Pleural mesothelioma is a form of cancer in the pleura (protective lining of the lung). It is caused by exposure to asbestos fibers and inhaling the fibers into the lungs.

What is Pleural Mesothelioma?

Pleural mesothelioma is the most common form of mesothelioma and makes up 75% of all mesothelioma diagnoses. Mesothelioma develops in the lungs when asbestos fibers are inhaled and latch onto the lining of the lungs, known as the pleura.

How Is Pleural Mesothelioma Treated?

  • Extrapleural Pneumonectomy Mesothelioma Treatment Icon

    Extrapleural Pneumonectomy

    This surgery involves the complete removal of the diseased lung, including the diseased pleura. It is the most common curative treatment for stage 1 and 2 pleural mesothelioma patients. Many patients who received this treatment reached remission.

  • Extrapleural Pneumonectomy Mesothelioma Treatment Icon

    Pleurectomy with Decortication

    This surgery involves removing pleura of the lung, as well as all visible tumors, and spares the lung. It is considered less radical than the EPP and has been successful in the treatment of pleural mesothelioma for many patients.

  • Mesothelioma Chemotherapy Treatment Icon


    This is commonly used to reduce the size and strength of tumors prior to, during and after pleural mesothelioma surgical procedures. The standard chemotherapy drugs used are Alimta combined with cisplatin.

  • Mesothelioma Radiation Treatment Icon


    This is one of the least invasive treatment options for pleural mesothelioma. Radiation is commonly used to destabilize and shrink tumors. Radiation techniques are developing to specifically target tumors, leaving healthy tissue unharmed.


Prior to a pleural mesothelioma diagnosis, patients may experience symptoms associated with common illnesses, such as the onset of a fever, shortness of breath or coughing. Although these symptoms are common, if a patient has been exposed to asbestos in the past, it is important they consult a physician. Other symptoms include:

  • Lower Back Pain
  • Shortness of Breath (dyspnea)
  • Unexplained Weight Loss
  • Swelling of Face or Arms
  • Fluid Buildup (Pleural Effusion)
  • Chest Pain (Pleurisy)
  • Dry or Painful Cough
  • Fever or Sweating
  • Tissue Lumps in the Chest
  • Coughing up Blood (Hemoptysis)

Pleural mesothelioma can be hard to detect because its symptoms, such as shortness of breath and fever, are common in other respiratory ailments. Because mesothelioma is so rare, general practitioners may not readily recognize mesothelioma as a possible diagnosis. Fortunately, research is constantly underway to discover more effective ways to detect mesothelioma.


If test results determine the possible presence of cancerous tumors or growths, doctors perform a biopsy on the area. A biopsy is a small fluid or tissue sample that determines if cancer cells are present. Tissue biopsies are the most reliable, with a 96% conclusivity.

Can Pleural Mesothelioma Spread to Other Organs?

Mesothelioma in the pleura can metastasize to the lymph nodes, which can cause cancer to spread throughout the body more quickly. It is common for it to metastasize to the central organs. There have also been cases that linked pleural mesothelioma to spread to the brain, although this is uncommon.

Depending on the results of the biopsy and if the cancer has spread, a patient is diagnosed with a specific stage of pleural mesothelioma. The stages range from 1 to 4.

The 4 Stages:

  • Stage 1

    The cancer is only located in the pleural lining of the lungs.

  • Stage 2

    The cancer has spread to more of the lung, part of the diaphragm, and localized lymph nodes.

  • Stage 3

    The cancer has metastasized to nearby organs and more lymph nodes

  • Stage 4

    The cancer has spread to the other organs and all lymph nodes are fully involved.


The only known cause of mesothelioma is exposure to asbestos fibers. Asbestos products are usually found in homes and businesses built prior to the 1980’s. Occupational exposure is the most common form, although exposure in the home can occur as well.

Genetic factors may also play a role in the development of mesothelioma. However, this connection has not been fully investigated. The genetic links may actually be sourced to common exposure to asbestos-related environments.

Pleural Mesothelioma Develops When:

  • 1
    Inhaled asbestos particles irritate the pleura, resulting in inflammation. This can include both the visceral (inner) or the parietal (outer) pleura.
  • 2
    The body cannot expel all of the asbestos fibers. These fibers cause the pleural tissue to develop into scar tissue.
  • 3
    The scar tissue causes genetic damage and tumors.
 It takes anywhere from 10 to 50 years after asbestos exposure for mesothelioma to develop in the pleura.
Mesothelioma in the pleura spreads quickly because of its proximity to vital organs.

Generally, it develops in the lining of the lungs and then spreads to the rest of the lung, the chest wall, or the nearby diaphragm. The central location of the lungs in the body means the other vital organs are nearby.

Pleural Mesothelioma Body
Pleural Mesothelioma Lung

Pleural Mesothelioma

Veterans with Mesothelioma

The largest group (over 30 percent) of people diagnosed with mesothelioma is military veterans, specifically those who served in the Navy. Asbestos was so applicable as an insulator in military vehicles, naval vessels and bunkers that it was virtually impossible to avoid inhaling airborne asbestos fibers at some point.

This is why veterans make up the largest group of patients with pleural mesothelioma and why the VA grants them certain benefits. Veterans who have been diagnosed with this disease should be aware that:

  • Disability benefits are usually available to all veterans with mesothelioma, and these benefits can offset the costs of treatment, travel and missed work.
  • Finding a specialist is imperative because general oncologists are inexperienced in treating this rare disease.
  • There are pleural mesothelioma specialists in the VA health system who lead treatment centers that rival the top mesothelioma cancer centers.

Learn more about what veterans can do to support their families and live longer in our free Veteran’s Support Guide.


Extrapleural Pneumonectomy (EPP)

Extrapleural Pneumonectomy Mesothelioma Surgery TreatmentExtrapleural pneumonectomy is the most common surgical treatment for stage 1 or 2 malignant pleural mesothelioma. During EPP, a surgeon removes the diseased lung as well as the pleural space covering the lung, heart, and diaphragm.

The goal of EPP is to remove as much, if not all, of the cancerous tissue possible. Chemotherapy may be used as a pre-surgery (neoadjuvant) precaution to shrink the tumors and may also be recommended post-surgery (adjuvant). Dr. David Sugarbaker is the creator of the EPP for mesothelioma and is one of the leading mesothelioma physicians in the country.

Pleurectomy/Decortication (P/D)

Pleurectomy with Decortication Mesothelioma Surgery TreatmentPleurectomy with decortication may be used in stage 1 mesothelioma to remove the cancerous pleura. It also may be used in stages 3 or 4 to alleviate pain while breathing because the lung cannot expand entirely.

Pleurectomy with decortication helps ease breathing and controls the fluid build-up in the pleura. Tumors on the surface of the lung are also removed. The procedure was formerly considered inadequate for mesothelioma patients until Dr. Robert Cameron perfected the procedure.

Treatment Debate

There are 2 surgical treatment options available to most early stage (1 and 2) pleural mesothelioma patients. The options are the extrapleural pneumonectomy (EPP) and the pleurectomy/decortication (P/D). The EPP involves the removal of the affected lung and the P/D involves only the removal of the lining of the affected lung.

Each procedure has risks and benefits. Each procedure has improved the quality of life for countless of patients and have even produced survivors in each case. However, there is a contentious treatment debate in the mesothelioma community regarding the procedures.

On the side of the EPP, doctors believe the surgery does more to remove all cancerous material in patients, providing a better chance for survival. On the side of the P/D, doctors believe the EPP is too radical and that the P/D produces comparable survival rates to that of the EPP.

Secondary Treatment


Currently, the most effective form of chemotherapy given to pleural mesothelioma patients is the combination of Alimta and cisplatin. This combination is the standard for chemotherapy treatment and is given to all pleural mesothelioma patients.

Alimta is the only medication of its kind approved by the FDA to specifically treat mesothelioma. Doctors may also use drugs not yet been approved to treat mesothelioma patients.

Another form of chemotherapy given to pleural mesothelioma patients is known as intrapleural chemotherapy. This process involves a catheter which applies the chemotherapy directly to the tumor site. This technique is only used in stage 1 patients because the cancer has only spread to the pleura.


For mesothelioma patients, radiation techniques are rarely curative when used on their own. Radiation may be used before or after surgery, such as an extrapleural pneumonectomy. Radiation used after surgery has shown to greatly reduce the possibility of cancer recurrence.

Radiation is not usually used in the later stages of pleural mesothelioma because it has spread to other parts of the body. The only instance in which radiation would be used would be for palliative purposes.

There may be chest discomfort due to fluid build up or tumor pressure, in these circumstances, radiation may be used. The radiation may help with tumor pressure because it shrinks the tumor to alleviate the pain.

Mesothelioma specialists provide patients with a complete pleural mesothelioma treatment plan (including chemotherapy and radiation treatments). Find the right mesothelioma specialist for your diagnosis using our free Doctor Match program.


The prognosis tells them what their estimated life expectancy is based on the experience of past pleural mesothelioma patients.

There are many factors that play a role in a patient’s life expectancy, including:

  • Cell type
  • Stage of cancer
  • Age
  • Overall health
  • Type of treatment received

The type of treatment the patient receives depends on their personal diagnosis. The treatments most successful in improving life expectancy take a multimodal approach, such as having chemotherapy prior to surgery. Surgery alone can also greatly improve odds of survival.

One study done by Dr. David Sugarbaker showed there was a 5-year (or longer) survival rate in patients who underwent an extrapleural pneumonectomy. These patients had epithelioid cell types and no lymph node involvement (stage 1).

The earlier mesothelioma is detected the sooner treatment can begin. You can also learn how survivors beat their prognosis in our free Mesothelioma Survivor’s Guide.