What Is Pleural Mesothelioma?

Pleural mesothelioma is a rare cancer that develops within the pleura, the tissue that lines the outside of your lungs and the inside of the chest wall. It makes up the majority of all mesothelioma cases.

Inhaled asbestos fibers can go to the periphery of the lung and start causing inflammation that over many years can turn into a cancer called mesothelioma. Mesothelioma occurs most often in the lining around the lung called the pleura. And that’s what pleural mesothelioma is.

As is the case with all types of mesothelioma, exposure to asbestos fibers are the primary cause of pleural mesothelioma. When inhaled, these fibers can get lodged in the pleura and cause inflammation and scarring over time.

The pleura is vital for your normal lung function. It protects the lungs and allows them to move as needed within the chest cavity. If air or excess fluid enters your pleural space, it can affect breathing and even prevent the lungs from inflating properly.

Key Facts About Pleural Mesothelioma
  • Pleural mesothelioma accounts for more than 80% of mesothelioma cases in the U.S.
  • There are more than 1,000 new cases of pleural mesothelioma diagnosed each year in the U.S.
  • Pleural mesothelioma is more common in men than women.

Symptoms of Pleural Mesothelioma

The most common symptoms of pleural mesothelioma include back and chest pain, difficulty breathing and swelling. In our 2023 survey, 74% of mesothelioma survivors reported experiencing shortness of breath. Many people don’t experience significant symptoms until their mesothelioma is in an advanced stage.

Common Pleural Mesothelioma Symptoms
  • Chest pain or painful breathing
  • Coughing up blood
  • Difficulty swallowing
  • Dry, persistent cough
  • Fatigue
  • Fever or night sweats
  • Hoarseness
  • Lumps under the skin on the chest
  • Muscle weakness
  • Pain in the lower back or ribs
  • Shortness of breath or difficulty breathing
  • Swelling of the face or arms (edema)
  • Unexplained weight loss

Mesothelioma usually develops several decades after asbestos exposure. If you have a history of asbestos exposure, it’s important to know the symptoms of mesothelioma. This can help you and your doctor recognize the disease and confirm a diagnosis as early as possible. Pleural effusions (fluid around your lungs), pleural thickening and pleural plaques (areas of thickened pleura) can be the first signs of mesothelioma.


The percentage of respondents who reported experiencing shortness of breath in The Mesothelioma Center’s patient survey.

Source: State of Mesothelioma: 2023

Complications Commonly Associated With Pleural Mesothelioma

Certain medical conditions commonly arise in people with mesothelioma. Pleural mesothelioma primarily affects the lungs, but it can cause problems throughout your body.

Complications of Pleural Mesothelioma
  • Blood clots: Mesothelioma and other cancers can cause dangerous blood clots. These clots can be deadly if they enter your lungs.
  • Hemothorax: Pleural mesothelioma can cause bleeding into the pleural space. This can cause difficulty breathing and shock if the bleeding is severe.
  • Infection: Mesothelioma and other cancers, as well as cancer treatments, can weaken your immune system, increasing the risk of many types of infection.
  • Malnutrition: The symptoms of and treatments for mesothelioma and other cancers can impair your ability to eat and decrease your appetite.
  • Metastasis: Advanced mesothelioma can spread to other parts of your body. Cancer cells can enter the bloodstream and lymphatic system, allowing them to travel to distant parts of your body.
  • Pleural effusions: Pleural mesothelioma often causes fluid to accumulate in the pleural space, making it difficult for your lungs to expand normally.
  • Pneumothorax: If air enters the pleural space, it can cause a collapsed lung. This is an uncommon complication of pleural mesothelioma.
  • Respiratory failure: This occurs when the lungs can no longer properly exchange oxygen and carbon dioxide. Various conditions, including other complications listed here, can lead to respiratory failure.
Dr. Jacques Fontaine and Dr. Andrea Wolf
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What Causes Pleural Mesothelioma?

Pleural mesothelioma is caused when someone inhales asbestos fibers that become lodged in the pleura, the protective lining of the lungs. The sharp and pointed asbestos fibers are like needles that can become stuck in tissues in the body. 

An illustration depicting how pleural mesothelioma develops in the lung linings. It highlights how plaque forms in pleura from asbestos fibers.
This graphic shows how pleural mesothelioma develops.

Over time, asbestos fibers can migrate to the pleural lining, causing severe and ongoing irritation. Resulting scar tissue along with DNA mutations within cells can lead to cancer.

Who Is Most at Risk for Pleural Mesothelioma?

Occupational asbestos exposure is the  No. 1 cause of the disease. Several occupations pose the highest risk, including blue-collar workers and military veterans. Because pleural mesothelioma cancer usually takes 20 to 60 years to develop after a person’s first exposure to asbestos, most patients are diagnosed after age 70.

High Asbestos Exposure Risk Occupations
  • Construction Workers: No industry used asbestos more than the construction industry. As a result, construction workers are among the occupations most at risk of pleural mesothelioma.
  • Firefighters: In addition to exposure to asbestos in burning buildings, firefighting equipment, including ventilators and masks, once used asbestos.
  • Industrial Workers: Industrial worksites and applied industrial insulation heavily exposed workers to asbestos.
  • Military Veterans: The U.S. military used asbestos widely in machinery and construction materials. Veterans in shipyards experienced some of the heaviest exposure.
  • Power Plant Workers: Asbestos in parts and equipment such as arch chutes, electrical insulation and electrical panels exposed many power plant workers throughout the U.S.

Workers would carry asbestos fibers home on their clothing and tools after exposure to various types of asbestos products and building materials. This led to secondary asbestos 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.

How Pleural Mesothelioma Is Diagnosed

Doctors use multiple tests to diagnose pleural mesothelioma, including imaging scans and a biopsy. If you’re experiencing chest pain and difficulty breathing, your doctor may order a chest X-ray or CT scan, which can show fluid buildup, pleural thickening or tumors. 

Your primary care physician will then order a biopsy for analysis. A biopsy, which can determine the type of cancer cells present, is necessary to confirm a mesothelioma diagnosis.

Diagnostic Tools
  • Biopsy: Biopsies are tissue samples that can confirm your pleural mesothelioma cancer diagnosis.
  • Blood Tests: Blood tests identify biomarkers of cancer but cannot diagnose the condition alone.
  • Imaging Scans: X-rays, MRIs, CT scans and PET scans help spot the location of tumors.
  • Physical Examination: During a physical examination, your doctor will look for abnormalities, such as a bump on the skin, and check parts of your body that feel tender or painful.

The specific cancer cells found in a biopsy during the diagnostic process help doctors determine your prognosis and best treatment options. Varying cell types and distinct mesothelioma locations respond differently to treatments and can have different outcomes. 

A diagnosis of pleural mesothelioma is a life-changing event. It’s the beginning of a long and stressful journey, but there are steps you can take to cope with the stress of a mesothelioma diagnosis.

Staging Pleural Mesothelioma

Pleural mesothelioma stages indicate how far the cancer has progressed. Stages range from the earliest, stage 1, to the latest, stage 4. The stage of your mesothelioma can influence what treatment options doctors prescribe, along with their overall health.

Biopsies and imaging studies are important tools in the staging process. These tools help doctors determine the size and location of tumors.

Pleural Mesothelioma Progression Per Stage
Stage Progression
Stage 1 Tumors remain localized in and around the tissue lining of one lung.
Stage 2 Cancer cells are entering nearby lymph nodes.
Stage 3 Cancer has spread to nearby tissues and distant lymph nodes.
Stage 4 Cancer has spread to distant organs.

The International Mesothelioma Interest Group uses the TNM staging system, standing for tumor, node and metastasis. It’s the most commonly used staging system for pleural mesothelioma. Stages 1 and 2 are early stages with localized tumors. Stages 3 and 4 are more advanced stages where tumors have spread.

Doctor reviewing xray of lungs
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Pleural Mesothelioma Prognosis & Survival Rate

Its aggressive nature and often late diagnosis makes the prognosis for pleural mesothelioma generally poor. Factors that may affect your prognosis include your age, activity level, cancer stage and cell type.

Pleural Mesothelioma Prognosis Factors
  • Age: Younger patients tend to live longer.
  • Cancer Recurrence: A recurrence of mesothelioma is associated with a poorer prognosis.
  • Cell Type: The cell type of mesothelioma tumors also greatly influences prognosis.
  • Gender: Women tend to live longer with the disease than men.
  • Patient Activity Level: More active patients have a better prognosis.
  • Pleural Fluid: Higher amounts of pleural fluid in the chest are associated with a poorer 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 for long-term survival than a late-stage cancer.

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

Survival Rates of Pleural Mesothelioma

The 5-year pleural mesothelioma survival rate is 20% for early-stage cases with localized tumors. For all stages combined, the 5-year survival is 12%. Some patients with good overall health have survived for more than a decade with treatment.

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

While pleural mesothelioma prognosis is generally poor, forecasting your prognosis is challenging because mesothelioma is a very complex disease. Many factors influence prognosis, including cell type, stage, location, suitability for surgery, individual response to treatment and other medical conditions.

Life expectancy for mesothelioma is often less than 18 months, with a median survival of 8 to 14 months. Pleural mesothelioma progresses fast and is resistant to many existing therapies. However, no doctor can determine your life expectancy based only on a diagnosis of pleural mesothelioma. 

Improving Your Prognosis

Taking proactive steps can help you live longer and better with malignant pleural mesothelioma. Some patients have lived years with almost no symptoms after receiving treatment and maintaining their overall health. Diet, exercise and managing stress are all key components.

Inspiring stories from pleural mesothelioma survivors share ways they’ve confronted mesothelioma challenges and faced their own prognosis. For example, pleural mesothelioma survivor Epifanio Figuera shared, “You have to think about your potential and what you can do. Keep on going forward.”

Susan Dickman was told her prognosis was very poor when she was diagnosed with stage 4 peritoneal mesothelioma 12 years ago. Despite being told she wasn’t a candidate for surgery, Susan was determined to improve her prognosis and interviewed doctors until she connected with Dr. Levine, a nationally recognized specialist.

In June 2012, she underwent cytoreductive surgery with HIPEC. Today, 12 years later, Susan tells us, “You fight through it. You get positive and you pray. You surround yourself with people who you love. I deal with reality but I feel like I have a survival mentality. Life is good.”

What Are My Pleural Mesothelioma Treatment Options?

Treatment for pleural mesothelioma includes surgery, radiation therapy, chemotherapy and immunotherapy. Doctors often prescribe a combination of these treatments, known as multimodal therapy. 

Palliative care can relieve symptoms. It can help mesothelioma survivors at any stage in their treatment.

Development and testing of new pleural mesothelioma treatments are ongoing. You may be able to join clinical trials. Some pleural mesothelioma patients may be eligible for emerging treatments through compassionate use programs. 

Choosing Your Pleural Mesothelioma Treatment Options

Doctors and patients must work together to find a treatment strategy with the best chance of success that meets your needs. There is no one-size-fits-all treatment for pleural mesothelioma. Mesothelioma doctors also look at cell type and location of tumors to determine treatment recommendations for individual mesothelioma patients.

Discussing Treatments With Your Doctor
  • Chemotherapy: This is the most common type of pleural mesothelioma treatment. It usually uses a combination of cisplatin or carboplatin and Alimta (pemetrexed) to kill cancer cells or prevent them from reproducing.
  • Emerging Treatments: Novel therapies include gene therapy and photodynamic therapy. Researchers are refining these treatments to fight the disease more effectively with fewer side effects.
  • Immunotherapy: The U.S. Food and Drug Administration approved the Opdivo (nivolumab) and Yervoy (ipilimumab) combination immunotherapy for pleural mesothelioma in 2020.
  • Palliative Care: Managing symptoms to maintain or improve quality of life is important at all stages of mesothelioma care.
  • Radiation: Targeted radiation can destroy cancer cells and decrease tumor size. Radiation therapy can manage chest pain and help prevent recurrence after your surgery.
  • Surgery: Surgery is used in diagnosis and to relieve symptoms. Early-stage patients benefit the most from tumor-removing surgery. Procedures include extrapleural pneumonectomy and pleurectomy and decortication.

Ultimately, the choice of treatment is up you. Treatment goals can vary based on factors such as your health and personal perspectives on quality of life. 

Survivor Story
Survivor Story
Michael Cole Mesothelioma Survivor

A Brave Fight Against Pleural Mesothelioma

Michael Cole’s journey with malignant pleural mesothelioma began in 2015, leading him to thoracic surgeon Dr. David Sugarbaker. His aggressive approach, an extrapleural pneumonectomy surgery followed by heated chemotherapy, aimed to remove as much cancerous tissue as possible. While it marked the beginning of his treatment journey, Cole believes this aggressive approach was crucial for his chance at life.

Read Michael’s Story

Pleural Mesothelioma Research and Latest Developments

Make sure this section is up-to-date. Don’t know what happened here: “Read more about The Mesothelioma Center covers the latest advances in mesothelioma research The Mesothelioma Center here.” We should just take this whole line out and consider making a Learn more about the latest treatments button here instead that links to news. I do think it’s a really good idea to promote our news coverage around the site more.

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

Pleural mesothelioma specialists come from many different medical disciplines. This includes oncologists, surgeons and other experts with years of mesothelioma experience. Many specialists offer unique services such as clinical research trials and support resources.

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

Tampa, Florida

Jacques Fontaine

Pleural Specialist | Thoracic Surgery

Expertise: Pleural Mesothelioma, Lung Cancer, Thoracic Diseases, Minimally Invasive Surgery, Pleurectomy and Decortication Surgery

Languages: English, Spanish, French, Arabic

Dr. Robert B. Cameron, pleural mesothelioma doctor

Los Angeles, California

Robert B. Cameron

Pleural Specialist | Thoracic Surgery

Expertise: Pleurectomy and Decortication, Clinical Trials

Languages: English, Spanish, Vietnamese

According to Dr. Jacques Fontaine, a pleural mesothelioma surgeon, “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.” 

Working with a top specialist can improve your prognosis with pleural mesothelioma. Specialized treatments can improve symptoms and survival. These therapies are available at top cancer centers across the nation.

When Should I See a Doctor About Pleural Mesothelioma?

If you have a history of asbestos exposure, then you should discuss your risk of pleural mesothelioma and other asbestos-related diseases with your doctor. People with known asbestos exposure should undergo screenings for mesothelioma as early as possible and should monitor their health carefully.

Mesothelioma can take decades to develop, and serious symptoms may not appear until late in the disease. You should see your doctor as soon as possible if you have asbestos exposure and any symptoms of pleural mesothelioma. Early detection and treatment of pleural mesothelioma is essential for achieving the best outcomes.

Can Pleural Mesothelioma Be Prevented?

Raising awareness of mesothelioma and its connection to asbestos exposure can potentially help prevent future cases of pleural mesothelioma. Asbestos exposure is the primary cause of mesothelioma. 

Most people were exposed at work or during service in the military. Thanks to successful mesothelioma litigation that held manufacturers and employers responsible for exposure, asbestos use has been phased out of new products. However, legacy asbestos can still be found in older construction materials, machinery and brakes. If you work around asbestos, wear personal protective equipment such as a respirator. Avoid bringing home work clothes or equipment to avoid secondary exposure to your family. 

The U.S. Occupational Safety and Health Administration determines standards and best practices to reduce asbestos exposure. OSHA publishes rules and regulations for employers and manufacturers regarding the use of asbestos in industry. Following these guidelines reduces your risk of dangerous asbestos exposure.

Common Questions About Pleural Mesothelioma

How long do pleural mesothelioma patients live?

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

Is pleural mesothelioma curable?

Malignant 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 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 questions should I ask my doctor about pleural mesothelioma?

A diagnosis of pleural mesothelioma is just the beginning of your mesothelioma journey. You will have many questions for your doctor. Making a list of questions will help ensure that you get the answers you need.

Suggested Questions

  • What type of mesothelioma do I have?
  • How advanced is my cancer? What stage is it at?
  • What are my chances of survival? What is my prognosis?
  • How will mesothelioma change my day-to-day life?
  • Do you have experience with pleural mesothelioma?
  • What tests do I need before deciding on treatment?
  • What are my treatment options?
  • What are the downsides of these treatment options?
  • What kind of support services do you offer?

Be sure to take the time to list all the questions you have about your mesothelioma, treatment options, prognosis and what to expect in the coming months and years. Being prepared helps make the most of the time you have to speak with your doctors.

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