Respiratory Complications of Mesothelioma

Pleural mesothelioma patients experience a range of pulmonary complications. These complications become increasingly common as the cancer progresses to later stages.

Some of the most common mesothelioma symptoms, such as shortness of breath and pleural effusion, are respiratory complications caused by the cancer.

In general, respiratory complications result from the cancer growing or from certain treatments. There isn’t anything specific mesothelioma patients can do to avoid or reduce the risk of respiratory complications.

Patients should report any changes in lung function or worsening chest pain to catch respiratory complications early.

Cancer-Related Respiratory Complications

Pleural mesothelioma cancer can cause a variety of respiratory complications such as shortness of breath, pleural effusion and lung collapse.

Shortness of Breath

Dyspnea, or shortness of breath, is one of the most common respiratory complications of mesothelioma. In a 2011 study of 238 pleural mesothelioma patients published in Industrial Health, 79 percent reported shortness of breath.

Breathing techniques and supplemental oxygen help patients manage shortness of breath.

Pleural Effusion

Pleural effusion is a buildup of fluid between the layers of the pleural lining. The excess fluid presses against the lungs and contributes to breathing difficulties.

Approximately 90 percent of pleural mesothelioma patients get effusions. Treatments include thoracentesis, permanent pleural catheter drainage and pleurodesis.

Collapsed Lung

Pneumothorax, or collapsed lung, is an uncommon respiratory complication in mesothelioma patients. It happens when air enters the pleural space between the lung and chest wall. Less than 10 percent of patients experience a spontaneous pneumothorax.

Treatment may involve physical therapies and surgical procedures to release trapped air.

Atelectasis

Atelectasis is a partially collapsed lung. This respiratory complication is commonly triggered by pleural effusion and pleural thickening.

A 1999 study of 70 pleural mesothelioma patients published in Clinical Radiology found:

• 74 percent had obstructive atelectasis caused by effusion
• 9 percent had rounded atelectasis caused by the pleural lining folding in toward the lung

Treatment typically involves physical therapies or surgical procedures to address the root cause.

Pneumonia and Respiratory Infections

Pleural mesothelioma patients are at an increased risk of developing pneumonia and respiratory infections. According to a 2017 study published in Annals of Translational Medicine, approximately 2 percent of pleural patients who undergo surgery develop pneumonia.

Doctors prescribe antibiotics and antivirals to treat pneumonia and respiratory infections.

Respiratory Distress and Failure

Acute respiratory distress syndrome (ARDS) happens when the tiny air sacs of the lungs fill with excess fluid. It can develop after certain treatments, such as surgery or talc pleurodesis, or as a result of pneumonia.

Doctors treat ARDS with mechanical ventilation (sometimes called an artificial lung). Around 50 percent of all ARDS patients experience respiratory failure within 10 days. Most deaths from pleural mesothelioma tend to be a result of respiratory failure.

Treatment-Related Respiratory Complications

A number of respiratory complications can develop as a result of mesothelioma treatment side effects.

Respiratory Complications That May Develop Following Mesothelioma Surgery

• Pulmonary edema (excess fluid in the lungs)
• Pulmonary embolus (blood clotting in the lungs)
• Bronchial air leaks (air leaking from lungs)
• Mediastinal shift (shifting of organs inside the chest)
• Hemothorax (internal bleeding around lungs)
• Acute respiratory distress syndrome (lung failure)

Possible Respiratory Side Effects of Chemotherapy Drugs for Mesothelioma

• Cisplatin: May cause eosinophilic pneumonia (accumulation of a certain type of white blood cells in the lungs).
• Pemetrexed (Alimta): May cause pneumonitis (lung inflammation), diffuse alveolar hemorrhage (bleeding in the lungs) and ARDS.
• Gemcitabine: May cause pneumonitis, eosinophilic pneumonia and pulmonary fibrosis (lung tissue scarring).

Respiratory Complications Potentially Caused by Radiation Therapy

• Radiation pneumonitis (lung inflammation)
• Chronic radiation fibrosis (lung tissue scarring)

Call your oncologist immediately if you experience any changes in respiratory function. Catching respiratory complications early improves treatment outcomes.

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Karen Selby, RN

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 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.

Edited by Daniel King

Medical Review By Dr. Sanjay R. Jain