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.

What Is Pleural Mesothelioma?

Pleural mesothelioma is a rare cancer that develops within the pleura, the layer of tissue that lines the outside of the lungs and the inside of the chest wall. Mesothelioma is a type of cancer that can arise from certain types of cells in the body found in the pleura, peritoneum (lining of the abdomen), pericardium (outer lining of the heart) and testes.

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.

The majority of mesothelioma cases are pleural mesothelioma, and peritoneal mesothelioma is the next most common. Mesothelioma of the heart or testes is very rare. Asbestos exposure is the main cause of mesothelioma.

Understanding the Pleura and Its Role

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

The pleural space is the space between the visceral pleura covering the lungs and the parietal pleura covering the inside of the ribcage. Normally, there is only a small amount of fluid in this space that allows the two layers of pleura to glide against one another.

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.

Mesothelioma and other asbestos-related diseases can cause fluid around the lungs ( pleural effusions) and areas of thickened pleura (pleural plaques). Asbestos fibers inhaled into the lungs can reach the pleura, where they can cause plaques, effusions and malignant mesothelioma.

Pleural thickening and pleural plaques can be signs of asbestos exposure. While they’re not direct signs of cancer, they can occur alongside mesothelioma. Different conditions can cause pleural effusions, including mesothelioma.

Symptoms of Pleural Mesothelioma

The most common symptoms of pleural mesothelioma include back and chest pain, difficulty breathing and swelling. 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 recognize the disease and confirm a diagnosis as early as possible. Pleural effusions, pleural thickening and pleural plaques can be the first signs of mesothelioma.

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 the body.

Complications of Pleural Mesothelioma
  • Blood clots: Mesothelioma and other cancers can cause dangerous blood clots. These clots can be deadly if they enter the 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 the 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 the body. Cancer cells can enter the bloodstream and lymphatic system, allowing them to travel to distant parts of the body.
  • Pleural effusions: Pleural mesothelioma often causes fluid to accumulate in the pleural space, making it difficult for the 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.

Both cancer and cancer treatments can cause these and other complications. More advanced disease typically causes the most complications.

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.

I was shocked, but it wasn’t a big shock. I had always wondered after hearing so much about how dangerous asbestos turned out to be. I’m told, though, my mesothelioma was caught early.

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.

What Causes Pleural Mesothelioma?

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

I believe the number one thing is to understand asbestos shouldn’t be handled or disturbed at all unless you’re a professional certified in asbestos removal. A new goal in life for me is to make others aware of the dangers and how to lessen their potential asbestos exposure.

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 creates scar tissue and causes DNA mutations, which lead to cancer.

Who Is Most at Risk for Pleural Mesothelioma?

Occupational asbestos exposure is the number one cause of the disease. Several occupations pose the highest risk, including blue-collar workers and military veterans.

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 because of the long latency period.

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, 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 arch chutes, electrical insulation, electrical panels and more 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

The diagnostic process for pleural mesothelioma begins with symptoms and testing. Doctors may 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.

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

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 of pleural mesothelioma is vital for an effective treatment plan.

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.

Cell Types in the Diagnosis Process

There are three different mesothelioma cell types. The specific cancer cells found in a biopsy help doctors determine an individual’s prognosis and their best treatment options.

Mesothelioma Cell Types
  • Epithelioid: This is the most common mesothelioma cell type and has the best prognosis.
  • Sarcomatoid: This is a rare type of mesothelioma and typically has a poor prognosis.
  • Biphasic: This is a combination of epithelioid and sarcomatoid cell types. Prognosis varies based on which cell type is most prevalent.

Every case of mesothelioma is unique. Varying cell types and distinct mesothelioma locations respond differently to treatments and can have different outcomes.

Dr. Jacques Fontaine and Dr. Virginia Wolf
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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 a patient’s 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.

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Survival Rates of Pleural Mesothelioma

The five-year pleural mesothelioma survival rate is 20% for early-stage cases with localized tumors. Five-year survival is 12% for all stages combined. With treatment, however, some patients with good overall health have survived for more than a decade.

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 an individual’s 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 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 life expectancy based only on a diagnosis of pleural mesothelioma. 

Factors That Affect Your Prognosis for Pleural Cancer

Prognostic factors include personal and disease factors. They can 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.

Improving Your Prognosis

Taking proactive steps can help patients live longer and better with this condition. Some malignant pleural mesothelioma 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.”

Tim Crisler improved his prognosis and has been a pleural mesothelioma survivor for more than 20 years. Initially after successful mesothelioma treatment, he didn’t always make healthy choices. His outlook changed as he lived beyond his expectations, pushing him to stay healthy for himself and his family. 

“I partied like I was in my 20s again because I thought I wasn’t going to live very long,” Crisler said. “But after five years or so, when nothing bad happened, I started wanting to do the right thing and live a better life. And I did. I have.” 

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 Treatment Options for Pleural Mesothelioma

Doctors and patients must work together to find a treatment strategy with the best chance of success that meets the patient’s 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 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 to the patient. Treatment goals can vary based on factors such as an individual’s health and personal perspectives on quality of life. 

Survivor Story
Michael Cole Mesothelioma Survivor

A Brave Fight Against Pleural Mesothelioma

Survivor Story

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

Pleural mesothelioma treatments have advanced over the past few decades, but progress is slow. Research is ongoing around the world to find new and improved treatments for mesothelioma. However, despite some promising results, finding new effective treatments is difficult.

Recent research has shown that immunotherapy is an effective first-line therapy for pleural mesothelioma that can offer improved survival compared to standard chemotherapy. Research into targeted therapies is opening up a new frontier for treating pleural mesothelioma. Studies have found that specific molecular markers in mesothelioma cells can reveal their susceptibility to new treatments, potentially improving disease prognosis. 

Read more about The Mesothelioma Center covers the latest advances in mesothelioma research The Mesothelioma Center here.

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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 Specialist
Thoracic Surgery
Pleural Mesothelioma Lung Cancer Thoracic Diseases Minimally Invasive Surgery Pleurectomy and Decortication Surgery
Tampa, Florida
Dr. Robert B. Cameron
Pleural Specialist
Thoracic Surgery
Pleurectomy and Decortication Clinical Trials
Los Angeles, California
Dr. Abraham Lebenthal
Pleural Specialist
Thoracic Surgery
Pleural Mesothelioma Lung Cancer Video-Assisted Thoracoscopic Surgery Pleurectomy and Decortication Surgery

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.

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 the risk of dangerous asbestos exposure.

Legal Options for Mesothelioma Survivors

While the dangers of asbestos exposure were not widely known for some time, asbestos manufacturers knew some of the risks and failed to protect consumers. Many people exposed to asbestos at work had no idea that they and their families were in any danger. 

Asbestos manufacturers and employers who didn’t protect workers from exposure can be liable for the damages asbestos exposure causes. Filing a mesothelioma lawsuit can help mesothelioma survivors find justice. Successful legal claims can also help cover medical expenses and lost wages.

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.

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.