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Written By: Karen Ritter, RN BSN

Malignant Mesothelioma

Mesothelioma is a rare type of cancer caused by asbestos exposure. Microscopic asbestos fibers can be unknowingly inhaled or swallowed, causing irritation to tissues, cell mutation and mesothelioma tumor formation. The disease typically forms in the lining of the lungs or abdomen. It can often take decades for cancer to form and present symptoms, making diagnosis and treatment of mesothelioma challenging. Connecting with a mesothelioma specialist is essential to fighting this rare disease.

Dr. Abraham Lebenthal

Medically Reviewed By

Dr. Abraham Lebenthal

Mesothelioma Thoracic Surgeon


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Statistics for Mesothelioma

  • Less than 3,000 cases are diagnosed each year in the U.S.
  • Asbestos exposure is the only cause, and it takes decades to develop after exposure.
  • The prognosis is typically poor due to challenges in diagnosis and treatment.
  • The four types of mesothelioma are pleural (80%), peritoneal (20%), pericardial (1%) and testicular (rare occurrence).
  • Mesothelioma occurs more often in men than women.
  • At-risk occupations include military veterans, shipbuilding, construction, electrical work, automobile repair, mining, plumbing, roofing and more.
asbestos fibers injested in the body with mesothelioma tumors forming in the lining around the lungs

Asbestos Fibers Entering the Body

Cause of Mesothelioma

Mesothelioma is a type of cancer that develops due to asbestos exposure. Asbestos is a naturally occurring mineral that was frequently used throughout many American industries during the 20th century. The mineral was valued for its affordability, durability and resistance to heat.

However, the health risks associated with the substance were unknown to the public until the late 1980s, which was decades after the majority of American buildings, schools, offices, homes and countless other structures, products and materials contained asbestos.

Anyone diagnosed with mesothelioma was likely exposed to asbestos in some way. Asbestos exposure can occur by the slightest disturbance of an asbestos-containing product or material. Since the mineral was used throughout construction and other industries that involve hard labor or power tools, exposure was a common occurrence on job sites.

Chrysotile and Tremolite asbestos

Drilling, sawing, grinding, hammering, or any other sort of action can disturb asbestos and send microscopic fibers into the air – similar to a cloud of dust. Anyone near the asbestos dust is at risk of exposure.

Without proper protective equipment, one can inhale or swallow the tiny, needle-like fibers, causing mesothelioma among other severe health conditions. The asbestos fibers can become lodged in the protective linings of the lungs, abdomen or heart, causing tissue irritation, cell mutation and the development of mesothelioma.

One of the challenges of mesothelioma is the long latency period, which is the length of time between initial exposure and official diagnosis. It can often last decades, resulting in late-stage diagnosis, difficulty treating the cancer and a poor prognosis.

Who Is at Risk?

The only risk factor for mesothelioma is exposure to asbestos. Due to the widespread use of asbestos throughout the U.S. in the 20th century, many people are at risk of developing mesothelioma. Exposure to the substance often occurred on job sites or through the use of certain consumer products.

People exposed to asbestos while at work are victims of occupational asbestos exposure and have an increased risk of mesothelioma.

Anyone who worked in these occupations has a higher risk of developing mesothelioma:

  • Construction and insulation workers
  • Military veterans
  • Electricians
  • Pipefitters and plumbers
  • Automobile mechanics
  • Firefighters
  • Shipbuilders and shipyard workers

Others risk:

Types of Mesothelioma

There are technically four types of mesothelioma. However, two are more commonly diagnosed: pleural mesothelioma and peritoneal mesothelioma. The other two – pericardial mesothelioma and testicular mesothelioma – are rare occurrences.

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Pleural Mesothelioma

  • Accounts for approximately 75-80% of all mesothelioma cases
  • Forms in the lining of your lungs (pleura)
  • Main symptoms: Shortness of breath, chest pain, persistent cough, fluid buildup around the lungs (pleural effusions)
  • Treatment: Surgery, chemotherapy, immunotherapy, radiation, tumor treating fields and clinical trials
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Peritoneal Mesothelioma

  • Accounts for approximately 10-15% of all mesothelioma cases
  • Forms in the lining of your abdomen (peritoneum)
  • Main symptoms: Abdominal pain, unexplained weight loss, abdominal distension and fluid buildup in the abdomen (ascites)
  • Treatment: Surgery, chemotherapy, HIPEC (heated intraperitoneal chemotherapy), immunotherapy and clinical trials
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Pericardial Mesothelioma

  • Accounts for approximately 1% of all mesothelioma cases
  • Forms in the lining of your heart (pericardium)
  • Main symptoms: Shortness of breath, chest pain and irregular heartbeat
  • Treatment: Surgery, chemotherapy and clinical trials
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Testicular Mesothelioma

  • Accounts for less than 1% of all mesothelioma cases
  • Forms in the lining of the testes
  • Extremely rare occurrence

How To Diagnose Mesothelioma

A biopsy is the only definitive way to confirm a mesothelioma diagnosis. A biopsy is a surgical procedure required in order to retrieve tissue samples, so a pathology lab can run tests and detect the presence of cancer.

doctor with a patient for examination

Unfortunately, mesothelioma is often misdiagnosed and frequently mistaken for other illnesses.

We suggest visiting a renowned cancer center with mesothelioma specialists to undergo the required testing for determining an accurate diagnosis of mesothelioma. Tests used to help diagnose mesothelioma include:

  • Chest X-ray
  • CT scan
  • PET scan
  • Biopsy

Symptoms of Mesothelioma

Symptoms of mesothelioma often do not emerge until 20-50 years after asbestos exposure. Initial symptoms of mesothelioma may mimic those of common illnesses, such as shortness of breath or abdominal pain. It’s important to be aware of the signs and symptoms of mesothelioma if you have a history of exposure.


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Pleural effusions

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Night sweats

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Chest or abdominal pain

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Weight loss

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Difficulty breathing

Symptoms of Pleural Mesothelioma

Pleural mesothelioma forms in the lungs, which results in symptoms resembling a severe cold or pneumonia. Symptoms of mesothelioma may include:

  • Shortness of breath
  • Persistent cough
  • Fatigue
  • Chest pain
  • Difficulty breathing
  • Generalized fatigue
  • Unexplained weight loss
  • Night sweats
  • Fever
  • Fluid buildup in or around the lungs (pleural effusions)

Symptoms of Peritoneal Mesothelioma

Peritoneal mesothelioma forms in the abdomen, which means symptoms may be similar to gastritis or irritable bowel conditions. Symptoms of mesothelioma may include:

  • Abdominal pain
  • Bloating
  • Unexplained weight loss
  • Nausea
  • Vomiting
  • Constipation or other bowel issues
  • Fatigue
  • Digestion problems
  • Fluid buildup in the abdominal cavity (ascites)

Stages of Mesothelioma

There are four stages of mesothelioma, which are determined by how the cancer spreads in the body. Stage 1 and stage 2 are considered the early stages of mesothelioma, while stage 3 and stage 4 are considered more advanced. The most common mesothelioma diagnosis is stage 3 mesothelioma. Treatment options vary depending on the stage of diagnosis.

Stage 1

lung with stage 1 mesothelioma tumor growth
  • Average life expectancy: 20 months
  • Mesothelioma is contained to the lining, where it formed
  • Other organs and lymph nodes have not been affected
  • Many treatment options available to extend life expectancy

Stage 2

lung with stage 2 mesothelioma tumor growth
  • Average life expectancy: 19 months
  • Mesothelioma may have spread beyond the lining
  • Nearby organs and lymph nodes are now at risk
  • Many treatment options available to extend life expectancy

Stage 3

lung with stage 3 mesothelioma tumor growth
  • Average life expectancy: 16 months
  • Mesothelioma is no longer localized to the lining
  • Lymph nodes, surrounding tissue and other organs may now be affected
  • Treatments are used to slow progression and minimize symptoms

Stage 4

lung with stage 4 mesothelioma tumor growth
  • Average life expectancy: 11 months
  • Mesothelioma has spread to distant organs and tissues
  • Patients may experience painful and difficult symptoms
  • Treatment is concentrated on palliative care (pain relieving)

Treatment for Mesothelioma

The main options for mesothelioma cancer treatment are surgery, chemotherapy, immunotherapy and radiation. Doctors often use a combination of treatments to improve overall survival. New and emerging therapies include Optune Lua (tumor treating fields device), virotherapy and gene therapy. Specialists develop treatment plans based on varying factors, such as the type of mesothelioma and the patient's overall health and age at the time of diagnosis.

The United States Food and Drug Administration has approved three therapies for unresectable mesothelioma:

  • Pemetrexed and cisplatin – chemotherapy drugs
  • Keytruda, Opdivo and Yervoy – immunotherapy drugs
  • Optune Lua – tumor treating fields device
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Surgery is often the most effective way to treat mesothelioma. It removes all visible tumors and diseased tissue, which can improve the effectiveness of other mesothelioma treatments. Surgical options for mesothelioma include:

  • Extrapleural pneumonectomy (EPP)
  • Pleurectomy with decortication (P/D)
  • Cytoreduction surgery with HIPEC (heated intraperitoneal chemotherapy)
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Chemotherapy involves the use of cancer-killing drugs to slow the progression of the cancer, shrink tumors, and kill mesothelioma cells. It is often used as a stand-alone treatment if surgery is not an option. Many doctors administer chemotherapy prior to surgery to slow the progression of the cancer and shrink the tumors. Pre-surgical chemotherapy can help to improve the success of surgical tumor removal. After surgery, chemotherapy is used to kill any remaining mesothelioma cells.

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Immunotherapy uses medications to help boost the patient’s immune system and help fight mesothelioma. In 2020, the FDA approved two immunotherapy drugs, Opdivo and Yervoy, for the treatment of unresectable pleural mesothelioma. This medication combination is becoming a first-line treatment and is proving to extend survival. The FDA has also approved another immunotherapy drug, Keytruda, for the treatment of a select group of pleural mesothelioma patients.

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Radiation uses high-energy beams to kill diseased cells, such as mesothelioma cells. This treatment method is primarily used for pleural mesothelioma. When used before or after surgery, radiation may improve overall survival times.

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Optune Lua

Optune Lua was approved by the FDA in 2019 for the treatment of unresectable pleural mesothelioma. It is a wearable device that sends electrical waves through the body in an attempt to disrupt cancer cell division and growth. Optune Lua is paired with chemotherapy and has led to an 18-month median survival in some patients.

Mesothelioma Survival

The average survival for mesothelioma cancer is 1-2 years, which can vary depending on several contributing factors based on the health and age of the patient, where the patient's mesothelioma originally formed and the treatment plan.

Some patients may have a more positive prognosis due to eligibility for surgery or participating in a clinical trial that focuses on mesothelioma research. Others outlive their initial life expectancy due to surgery effectiveness or overall health.

There are other ways to improve a mesothelioma prognosis if surgery is not an option. Prioritizing overall health is key to improving a prognosis. Implementing healthy diet and lifestyle changes can positively impact your life expectancy, as well as maintaining an optimistic outlook on life. Staying hopeful and positive can be beneficial to a patient's mental, emotional and physical state.

Prognosis for Pleural Mesothelioma

Doctors typically predict people with pleural mesothelioma will live at least 12-18 months with treatment, such as immunotherapy or chemotherapy. Surgery, a more aggressive treatment, can improve a pleural mesothelioma prognosis to around two years.

Survival for early-stage (stage 1 or 2) malignant pleural mesothelioma patients:

  • Patients diagnosed with stage 1 lived for an average of 22 months.
  • Patients diagnosed with stage 2 live for an average of 19 months.

Survival for late-stage (stage 3 or 4) pleural mesothelioma patients:

  • The average survival is around 15 months for stage 3.
  • The average survival is usually 11-12 months for stage 4.

These figures include all the mesothelioma cell types (epithelioid, sarcomatoid and biphasic mesothelioma).

Unfortunately, most patients are diagnosed in stage 3 or stage 4. The disease often hides in tissue linings for years before symptoms occur, and by the time patients see their doctor and get a biopsy for diagnosis, the disease is in stage 3 or stage 4.

Prognosis for Peritoneal Mesothelioma

Peritoneal mesothelioma patients typically have the longest expected survival as the cancer does not spread as quickly.

The main staging system used for peritoneal mesothelioma is called the Peritoneal Cancer Index (PCI). It involves establishing a score for different sections of the abdomen. Depending on the score, doctors will determine a stage, or whether the cancer is localized or metastatic. Patients with localized tumors, or low PCI scores, are considered an early-stage diagnosis.

Surgical treatment for peritoneal mesothelioma depends more on overall health than on the stage of diagnosis. Cytoreductive surgery and HIPEC is the primary reason for the hopeful outcomes for malignant peritoneal mesothelioma patients. This mesothelioma treatment approach is associated with a predicted life expectancy of 3-5 years depending on specific patient factors, such as age and health.

Mesothelioma Specialists and Treatment Centers

Seeking advice from a doctor specializing in mesothelioma is crucial after receiving a diagnosis of this rare cancer. Whether you are looking for an initial consultation or a second opinion, this is the best way to find the most effective treatments for your specific diagnosis.

Top Mesothelioma Treatment Centers:

  • Brigham and Women’s Hospital (Boston)
  • National Cancer Institute (Bethesda, Maryland)
  • Baylor St. Luke’s Medical Center (Houston)
  • Mount Sinai Medical Center (New York City)
  • MD Anderson Cancer Center (Houston)
  • Moffitt Cancer Center (Tampa)
  • Memorial Sloan Kettering Cancer Center (New York City)

VA Healthcare System for Mesothelioma

Veterans with mesothelioma can seek treatment at VA hospitals with dedicated mesothelioma programs.

Specialists from prestigious cancer centers work at these VA hospitals as part of the VA healthcare system:

  • Houston VA
  • Los Angeles VA

Mesothelioma Support Resources

There are specialized resources available to support people with mesothelioma, mesothelioma survivors and their loved ones. Online and in-person support groups are offered to patients, family members and caregivers.

Other support resources:

  • Help finding mesothelioma specialists
  • Patient guidance and assistance from a registered nurse
  • Travel grants and discounted lodging
  • Explanation of legal rights
  • Financial compensation
  • Help with filing VA claims from a VA-accredited claims agent
  • VA benefits for veterans and their families

Get in Touch With an Expert

Our patient advocates dedicate their professional lives to helping people affected by mesothelioma. They are an invaluable asset in helping you fight this cancer.

Available resources:

  • Large database of top specialists and treatment centers
  • Subject matter experts with knowledge of mesothelioma and treatment methods
  • Access to travel grants, travel discounts and housing assistance if travel is required to visit a mesothelioma doctor or receive treatment
  • Expert assistance in filing all asbestos-related VA claims

Legal Rights and Assistance

Asbestos exposure is a result of deceit and negligence by the asbestos industry, its manufacturers and associated corporations. American companies knew asbestos was dangerous, but they continued manufacturing the mineral into everyday products.

Since asbestos is the only known cause of this rare cancer, the companies responsible for asbestos manufacturing and distribution are legally liable for mesothelioma. The victims of this rare cancer deserve compensation. Fortunately, mesothelioma attorneys dedicated to advocating for people with asbestos diseases can help you receive the compensation you rightfully deserve.

Types of Mesothelioma Compensation

Victims of mesothelioma can file lawsuits and asbestos trust fund claims to receive compensation. Lawsuits can lead to verdicts or settlements in excess of $1 million.

Asbestos trust fund claims are the most common mesothelioma compensation. When asbestos companies tried to file for bankruptcy in order to sidestep future mesothelioma lawsuits, the court system required them to establish trust funds to compensate future victims.

Common Questions About Mesothelioma

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What is mesothelioma?

Mesothelioma is a type of cancer that occurs due to asbestos exposure. There are two main types. The most common type is called pleural mesothelioma, and the second most common is peritoneal mesothelioma. Diagnosis and treatment can be challenging, but cancer research is ever-evolving and bringing new treatment approaches to the medical field. Surgery is typically the most effective treatment. However, if the cancer has spread to vital organs and tissues, surgery may not be an option. Chemotherapy and immunotherapy are common treatments, as well.

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What causes mesothelioma?

The only proven cause of mesothelioma is asbestos exposure. Loose strands of asbestos float in the air, invisible to the naked eye, and are easily inhaled or ingested. These fibers can travel into your lungs or abdomen and lodge into sensitive mesothelial linings, which causes cells to mutate and tumors to form. Mesothelioma is not the only disease caused by asbestos exposure. Mesothelioma and lung conditions, such as cancer and asbestosis, may occur as a result of exposure.

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How many types of mesothelioma are there?

There are two main types of mesothelioma: pleural and peritoneal. Pleural mesothelioma is a form of lung cancer that develops in the thin lining covering your lungs and is the most common. Peritoneal mesothelioma is a form of cancer that develops in the lining around your abdomen, accounting for around 20%. Pericardial and testicular mesothelioma are two extremely rare types. Asbestos causes most cases of mesothelioma; however, the way asbestos fibers infiltrate the lining of the heart and testicles is unknown. Therefore, pericardial mesothelioma and testicular mesothelioma are very rare occurrences.

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Is mesothelioma always fatal?

Mesothelioma is an aggressive cancer that can spread quickly to vital organs, such as your lungs, diaphragm, heart or intestines. The average survival time for mesothelioma is 1-2 years, but medical advancements have improved the prognosis for many patients. Starting treatment immediately offers the best chance of beating this cancer.

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Who faces the highest risk of mesothelioma?

Men ages 55 and older account for the majority of all mesothelioma cases. This is due to men often working jobs that involved high risks of asbestos exposure. The occupations at greatest risk of developing mesothelioma are construction, electrical work, automobile repair, roofing, shipbuilding and military service.

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How many people get mesothelioma in the United States?

There are less than 3,000 documented cases of mesothelioma in the U.S. each year. This makes mesothelioma one of the rarest cancers. It is four times more common in men than women, and it predominantly affects older Americans compared to young adults.

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How do you know if you have mesothelioma?

The primary symptoms of mesothelioma are pain, fluid buildup in the chest or abdomen, fever, weight loss, decreased appetite, fatigue, and difficulty breathing. Unfortunately, these symptoms are also common with the flu, pneumonia and gastric ailments. If you have persistent or worsening symptoms, see your doctor immediately for evaluation and testing.

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How can you stop mesothelioma?

The main way to stop the spread of mesothelioma is through early diagnosis and early treatment. Multimodal treatment uses a combination of treatment methods to maximize the cancer-fighting effects. The top three treatments are surgery, chemotherapy and immunotherapy. Aggressive treatment has the best chance of extending survival.

Sources & Author

  1. Mesothelioma incidence in 50 states and the District of Columbia, United States, 2003–2008. International Journal of Occupational and Environmental Health. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4406225/. Accessed: 04/15/2021.
  2. Initial Analysis of the International Association For the Study of Lung Cancer Mesothelioma Database. Journal of Thoracic Oncology. Retrieved from: https://www.jto.org/article/S1556-0864(15)33132-4/fulltext. Accessed: 04/15/2021.
  3. Life Expectancy in Pleural and Peritoneal Mesothelioma. US National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292397/. Accessed: 03/19/19.
  4. Recurrence of Pericardial Mesothelioma Affecting the Myocardium After Pericardial Resection. U.S. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/29792828/. Accessed: 03/19/19.
  5. Mesothelioma: Symptoms and Signs. American Society of Clinical Oncology. Retrieved from: https://www.cancer.net/cancer-types/mesothelioma/symptoms-and-signs. Accessed: 04/15/2021.
  6. Initial analysis of the international association for the study of lung cancer mesothelioma database. Journal of Thoracic Oncology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/23070243/. Accessed: 04/15/2021.
  7. Presentation, initial evaluation, and prognosis of malignant pleural mesothelioma. UpToDate. Retrieved from: https://www.uptodate.com/contents/presentation-initial-evaluation-and-prognosis-of-malignant-pleural-mesothelioma. Accessed: 04/15/2021.
  8. Malignant peritoneal mesothelioma: Epidemiology, risk factors, clinical presentation, diagnosis, and staging. UpToDate. Retrieved from: https://www.uptodate.com/contents/malignant-peritoneal-mesothelioma-epidemiology-risk-factors-clinical-presentation-diagnosis-and-staging. Accessed: 04/15/2021.
Karen Ritter

About the Writer, Karen Ritter, RN

Karen Ritter, a registered nurse, is the lead patient advocate for Mesothelioma Guide. She has a deep passion for patient care, which includes helping patients and their families search for treatment options at the top mesothelioma cancer centers. She finds the balance between encouraging patients to receive the best treatment possible while enjoying their time with loved ones and friends. Karen is a valuable asset for patients due to her knowledge of mesothelioma, compassion for the victims of this disease and dedication to guiding patients through their treatment journey.

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