Pleural Mesothelioma

Pleural mesothelioma is a rare malignant cancer caused by inhaling asbestos fibers into the lungs. Almost 75 percent of mesothelioma cases form in the pleura, making it the most common of the four types.

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Pleural mesothelioma is a cancer that develops in the cells that form the outer lining of the lungs and inner lining of the chest cavities. It is the most common type of asbestos-related cancer. Clinical trials offer access to new treatments such as immunotherapy. All types of mesothelioma are named after the location where they form.

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.

Most patients are men because they were the majority of the workforce in professions, including heavy industry and construction, where asbestos exposure historically occurred.

Initial symptoms of malignant pleural mesothelioma include chest pain and shortness of breath. You may experience no symptoms at all in the early stages of the cancer’s progression.

The life expectancy of someone with pleural mesothelioma is often less than 18 months, but it depends on many factors.

Some patients live much longer with treatment. Combining several treatments, such as surgery, chemotherapy and radiation therapy, has helped people live for years after being diagnosed with pleural mesothelioma. Clinical trials offer access to new treatments such as immunotherapy.

How Does Asbestos Cause Pleural Mesothelioma?

Asbestos causes malignant pleural mesothelioma decades after a person inhales asbestos dust. The mineral’s needle-like fibers lodge in the lungs and gradually migrate into the pleural lining.

Plaque forming on the pleural lining of the lungs

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

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

Two layers make up the pleura lining. The outer layer lines the entire inside of the chest cavity, 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.

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Symptoms of Pleural Mesothelioma

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

What are Common Symptoms of Pleural Mesothelioma?

  • 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.

Pleural Mesothelioma

  • Most common type
  • Forms on soft tissue covering the lungs
  • Best treated with a multimodal approach
  • Symptoms: Shortness of breath, chest pain, dry cough
  • 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 Stages

A few different staging systems exist for malignant pleural mesothelioma. They all organize the cancer’s extent into four stages. 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.

The International Mesothelioma Interest Group created the most widely used staging system for pleural mesothelioma. It applies the tumor-node-metastasis (TNM) approach, which is also used to stage many other types of cancer.

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
Learn more about pleural mesothelioma staging

Diagnosing Pleural Mesothelioma

The diagnostic process for mesothelioma begins when a doctor evaluates the initial symptoms. 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 pulmonologist, oncologist or general hospital for further testing.

Primary care physicians often mistake pleural mesothelioma for common diseases, such as the flu or pneumonia, which have similar symptoms. Once medical professionals suspect cancer, they may mistake pleural mesothelioma for lung cancer.

Doctors may not suspect mesothelioma unless the patient reports a history of asbestos exposure.

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.

Top Pleural Mesothelioma Doctors in the U.S.

Several doctors at top cancer centers across the nation specialize in the treatment of asbestos-related cancer.

Jacques Fontaine, Thoracic Surgeon & Expert Contributor for Asbestos.com

Jacques Fontaine

H. Lee Moffitt Cancer Center

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Dr. Robert B. Cameron, Thoracic Surgeon

Robert B. Cameron

UCLA Jonsson Comprehensive Cancer Center

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Dr. Abraham Lebenthal - Thoracic Surgeon

Abraham Lebenthal

Brigham and Women's Hospital

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Pleural Mesothelioma Treatment Options

Researchers are testing several emerging treatment technologies in their quest for a cure. Mesothelioma specialists still primarily rely on traditional cancer treatments such as surgery, chemotherapy and radiation therapy.

Depending on how far your cancer has progressed, these therapies can be cytoreductive or palliative.

Cytoreductive treatments aim to fight the cancer. Palliative treatments ease symptoms and improve quality of life for patients. Certain palliative treatments also help control cancer growth.

Experts agree the best chance of extending survival comes from combining multiple treatments. This approach is called multimodal therapy.

It takes a multidisciplinary team to provide multimodal pleural mesothelioma treatment.

For example, when surgeons perform extrapleural pneumonectomy surgery, radiologists usually then administer radiation therapy to reduce the risk of local cancer recurrence, while oncologists prevent distant cancer spread with chemotherapy.

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

Surgery

Cytoreductive surgery is a treatment option for early-stage patients. One common procedure involves removing the tumor and affected pleura. A more aggressive surgical option aims to remove the pleura, the entire cancerous lung, the diaphragm and the heart sac.

Chemotherapy

The most common mesothelioma treatment is chemotherapy. It uses one or more drugs to kill cancer cells or prevent them from reproducing. Recent advancements have improved how well patients respond to chemotherapy, but success rates remain low overall.

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 reoccurrence after surgery.

Clinical Trials

A clinical trial is a research study to test a new treatment strategy or technology. You may be able to receive an experimental therapy by volunteering to join a clinical trial. Emerging cancer therapies are designed to fight cancer more effectively while causing fewer side effects for the patient.

Immunotherapy

Immunotherapy has generated great excitement in a cancer community. This class of drugs activates a patient’s own immune system against their cancer. Mesothelioma specialists are testing several immunotherapy drugs that have already been officially approved for other types of cancer.

Gene Therapy

Gene therapy is a broad category of experimental treatments that involve genetically modifying cells, bacteria or viruses. The first cancer treatment involving gene therapy was approved in 2017. Researchers are hopeful more breakthroughs are in store for the future.

Photodynamic Therapy

Photodynamic therapy is a type of targeted cancer treatment. It involves using a special drug to make cancer cells sensitive to light, and then using light energy to destroy the cancer. This can improve the results of surgery for pleural mesothelioma.

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Complementary and Alternative Medicine

Some patients benefit from combining complementary therapies with traditional cancer treatment.

For example, yoga breathing techniques sooth the lungs and relieve tension. Meditation reduces anxiety and depression and helps people cope with uncertainty.

Mental health counseling is an effective therapy for psychological stress. Joining a support group allows patients to connect and get support from other people facing cancer.

Acupuncture and acupressure are clinically proven to alleviate nausea and vomiting caused by chemotherapy drugs. Nutritional therapies and herbal medicine can promote quicker recovery, increase energy and help the immune system fight infection.

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

Pleural Mesothelioma Prognosis

The general mesothelioma prognosis, or the expected course and outcome for the disease, is grim for most patients because this cancer 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

  • 40% – One year after diagnosis
  • 20% – Two years after diagnosis
  • 10% – Three or more years after diagnosis

Prognostic Factors

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.

Patients in good health who can still perform normal daily tasks tend to respond better to treatment.

The cell type of mesothelioma tumors also greatly influences prognosis.

Among the subtypes of this disease, epithelial mesothelioma is the most common, and it has the best prognosis. Those with sarcomatoid and biphasic subtypes of mesothelioma have shorter median survival times, usually around six or eight months.

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Sarcomatoid mesothelioma is the most aggressive in terms of rapid growth and resistance to chemotherapy. Biphasic mesothelioma is a mix of both types of cells. A higher ratio of epithelial cells translates into a longer survival time for the patient.

Other important prognostic factors include your age, sex and smoking history. Generally, survival rates are higher for female patients, nonsmokers and patients younger than 55.

Cancerous pleural effusions are associated with shorter survival times. Treatment with surgery or chemotherapy may help.

Factors That Affect Your Prognosis

  • Stage of disease at diagnosis
  • Cancer cell type
  • Age of patient
  • Gender of patient
  • Patient’s smoking history
  • Amount of fluid in the chest
  • Patient’s activity level
  • Cancer recurrence

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 are able to 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.

Ways to 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

Cost of Pleural Mesothelioma Treatment

While there is no defined cost for pleural mesothelioma treatment, the average cost of a major lung surgery, which may be comparable to mesothelioma, is almost $40,000.

Costs vary by treatment plan, but they are never cheap. Chemotherapy and radiation treatments can easily add up to thousands of dollars a month.

A cancer diagnosis can also lead to lost wages, professional caregiving expenses and costs due to traveling for treatment. Financial planning is essential to making sure you can handle pleural mesothelioma’s impact on your budget.

Fortunately, help is available. Patients can receive assistance from nonprofit organizations dedicated to cancer patients. Government programs such as Social Security also help.

Veterans with mesothelioma can receive low-cost medical treatment through their VA benefits. They can receive extra financial assistance if their cancer was caused by military asbestos exposure.

All mesothelioma patients may be able to file a claim with a trust fund set up by the liable company. Financial assistance is also available through legal settlements and personal injury lawsuits.

Victims of asbestos exposure caused by corporate negligence have a right to legal compensation.

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Last Modified November 12, 2018

Registered Nurse and Patient Advocate

Karen Selby joined Asbestos.com in 2009. She is a registered nurse with a background in oncology and thoracic surgery and was the regional director of a tissue bank before becoming a Patient Advocate at The Mesothelioma Center. Karen has assisted surgeons with thoracic surgeries such as lung resections, lung transplants, pneumonectomies, pleurectomies and wedge resections. She is also a member of the Academy of Oncology Nurse & Patient Navigators.

Walter Pacheco, Managing Editor at Asbestos.com
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14 Cited Article Sources

  1. Bonelli, M.A. et al. (2017). New therapeutic strategies for malignant pleural mesothelioma. Biochemical Pharmacology, 123(1), 8-18.
    Retrieved from: https://doi.org/10.1016/j.bcp.2016.07.012
  2. Shavelle, R. et al. (2017). Live expectancy in pleural and peritoneal mesothelioma. Lung Cancer Int., 2782590. doi: 10.1155/2017/2782590
  3. Zouk, A.N., & Batra, H. (2017). Malignant pleural mesothelioma: Spotlight on recent advances in diagnosis and treatment. EMJ Oncol., 5(1), 103-111.
    Retrieved from: http://emjreviews.com/therapeutic-area/oncology/malignant-pleural-mesothelioma-spotlight-on-recent-advances-in-diagnosis-and-treatment/
  4. National Comprehensive Cancer Network. (2016). NCCN Guidelines for Patients. Malignant Pleural Mesothelioma.
    Retrieved from: https://www.nccn.org/patients/guidelines/mpm/files/assets/common/downloads/files/mpm.pdf
  5. Patel, S.C., & Dowell, J.E. (2016). Modern management of malignant pleural mesothelioma. Lung Cancer (Auckl), 7, 63–72. doi: 10.2147/LCTT.S83338
  6. Cancer Research UK. (2014, July 10). Statistics and outlook for mesothelioma.
    Retrieved from: http://cancerhelp.cancerresearchuk.org/type/mesothelioma/treatment/statistics-and-outlook-for-mesothelioma
  7. National Comprehensive Cancer Network. (2014). Malignant Pleural Mesothelioma NCCN Guideline for Patients.
    Retrieved from: http://www.nccn.org/patients/guidelines/mpm/#38
  8. Spaggiari, L. et al. (2014). Extrapleural Pneumonectomy for Malignant Mesothelioma: An Italian Multicenter Retrospective Study. Annals of Thoracic Surgery, 97, 1859–66.
    Retrieved from: http://dx.doi.org/10.1016/j.athoracsur.2014.02.004
  9. Cancer Research UK. (2013, December 17). Pleural mesothelioma treatment.
    Retrieved from: http://www.cancerhelp.org.uk/help/default.asp?page=4473
  10. Frost, G. (2013). The latency period of mesothelioma among a cohort of British asbestos workers (1978–2005). British Journal of Cancer, 109, 1965–1973. doi: 10.1038/bjc.2013.514
  11. Dodson, R. & Hammar, S. (2012). Asbestos: Risk Assessment, Epidemiology, and Health Effects, Second Edition. Taylor & Francis: Boca Raton.
  12. Kaufman, A., & Flores, R. (2011). Surgical treatment of malignant pleural mesothelioma. Curr Treat Options Oncol., 12(2), 201-216. doi: 10.1007/s11864-011-0154-4
  13. Zauderer, M., & Krug, L. (2011). The evolution of multimodality therapy for malignant pleural mesothelioma. Curr Treat Options Oncol., 12(2), 163-172. doi: 10.1007/s11864-011-0146-4
  14. Surveillance, Epidemiology, and End Results Program. (n.d.). Table 17.5. Mesothelioma Survival Rates by Year of Diagnosis. All Races, Males and Females. Retrieved from: https://seer.cancer.gov/archive/csr/1975_2006/results_merged/sect_17_mesothelioma.pdf
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