is to remove the cancer and prevent it from recurring as long as possible.

The two most common surgeries for pleural mesothelioma are the extrapleural pneumonectomy and pleurectomy and decortication. A pleural mesothelioma specialist can determine if you are eligible for surgery and advise you on which procedure may be the best option for your diagnosis.

Extrapleural Pneumonectomy

A more aggressive surgical option, the extrapleural pneumonectomy removes the pleura, the entire cancerous lung, the diaphragm and the heart sac (pericardium).

Pleurectomy and Decortication

A pleurectomy and decortication, or radical pleurectomy, involves removing the tumors and affected pleura (lining of the lung).

Radiation Therapy

Targeted radiation can destroy cancer cells and decrease tumor size. Radiation therapy cannot cure pleural mesothelioma, but it is an effective way to manage chest pain. Radiation can also help prevent cancer recurrence after surgery.

External beam radiation therapy is the most common form of radiation therapy for pleural mesothelioma. Sessions are fast, painless and only take a few minutes.

Emerging Treatments

Emerging treatments include the use of immunotherapy, gene therapy and photodynamic therapy to treat pleural mesothelioma. These treatments are designed to fight cancer more effectively, while causing fewer side effects for the patient.

You may be able to receive an experimental therapy through a pleural mesothelioma clinical trial. Some patients may be eligible for immunotherapy drugs and other emerging treatments through compassionate use programs.

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    Complementary and Alternative Medicine

    Some patients may benefit from combining complementary therapies, such as medical marijuana, dietary supplements or acupuncture, with conventional cancer treatment to ease symptoms and treatment side effects.

    To avoid harmful drug interactions, always consult your medical team before starting any complementary medicine or therapy.

    5 Tips When Considering Treatment

    1. Set clear treatment goals. What’s most important to you, longevity or quality of life?
    2. Research each treatment option and ask your doctor as many questions as you can think of.
    3. Determine where you will receive recurring treatments such as immunotherapy infusions. Will you have to travel far and how often?
    4. Consider the side effects of suggested chemotherapy drugs and how it may impact your quality of life.
    5. Seek a second opinion. Surgery may still be an option, or you may be eligible for a clinical trial.
    Emily Ward, pleural mesothelioma survivor
    Emily Ward
    Pleural Mesothelioma Survivor

    Top Pleural Mesothelioma Doctors in the US

    Dr. Jacques Fontaine, pleural mesothelioma doctor and expert contributor for Asbestos.com
    Jacques Fontaine
    Thoracic Surgeon

    Dr. Jacques Fontaine is the Director of the Mesothelioma Research and Treatment Center at Moffitt Cancer Center in Tampa, Florida. He specializes in minimally invasive thoracic surgery including robotic surgery. Fontaine became a pleural mesothelioma specialist while studying under Dr. Sugarbaker at the International Mesothelioma Program at Brigham & Women’s Hospital.

    Dr. Robert B. Cameron, pleural mesothelioma doctor
    Robert B. Cameron
    Thoracic Surgeon

    Dr. Robert B. Cameron developed a lung-sparing surgery for pleural mesothelioma that not only extends survival but offers greater quality of life by preserving the lung. Cameron’s surgery has a lower risk of complications and studies report longer survival times.

    Dr. Abraham Lebenthal, pleural mesothelioma doctor
    Abraham Lebenthal
    Thoracic Surgeon

    Dr. Abraham Lebenthal is a respected thoracic surgeon who treats pleural mesothelioma patients at Brigham and Women’s Hospital and Boston VA Hospital. Lebenthal worked alongside Dr. David Sugarbaker at Brigham and teaches at Harvard Medical School.

    Did You Know?
    The average cost of mesothelioma treatment is $11,000 to $12,000 a month.
    An experienced mesothelioma lawyer can help you and your family get money to cover treatment costs, travel expenses and more.
    Learn how to choose a mesothelioma lawyer

    Diagnosing Pleural Mesothelioma

    The diagnostic process for pleural mesothelioma begins when a doctor evaluates the initial symptoms for the disease. Chest pain and breathing difficulty warrant a chest X-ray, which reveals fluid buildup or tumors around a lung. The patient must be referred to a specialist for further testing.

    Specialists must use advanced imaging scans and tissue biopsies to confirm a pleural mesothelioma diagnosis. In addition to identifying the cancer, determining the cancer stage and cell type is vital to creating an effective treatment plan.

    Most cases of malignant mesothelioma are diagnosed with the epithelial cell type, which is also called epithelioid. The least common cell type is sarcomatoid mesothelioma. It is aggressive and difficult to treat, and most of these cases occur in pleural patients. The biphasic cell type is a blend of these two cells types.

    Pleural Mesothelioma CT Scan
    Pleural Mesothelioma with Effusion and Thickening in the Right Lung.

    There are a number of conditions that may indicate a person’s history of asbestos exposure and the potential of a mesothelioma diagnosis, including pleural plaques, pleural effusions and pleural thickening.

    In a 2020 study published in Case Reports, a case of pleural mesothelioma was discovered through testing of metastatic gastric and colonic polyps identified in imaging scans. These polyps were the only sign that the patient had pleural mesothelioma.

    Pleural Plaques

    Small areas of thickening on the pleura are the most common sign someone has been exposed to asbestos in the past. Pleural plaques are not cancerous and usually do not cause symptoms, but they may indicate an elevated risk for cancer.

    Pleural Effusion

    Irritation from asbestos fibers can cause excess fluid to build up between the two layers of the pleura. This condition, called pleural effusion, is present in many pleural mesothelioma cases. 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

    When large areas of the pleura stiffen because of scarring, it may become difficult and painful to breathe. Pleural thickening around both lungs is often a sign of significant asbestos exposure. Repeated episodes of pleural effusion can cause pleural thickening to worsen as scar tissue collects.

    Pleural Mesothelioma Stages

    Pleural mesothelioma staging

    Pleural mesothelioma staging is how doctors determine the progression of cancer in a patient’s body. The stage influences what treatment options can be used.

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

    Stages 1 and 2, which are considered the early stages, indicate localized tumors. Stages 3 and 4, which denote the later stages, classify spreading tumors.

    Mesothelioma Life Expectancy by Stage for Patients Eligible for Surgery
    Stage Time Progression
    Stage 1 22.2 months Tumors remain localized in and around the tissue lining of one lung
    Stage 2 20.0 months Cancer cells are entering nearby lymph nodes
    Stage 3 17.9 months Cancer has spread to nearby tissues and distant lymph nodes
    Stage 4 14.9 months Cancer has spread to distant organs

    Prognosis for Pleural Mesothelioma

    The average pleural mesothelioma prognosis, or the expected course and outcome for the disease, is poor for most patients because this cancer progresses quickly and is resistant to many existing therapies.

    Accurately forecasting an individual’s prognosis is challenging because this disease is complex. Each person responds differently to treatment.

    Pleural Mesothelioma Survival Rate by Year
    Year(s) After Diagnosis Survival Rate
    1 year 73%
    3 years 23%
    5 years 12%
    10 years 4.7%

    Factors That Affect Your Prognosis

    • Stage: The most important factor in a mesothelioma prognosis is the stage of the disease at diagnosis. An early-stage cancer offers a better chance of long-term survival than a late-stage cancer.
    • Cell type: The cell type of mesothelioma tumors also greatly influences prognosis.
    • Age: Younger patients tend to live longer.
    • Gender: Women tend to live longer with the disease than men.
    • Pleural Fluid: Higher amounts of pleural fluid in the chest are associated with a poorer prognosis.
    • Patient Activity Level: More active patients have a better prognosis.
    • Cancer Recurrence: A recurrence of mesothelioma is associated with a poorer prognosis.

    Improving Your Prognosis

    By taking proactive steps, it is possible to live longer and better with malignant pleural mesothelioma. Some patients even achieve remission after treatment and live for years with almost no cancer symptoms.

    The inspiring stories of mesothelioma survivors reveal many different ways to confront the challenge of cancer. However, many survivors make the same basic choices to promote their well-being.

    How Can People Live Longer with Pleural Mesothelioma?

    • Seek treatment from an experienced mesothelioma specialist
    • Improve your lifestyle to boost your overall health
    • Access the latest therapies through a clinical trial
    • Use palliative and complementary medicine to improve your quality of life

    Hope for a Mesothelioma Cure

    There is no definitive cure for pleural mesothelioma. However, a combination of surgery, chemotherapy and radiation therapy have allowed patients to improve their prognosis. Even patients who are not eligible for surgery have survived for years after their diagnosis thanks to experimental clinical trials and emerging treatments such as immunotherapy.

    Researchers around the world have dedicated their careers to finding more effective treatments with the goal of curing pleural mesothelioma and diagnosing the malignancy at an earlier stage.

    Examples of pleural mesothelioma survivors who have beaten their prognosis:
    • Emily Ward was diagnosed in 2012 after working for 43 years as a registered nurse. She put her medical background to work as she found the top mesothelioma specialists available to treat her cancer, including the late Dr. David Sugarbaker. After a pleurectomy and decortication, three rounds of chemotherapy and now monthly Keytruda treatments, Ward is enjoying a good quality of life doing many of the things she did before her diagnosis.
    • Tim Crisler passed the 17-year mark as a pleural mesothelioma survivor in 2019. He credits his lung-removing extrapleural pneumonectomy surgery for his long-term survival. He still deals with residual pain, but he has been able to travel the country on his beloved Harley Davidson since his diagnosis in 2002. “I have absolutely no issues with mesothelioma cancer today,” he said. “That hasn’t touched me in a long time.”
    • Sallie Morton survived pleural mesothelioma for four years while foregoing conventional treatment. She wasn’t eligible for surgery when she was diagnosed in 2013 at the age of 87, and she declined chemotherapy after seeing too many friends deal with the harsh side effects of the drugs. She did it her way, surprising doubters and hosting events and parties to the end. “She’s one gutsy broad,” is how she often described herself.

    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 an inflammatory response by the immune system. 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?

    Pleural mesothelioma 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 pleural mesothelioma 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.


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