Pleural mesothelioma is a cancer of the protective lining of the lung, known as the pleura. It is caused by inhaling asbestos fibers into the lungs. It is the most common form of mesothelioma.

What is Pleural Mesothelioma?

Pleural mesothelioma makes up roughly 75 percent of all mesothelioma diagnoses. Mesothelioma develops in the lungs when asbestos fibers are inhaled and lodge into the lining of the lungs (pleura). The average life expectancy of a person with pleural mesothelioma is between 12 and 21 months depending on how advanced the disease is and the treatments they receive.

How Is Pleural Mesothelioma Treated?

  • Extrapleural Pneumonectomy (EPP)

    This surgery involves the complete removal of the diseased lung and lining. It is a common curative treatment for stage 1 and 2 pleural mesothelioma patients.

  • Pleurectomy with Decortication (P/D)

    A surgeon spares the lung while removing the diseased pleura and all visible tumors. It is less radical than the EPP, but has led to similar survival times in patients.

  • Chemotherapy

    The standard chemotherapy drugs for pleural mesothelioma are Alimta and cisplatin. Chemotherapy is often used before and after surgery.

  • Radiation

    Radiation techniques are being developed to specifically target tumors, leaving healthy lung tissue unharmed. It is the least invasive treatment option for pleural mesothelioma.


Pleural mesothelioma patients may experience symptoms associated with common illnesses, such as the onset of a fever, shortness of breath or persistent 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.


The first step toward diagnosing pleural mesothelioma is taking imaging tests, such as X-rays or CT scans. If the test results determine the possible presence of cancerous tumors, doctors perform a biopsy on the suspected lung. 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, such as the heart and diaphragm. There have also been cases of pleural mesothelioma spreading to the brain, but this is uncommon.

Depending on the results of the biopsy and how much 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 of Pleural Mesothelioma:

  • 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 asbestos exposure is the most common cause of mesothelioma although exposure in the home can occur as well.

Genetic factors may also play a role in the development of mesothelioma. It seems some people who are exposed to asbestos have a genetic makeup that puts them at a higher risk of developing mesothelioma. However, this connection has not been fully investigated.

How Pleural Mesothelioma Develops

  • 1
    Inhaled asbestos particles are sharp and can get stuck in the pleura. This can include both the visceral (inner) or the parietal (outer) pleura.
  • 2
    The body cannot expel all of the asbestos fibers. These fibers can cause irritation, inflammation, scarring, and genetic damage.
  • 3
    The genetically damaged cells can no longer receive signals to stop dividing. They multiply indefinitely, creating 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 mesothelioma can easily spread to nearby organs.

Veterans with Pleural 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)

The extrapleural pneumonectomy is a common surgical treatment for stage 1 or 2 malignant pleural mesothelioma. During an EPP, a surgeon removes the diseased lung as well as the pleural space covering the lung, heart, and diaphragm.

The goal of the 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 perfected the EPP for mesothelioma and is one of the leading mesothelioma physicians in the country.

Pleurectomy/Decortication (P/D)

The pleurectomy/decortication is used in early stage mesothelioma to remove the cancerous pleura. It may also be used in later stages to alleviate pain and improve breathing by allowing the lung to expand more easily.

The pleurectomy/decortication helps ease breathing and controls the fluid buildup in the pleura. Tumors on the surface of the lung are also removed. The pleurectomy with decortication was formerly considered inadequate for mesothelioma patients until Dr. Robert Cameron perfected the procedure. It is now considered a highly effective surgery that rivals the EPP.

Secondary Treatment


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 most 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 approved for mesothelioma because of the limited treatment options available for mesothelioma patients.

Pleural mesothelioma patients are often given intrapleural chemotherapy. This process uses a catheter to apply chemotherapy directly to the tumor site. This technique is mostly used in stage 1 patients because the cancer has only spread to the pleura.


Radiation alone is rarely curative for mesothelioma patients. 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 used for late stage patients to help ease pain caused by fluid buildup or tumor pressure. The radiation can shrink the tumor, which can alleviate pressure in the chest and lungs.

Not every patient receives the same types of chemotherapy and radiation. Mesothelioma specialists can provide their patients with a specialized treatment plan. Find the right mesothelioma specialist for your diagnosis using our free Doctor Match program.


The prognosis is an estimate of a particular patient’s outlook and life expectancy 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 at 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. Learn more about pleural mesothelioma and treatments that can improve your prognosis in our free Mesothelioma Guide.