Pleural Mesothelioma

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Pleural mesothelioma is a cancer that develops in the pleura, which is the protective lining of the lungs and chest cavity. Malignant pleural mesothelioma is caused by asbestos exposure and is the most common type of mesothelioma. Symptoms can include shortness of breath, and the top pleural treatment is chemotherapy.

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Thoracic surgeon Dr. Jacques Fontaine explains pleural mesothelioma and where it forms.
Thoracic surgeon Dr. Jacques Fontaine explains pleural mesothelioma and where it forms.

What Is Pleural Mesothelioma?

Pleural mesothelioma is a rare malignant cancer. 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 percent live at least one year

How Does Asbestos Cause 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 pleura 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.

Asbestos exposure also causes:

Asbestos exposure may also cause calcified pleural plaques, but these are not mesothelioma or any other cancer. They do not require treatment. A mesothelioma doctor can differentiate benign pleural plaques from mesothelioma based on imaging scans and findings at the time of the thoracoscopy, also known as VATS.


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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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 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.

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


Pleural mesothelioma staging
Pleural Mesothelioma Stages

The International Mesothelioma Interest Group created 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


Pleural Mesothelioma Treatment

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.

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


Cytoreductive surgery is a treatment option for early-stage patients. One common procedure, a pleurectomy-decortication or radical pleurectomy, involves removing the tumor and affected pleura. A more aggressive surgical option, the extrapleural pneumonectomy, removes the pleura, the entire cancerous lung, the diaphragm and the heart sac, which is also known as the pericardium.

The goal of surgery is to remove the cancer and prevent it from recurring as long as possible, hopefully, for several months to years.


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, such as immunotherapy, gene therapy and photodynamic therapy, are designed to fight cancer more effectively while causing fewer side effects for the patient.


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 is used at the time of the surgery and can improve the results of surgery.

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Complementary and Alternative Medicine

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

  • Yoga breathing techniques help lung function 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.

Top Pleural Mesothelioma Doctors in the U.S.

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

Dr. Jacques Fontaine

H. Lee Moffitt Cancer Center

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.

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Dr. Robert B. Cameron, pleural mesothelioma doctor

Dr. Robert B. Cameron

UCLA Jonsson Comprehensive Cancer Center

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.

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Dr. Abraham Lebenthal, pleural mesothelioma doctor

Dr. Abraham Lebenthal

Brigham and Women's Hospital

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

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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


The average pleural mesothelioma prognosis, or the expected course and outcome for the disease, is grim 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

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

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 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.

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

Cost of Cancer Care

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 around $40,000.

Costs vary by treatment plan. Chemotherapy and radiation treatments can 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.

See If You Have Financial Assistance Available

Financial Planning

Financial planning is essential to making sure you can handle the cancer’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.
  • Mesothelioma lawyers can help patients 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.

Financial assistance and planning can help families affected by mesothelioma afford the costs of cancer care and recovery.

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Registered Nurse and Patient Advocate

Karen Selby joined 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
Edited by
Dr. Jacques Fontaine
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Last Modified October 4, 2019

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