Pleural Mesothelioma
Pleural mesothelioma is a cancer of the lining of the lungs, known as the pleura. It is caused by inhaling asbestos fibers. Pleural mesothelioma accounts for about 85% of all mesothelioma diagnoses. Symptoms of pleural mesothelioma include shortness of breath, dry cough and chest pain.
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What Is Pleural Mesothelioma?
Pleural mesothelioma is a rare cancer of the lining around the lungs, called the pleura. Doctors also call it malignant pleural mesothelioma, which means the same thing. It is caused by asbestos fibers. After inhalation, the fibers can embed in the pleura, causing inflammation and scarring. Over time, these processes can lead to the development of mesothelioma tumors.
- Pleural malignant mesothelioma is the most common form of mesothelioma cancer.
- Symptoms of pleural mesothelioma include chest pain, dry cough, fatigue and shortness of breath.
- Some pleural mesothelioma patients have achieved long-term survival after aggressive treatment, but it is not considered to be a curable cancer.
- Median survival after a pleural mesothelioma diagnosis is about one year. The 5-year relative survival rate for all stages combined is about 15%.
- Each year, about 2,500 people are diagnosed with pleural mesothelioma.
- Diagnosing pleural mesothelioma typically involves of multiple tests, including scans and biopsies.
- Pleural mesothelioma is often treated with systemic therapy, such as immunotherapy, chemotherapy or both. Surgery is an option for a small number of patients with early-stage disease.
Every patient’s experience with pleural mesothelioma is different. A patient’s outlook depends on several factors, including how early the cancer is diagnosed, whether it has spread and how well it responds to treatment. Overall health can also play an important role.
What Is the Prognosis for Pleural Mesothelioma?
As with all types of malignant mesothelioma, prognosis for pleural malignant mesothelioma depends on a number of factors. For patients who do not receive treatment, the median survival time is six months. However, treatment can improve life expectancy. The 2026 National Comprehensive Cancer Network (NCCN) Guidelines for Mesothelioma: Pleural recommend systemic therapy as the main treatment for most patients.
| Stage at Diagnosis (SEER) | 5-Year Relative Survival Rate |
|---|---|
| Localized | 23% |
| Regional | 15% |
| Distant | 11% |
| All stages combined | 15% |
The most important mesothelioma prognosis factors of pleural malignant mesothelioma patients are:
- Cell type (histopathology)
- Stage of mesothelioma
- Patient’s gender and age
Most pleural mesothelioma patients are diagnosed with the epithelioid cell type, which is the most common. Epithelioid cells typically form in solid sheets or cord arrangements, meaning they adhere closely together and don’t metastasize as quickly. They are also the most responsive to treatment. In the CheckMate 743 trial, patients with the epithelioid cell type lived a median of 18.2 months on immunotherapy and 16.7 months on chemotherapy.
The other cell types, sarcomatoid and biphasic, are less common and indicate a worse prognosis than epithelioid. Sarcomatoid mesothelioma spreads quickly and responds poorly to chemotherapy on its own. Immunotherapy changed that. In the CheckMate 743 trial, patients with non-epithelioid mesothelioma lived a median of 18.1 months on nivolumab plus ipilimumab, compared with 8.8 months on chemotherapy. The 2026 NCCN Guidelines for Mesothelioma: Pleural now favor immunotherapy for these cell types.
Patients with biphasic pleural mesothelioma experience an intermediate life expectancy, depending on whether epithelioid or sarcomatoid cells are more dominant.
According to recent data, within the last decade, malignant pleural mesothelioma patients have been surviving longer overall as available treatments and diagnostic methods improve. Some patients are now becoming long-term survivors. Heather Von St. James was diagnosed with pleural mesothelioma in 2005 with an initial prognosis of 15 months. Following her treatment, she has survived for more than 20 years.
Did You Know?
Pleural mesothelioma is the most common type of mesothelioma and is most often diagnosed in men over age 60.
80 – 90% of all mesothelioma cases are pleural mesothelioma and occur in men 65 or older.
What Causes Pleural Mesothelioma?
Malignant pleural mesothelioma is caused by inhalation of asbestos fibers. The mineral slivers can travel through lung tissue and lodge in the pleura. Over time, asbestos fibers cause inflammation. The fibers can also activate biological pathways that lead to DNA damage. As a result, mesothelioma tumors may develop.
Other factors may contribute to the development of mesothelioma, including:
- Erionite exposure: Erionite is a natural mineral similar to asbestos. It has been linked to mesothelioma and lung cancer.
- Radiation exposure: Radiation treatments for cancer can damage healthy cells, potentially leading to cancer. Prior radiation therapy has been tentatively linked to mesothelioma.
What Are the Symptoms of Pleural Mesothelioma?
After asbestos exposure, it can take 10 - 50 years for pleural mesothelioma symptoms to develop. Symptoms typically first present in the chest cavity and respiratory system.
Pleural Mesothelioma Symptoms
- Chest pain
- Coughing up blood
- Difficulty swallowing
- Dry cough
- Fatigue
- Fever
- Fluid around the lung (pleural effusion)
- Night sweats
- Shortness of breath (dyspnea)
- Weight loss
As the disease becomes more advanced, new and worsening symptoms may arise. For instance, stage 4 pleural mesothelioma symptoms may include coughing up blood and difficulty swallowing.
Pleural malignant mesothelioma patients may be diagnosed with a co-occurring asbestos-related condition, which can impact symptom onset.
These asbestos-related conditions may also develop independently of pleural mesothelioma:
- Pleural effusion develops when an abnormal amount of fluid collects in between the two layers of the pleura. This fluid can compress the lungs, making it difficult to breathe. Pleural effusion and associated breathing problems are common symptoms in pleural mesothelioma.
- Pleural plaques are areas of thickened tissue on the surface of the pleura. Pleural plaques often do not cause symptoms. This condition is one of the most common side effects of asbestos exposure. Asbestos-exposed individuals with pleural plaques may have an elevated risk of developing mesothelioma.
- Pleural thickening is a condition in which scar tissue thickens the pleura. Pleural thickening can be benign or malignant. It is caused by asbestos exposure and other conditions that cause inflammation.
- Asbestosis is a benign, chronic lung disease caused by inhaling asbestos fibers. It is a form of pulmonary fibrosis. Patients with asbestosis develop scar tissue within their lungs. This makes the lungs less flexible and breathing more difficult. Patients with asbestosis may have an increased risk of developing pleural mesothelioma.
How Is Pleural Mesothelioma Diagnosed?
Diagnosing pleural mesothelioma often consists of multiple tests. One or more imaging scans, such as an X-ray or CT scan, may be performed first to identify tumors or metastasis (spreading of disease). If a tumor is detected, blood tests may be performed to look for certain biomarkers (high levels of specific substances in the blood), which can help differentiate mesothelioma from other conditions.
Currently, a biopsy is the only way to verify a malignant pleural mesothelioma diagnosis. Tests like a thoracentesis or thoracoscopy may be performed to take a tissue or fluid sample for analysis. For a thoracentesis, a doctor will insert a fine needle to remove fluid buildup in the chest.
The 2026 NCCN Guidelines for Mesothelioma: Pleural recommend three steps for anyone with a repeated pleural effusion or pleural thickening:
- A chest CT scan with contrast.
- A thoracentesis to draw fluid for testing and a pleural biopsy. A thoracoscopic biopsy is the preferred kind.
- A blood test for soluble mesothelin-related peptide (SMRP) is optional. NCCN also recommends that care be managed by a team experienced in pleural mesothelioma.
A thoracoscopy is more invasive. Doctors insert a viewing tube called a thoracoscope into the chest to inspect the lungs and surrounding pleura. They can then remove a tissue sample or draw fluid for analysis. After the biopsy, a pathologist will study the cells to make a definitive diagnosis, including cell type and how the disease is expected to progress.
Malignant Pleural Mesothelioma Stages
As part of the diagnostic process, a mesothelioma specialist will also determine the stage of the disease, or how far it has spread. A patient’s stage is an important indicator of prognosis and helps determine available treatment options.
The most common system used to determine pleural mesothelioma stage is the Tumor, Node, Metastasis or TNM staging system. The 2026 NCCN Guidelines for Mesothelioma: Pleural follow the ninth edition of the TNM system, which changed how tumor thickness and lymph node spread are scored. Doctors will use the system to score a specific area of the body based on the size of the tumor, if the cancer has spread to the lymph nodes and if the cancer has spread to distant organs.
Determining the life expectancy of a patient with pleural mesothelioma depends on several individual factors. In general, patients with higher TNM stages have shorter life expectancies. The appearance of mesothelioma cells under a microscope, known as cell type, can also affect prognosis.
In one study of patients with pleural mesothelioma who were eligible for surgery, the average life expectancy was 77 months for patients with stage 1 disease and 25 months for those with stage 3 disease. Patients with stage 4 pleural mesothelioma typically have a life expectancy of less than 12 months.
After the stage is determined, the medical team can develop an effective treatment plan for an individual’s case.
Pleural Mesothelioma Doctors
Finding a pleural mesothelioma doctor is an essential aspect of a patient’s care. Since the cancer is rare, many primary care physicians and oncologists have little to no experience with the disease. A specialist can accurately make a malignant mesothelioma diagnosis and develop personalized treatment plans, often using new research and clinical trials.
Top Pleural Mesothelioma Doctors in the Country
Pleural Mesothelioma Treatment Options
Most patients with pleural mesothelioma are treated with systemic therapy, which uses drugs that travel throughout the body. The 2026 NCCN Guidelines for Mesothelioma: Pleural recommend systemic therapy as the main treatment for most patients, whether or not the tumor can be removed with surgery. A pleural mesothelioma treatment plan will largely depend on the cell type and stage of disease. Generally, treatment plans are not intended to cure the disease.
Surgery is an option for a small number of pleural mesothelioma patients. The surgery may be aggressive with the goal of extending life expectancy, or less aggressive with the goal of palliating symptoms (relieving discomfort).
Surgery may be an option for patients with clinical stage 1 disease and the epithelioid cell type who are well enough for a major operation. Pleurectomy/decortication (P/D) is one common surgical option that involves removal of the lining of the lung and chest wall, as well as other impacted tissues and organs.
Another option is an extrapleural pneumonectomy (EPP). The more aggressive procedure includes removing the affected lung, part of the diaphragm and the linings of the heart and lungs. Randomized trials have not found that these operations extend life. The MARS 2 trial, published in 2024, compared extended pleurectomy/decortication plus chemotherapy against chemotherapy alone. Patients who had the surgery lived a median of 19.3 months. Patients who had chemotherapy alone lived 24.8 months. Because of those results, the 2026 NCCN Guidelines for Mesothelioma: Pleural no longer recommend cytoreductive surgery as a primary treatment for stage 2 to stage 4 disease. The guidelines also advise against it for the sarcomatoid and biphasic cell types. When surgery is chosen, NCCN recommends pleurectomy/decortication over extrapleural pneumonectomy.
Doctors often recommend chemotherapy as an additional treatment before or after surgery, or as a first-line therapy for patients with more advanced disease. Two immunotherapy regimens are preferred first-line options for every cell type in the 2026 NCCN Guidelines for Mesothelioma: Pleural. The first is Opdivo® (nivolumab) with Yervoy® (ipilimumab). The second is Keytruda® (pembrolizumab) given with chemotherapy. Carboplatin or cisplatin with Alimta® (pemetrexed) remains a preferred option for the epithelioid cell type. Radiation therapy may also be recommended for select patients to shrink tumors, which may also help relieve symptoms.
After receiving a prognosis of 15 months, pleural mesothelioma patient Heather Von St. James underwent an extrapleural pneumonectomy on February 2, 2006. Heather’s surgery, chemotherapy and radiation were successful. She has survived for more than 20 years and now works as a mesothelioma awareness advocate.
A 2026 study using SEER-Medicare data found that medical care cost an average of about $11,400 per month, plus about $400 per month for prescription medications. Based on the patients’ median survival of about 16 months, total medical costs could reach $150,000 - $200,000 or more per patient. The study did not include the cost of cancer drugs or administering these treatments, so actual costs may be higher.
Understanding treatment costs, along with the risks and benefits of available therapies, is crucial as patients and their loved ones make treatment decisions.
Emerging and Experimental Treatments
Because malignant pleural mesothelioma comprises the majority of mesothelioma cases, most experimental treatment options focus on this specific type. Immunotherapy is no longer experimental for this cancer and is now a standard first-line treatment. Treatments still under study include gene therapy, photodynamic therapy and tumor vaccines, which have shown early promise in clinical trials.
Research is also advancing the efficacy of standard treatments. One study tested pleurectomy/decortication or extrapleural pneumonectomy followed by a heated chemotherapy wash.
A 2026 cohort study of cytoreductive surgery with and without a heated chemotherapy wash found more serious complications in the heated wash group and no survival benefit.
Researchers continue to investigate mesothelioma treatment options to decrease recurrence rates and limit disease progression for patients.
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Common Questions About Pleural Mesothelioma
What causes pleural mesothelioma?
What are the symptoms of pleural mesothelioma?
How is pleural mesothelioma diagnosed?
What is the main treatment for pleural mesothelioma?
How long do pleural mesothelioma patients live?
Is pleural mesothelioma curable?
Note: This page contains statistics gleaned from large groups of patients. These statistics cannot forecast a single patient’s risk, cancer experience or the success of any given treatment. Patients should discuss all cancer screening and treatment decisions with an experienced oncologist.
Sources
American Cancer Society - Causes, Risk Factors, and Prevention of Mesothelioma; 2/3/2026
National Library of Medicine - Life Expectancy in Pleural and Peritoneal Mesothelioma; 1/23/2017
Journal of the National Cancer Institute - Pleural Plaques and the Risk of Pleural Mesothelioma; 2/19/2013
Sage Journals - Malignant Pleural Mesothelioma: A Comprehensive Review; 10/1/2006
Free Pleural Mesothelioma Guide
Dr. Francis Perry Wilson is the Director of the Clinical and Translational Research Accelerator at the Yale University School of Medicine. He specializes in nephrology and clinical research.
Amy Zappone brings nearly two decades of experience in education and research-based communication. At Mesothelioma.com, she translates complex topics into understandable resources that help patients and families make informed decisions.
