Almost all mesothelioma cases start in one of two areas: the pleura or the peritoneum. Hence, the two most common types of the disease are pleural mesothelioma and peritoneal mesothelioma.

Most patients only have one type, and their treatment options will be based on which one it is. What about the people who have both?

A recent study examined 50 patients who had both pleural mesothelioma and peritoneal mesothelioma. All forms of this cancer are extremely rare, with only around 3,000 new cases in the United States each year. So cases involving two types is quite noteworthy.

The study investigates treatment options for these unique mesothelioma cases and whether a dual diagnosis leads to extreme limitations.


Where and How Does Mesothelioma Form?

Most patients have pleural mesothelioma, which develops in the thin membrane cavity separating the chest wall and lungs (pleura). Peritoneal mesothelioma originates in the peritoneum, which lines the exterior of the abdominal cavity.

The only proven cause of this cancer is asbestos exposure. Small, invisible-to-the-naked-eye asbestos fibers can enter our bodies either through inhalation or ingestion. While the body can discard most of these particles, some reach the pleura or peritoneum and lodge into the cellular lining. These fibers are irritants and cause the cells to mutate, duplicating at unchecked rates and clumping together to form tissue masses known as tumors.

While not an exact science, inhaling asbestos is linked most often to pleural mesothelioma. Sure enough, ingesting these particles is connected usually to peritoneal mesothelioma. Mesothelioma expert Dr. Daniel Sterman, of NYU Langone Health, confirmed to Mesothelioma Guide that these cause-and-effect relationships are credible.

Most mesothelioma patients want to know their disease’s cause and where it originated. Once they absorb this information, they’ll likely want to know their prognosis and treatment options. The end goal is to kill most or all of the cancer — or at least stop it from spreading any further.

Is that twice as hard to accomplish for patients with two types of mesothelioma? The answer, according to the study, is an encouraging “no.”


The Cases Involving Both Types of Mesothelioma

The median survival rate for the 50 patients examined was 33.9 months. Attaining a 33.9-month median survival is promising considering the stats for pleural mesothelioma. This type of the cancer has a life expectancy between 12 and 21 months for most patients, with a wide range due to stage and treatment options.

For peritoneal mesothelioma, the survival time is often longer. Some patients survive for five years.

The researchers also found that these patients often learned quickly about their other disease. Around 52% of them were diagnosed with the “second-cavity disease” within one year after the initial diagnosis. Learning of both mesotheliomas as soon as possible can help patients form a treatment plan and attack the tumors before they spread to vital organs.


Treatment Options for Dual-Cavity Mesothelioma

“The presence of disease in both cavities is not a contraindication to multimodality treatment aimed at prolonging survival,” the study states.

In other words, these patients weren’t restricted from the top mesothelioma treatment options: surgery, chemotherapy or radiation. Pleural mesothelioma patients have two primary surgical procedures: extrapleural pneumonectomy and pleurectomy with decortication. Peritoneal mesothelioma patients often undergo cytoreduction with heated intraperitoneal chemotherapy.  Chemotherapy and radiation can be used before, during or after treatment to shrink the size of the tumors or address the remaining diseased cells not removed during the operation.

This multimodal approach doesn’t change just because someone has both types of the cancer. Both diseases can be addressed, and patients can live long and healthy lives.

If you have either pleural mesothelioma or peritoneal mesothelioma — or both — then we can help you find a doctor who specializes in this rare cancer. Going to a hospital with a renowned mesothelioma department is vital to improving your prognosis. Email our patient advocate and registered nurse, Karen Ritter, at to connect with a specialist.

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    Sources & Author

  1. 50 Patients with Malignant Mesothelioma of Both the Pleura and Peritoneum: A Single-Institution Experience. Annals of Surgical Oncology. Retrieved from: Accessed: 11/01/19.
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About the Writer, Devin Golden

Devin Golden is the content writer for Mesothelioma Guide. He produces mesothelioma-related content on various mediums, including the Mesothelioma Guide website and social media channels. Devin's objective is to translate complex information regarding mesothelioma into informative, easily absorbable content to help patients and their loved ones.