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Pleural Mesothelioma

Pleural mesothelioma is a rare and malignant cancer caused by asbestos. Mesothelioma tumors form in the pleura, a thin membrane of cells that line the lungs and chest wall.

Parts of the Lung Affected by Pleural Mesothelioma
Parts of the Lung Affected by Pleural Mesothelioma

How Is Pleural Mesothelioma Unique?

As the most common type of asbestos-related cancer, malignant pleural mesothelioma accounts for approximately 80 – 90 percent of all mesothelioma cases. Pleural mesothelioma differs from other types in four primary ways:

Location: Pleural mesothelioma is located in the linings of the lungs and the chest wall, known as the pleura.

Symptoms: As the disease mostly affects the lungs, the primary symptoms affect the respiratory system, such as shortness of breath, or the thoracic cavity, such as chest pain.

Treatment: The standard treatment for pleural mesothelioma is surgery, which often includes removal of some or all of the pleura and possibly part of the lung, combined with chemotherapy and/or radiation.

Survival: The prognosis for pleural mesothelioma is poor, with a median survival time of about 1 year. However, there are cases of long-term survival, in some cases as long as 20 years.

What You Need to Know About Pleural Mesothelioma
  • Pleural mesothelioma is the most common form of asbestos-related cancer.
  • About 2,500 people are diagnosed with pleural mesothelioma each year.
  • Standard treatments include surgery, chemotherapy, and radiation.
Cause
Asbestos inhalation
Location
Lung/chest lining (pleura)
Common Symptoms
  • Chest pain
  • Dyspnea (shortness of breath)
  • Pleural effusion (fluid buildup)
Treatment
  • Surgery
  • Chemotherapy
  • Radiation
Prognosis
6 – 12 months

What is the Prognosis for Pleural Mesothelioma?

As with all types of mesothelioma, prognosis for pleural mesothelioma is relatively poor. For patients who do not receive treatment, the median survival is only six months; however, certain types of treatment can improve prognosis significantly.

For example, studies have shown that patients who receive a cocktail chemotherapy treatment of pemetrexed (Alimta) and cisplatin have a longer median survival time (12.1 months) than chemotherapy using cisplatin alone (9.1 months).

The biggest factors affecting the prognosis of pleural mesothelioma patients are:

  • Tumor size and staging
  • Cell type (histopathology)
  • Patient’s gender and age
  • Stage of the cancer

In general, patients who are women, younger, or have an early-stage diagnosis (Stage 1 or Stage 2) have a better prognosis than those who are men, older, or have a late-stage diagnosis.

What are the Symptoms of Pleural Mesothelioma?

Anywhere from 20 to 50 years can pass between the time a person is exposed to asbestos and when pleural mesothelioma symptoms begin to appear. Once symptoms do begin to occur, they often show up first in the chest and respiratory system, although some symptoms (like weight loss or fever) can be systemic.

Common Symptoms

  • Chest pain
  • Shortness of breath (dyspnea)
  • Fluid in the lungs (pleural effusion)
  • Dry cough

Less Common Symptoms

  • Weight loss
  • Fever
  • Fatigue
  • Night sweats

Pleural mesothelioma can also be accompanied by a set of other conditions that could display symptoms of their own. These include:

  • Pleural plaque – a chalky substance that forms on the lungs due to calcification
  • Diffuse pleural thickening (DPT) – Gray, fibrous tissue that fills in pleural spaces
  • Asbestosis – Scarring of the lungs (fibrosis)

These conditions may also occur on their own in individuals who do not have pleural mesothelioma.

How is Pleural Mesothelioma Diagnosed?

Malignant pleural mesothelioma symptoms often present with symptoms that are similar to those of other diseases, making diagnosis extremely difficult in many cases. The most common way to diagnose the disease is to undergo a series of tests that can rule out other diseases, including various types of cancer.

The first step is usually to perform one or more imaging scans (x-ray, CT, PET, or MRI) to identify potential tumors. If such a tumor is detected, one or more blood tests may be performed to look for certain biomarkers (high levels of specific substances in the blood). If these tests point toward the possibility of mesothelioma, the diagnosis will need to be verified through a biopsy – usually through a thoracoscopy, thoracotomy, thoracentesis, or mediastinoscopy.

The most common misdiagnoses for pleural mesothelioma include:

  • Chronic Obstructive Pulmonary Disease (COPD)
  • Pneumonia
  • Asthma
  • Influenza (the flu)
  • Other chest cancers, such as lung cancer or adenocarcinoma

What Treatments are Available for Pleural Mesothelioma?

All types of mesothelioma are treated using a combination of three types of therapy:

  • Surgery – Cytoreduction surgery (also called “debulking”) is often performed with the intent of removing as many cancer cells as possible.
  • Chemotherapy – A combination of chemotherapy drugs (usually pemetrexed [Alimta] and Cisplatin) are administered to kill remaining tumor cells.
  • Radiation – A blast of targeted radiation to shrink tumors in the body.

Pleurectomy/Decortication (P/D)

This type of surgery involves removing the parietal pleura (the outer membrane) as well as a portion of nearby organs and tissue, such as the mediastinum, diaphragm, and pericardium. Although it can help treat many symptoms of mesothelioma – such as pleural effusion – it is not considered a curative operation, and results in recurrence about 80 – 90 percent of the time.

Because P/D is usually less stressful on the body, it is usually offered as a palliative treatment patients who have a later stage of the disease, or when curative options are not viable.

Extrapleural Pneumonectomy (EPP)

Patients who are in better physical condition can undergo EPP, which is a potentially curative treatment that removes the affected pleura along with a portion of the lung, nearby lymph nodes, and adjacent tissue. It is the only type of surgery associated with long-term survival.

Because it is heavily invasive and stressful on the body, EPP is used almost exclusively for patients who meet the following criteria:

  • Stage 1 or 2 mesothelioma
  • Epithelial cell type mesothelioma
  • Have not previously had coronary bypass surgery or pleurectomy
  • Cardiac ejection fraction measurement of 45 percent or greater (this measures how well your heart pumps blood)
  • No cardiac dysfunction and/or arrhythmia
  • No liver, renal, or similar diseases
Top Pleural Mesothelioma Doctors in the Country
Robert Brian Cameron, M.D.

Robert Brian Cameron, M.D.

Director, Thoracic Oncology Map Marker University of California Los Angeles Medical Center
Anne Tsao, M.D.

Anne Tsao, M.D.

Director, Mesothelioma Program / Thoracic Chemo-Radiation Program Map Marker University of Texas M.D. Anderson Cancer Center

Emerging and Experimental Treatments

Since pleural mesothelioma makes up the majority of mesothelioma cases, most experimental treatments focus on pleural mesothelioma. The most promising experimental treatments included the following.

Immunotherapy: These treatments focus on jumpstarting or boosting the body’s immune system to fight cancer.

Gene Therapy: Gene therapy involves fixing genetic problems that are the source of cancerous cells.

Photodynamic Therapy: Through a photosensitizing agent and a light source, researchers have been able to kill cancer cells.

Resources for Pleural Mesothelioma Patients

Costs Related to Pleural Mesothelioma

As with all types of cancer, pleural mesothelioma treatment costs can be extremely high. The costs associated with the disease can be lumped into several categories:

  • Diagnostic testing costs
  • Treatment expenses
  • Follow-up and recovery costs

How much an individual (and their family) spends on mesothelioma will likely depend on a variety of factors, such as the exact diagnosis, the stage when the disease is diagnosed, what is covered by insurance, and even where the patient resides.

Because asbestos is the only scientifically proven cause of pleural mesothelioma, those who are diagnosed with this deadly cancer may be able to receive legal compensation for many different things, from lost income to medical costs, as well as damages for pain and suffering related to the disease. If you or a loved one has been diagnosed, you should strongly consider taking steps to help offset this potential financial burden.

Learn more about the financial assistance that is available if you or a loved one has been diagnosed with peritoneal mesothelioma. Financial aid options available to you can include mesothelioma trust funds as well as grants to cover travel, treatment and housing.

You can also explore your legal rights to compensation from asbestos companies liable for your exposure to asbestos.

View Sources

Sources

Ismail-Khan, Rooh, et al. “Malignant Pleural Mesothelioma: A Comprehensive Review.” Cancer Control. 2006 Oct. 13(4): 255-263.

Miles, Susan E. “Clinical consequences of asbestos-related diffuse pleural thickening: A review.” Journal of Occupational Medicine and Toxicology. 2008; 3:20. DOI: 10.1186/1745-6673-3-20

Pairon, Jean-Claude, et al. “Pleural Plaques and the Risk of Pleural Mesothelioma.” Journal of the National Cancer Institute. 20 February 2013, 105(4P): 293-301. DOI: 10.1093/jnci/djs513

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