Written By: Devin Golden
Pleural Mesothelioma
Pleural mesothelioma is a type of cancer that forms in the lining of the lung, known as the pleura. Asbestos exposure is the only known cause. Pleural mesothelioma is the most common type of mesothelioma and has an average survival of approximately 1-2 years.
Medically Reviewed By
Dr. Abraham Lebenthal
Mesothelioma Thoracic Surgeon
Medically Reviewed By
Dr. Abraham Lebenthal
Mesothelioma Thoracic Surgeon
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Everything You Need to Know About Pleural Mesothelioma
Important Facts About Pleural Mesothelioma
- Pleural mesothelioma is the most common type of mesothelioma, accounting for approximately 75-80% of all mesothelioma cases.
- The only known cause of malignant mesothelioma is asbestos exposure.
- Around 80% of patients diagnosed with pleural mesothelioma are males.
- Treatments for pleural mesothelioma include surgery, chemotherapy, immunotherapy, radiation and tumor treating fields.
- Median survival time is usually 1-2 years depending on stage of cancer, patient’s age, overall health status, and therapies used to treat pleural mesothelioma. Some patients survive much longer, and the 5-year survival is 10% and rising as treatment improves.
- Aggressive treatments improve overall survival from pleural mesothelioma. Nearly 50% live for at least one year.
What Is Pleural Mesothelioma?
Pleural mesothelioma is one of four types of the cancer known as mesothelioma. Pleural mesothelioma forms in the lining of the lungs. This lining is called the pleura, which is the thin membrane between the chest wall and lungs.
Mesothelioma is diagnosed in approximately 2,500-3,000 people in the United States each year. Pleural mesothelioma accounts for nearly 80% of all cases of mesothelioma, which equals approximately 2,000 cases per year in the United States.
The average life expectancy for people with pleural mesothelioma is 11-20 months. Patients have been able to exceed this average and even live cancer-free due to surgery, immunotherapy, chemotherapy and radiation.
Malignant Pleural Mesothelioma Causes
The only cause of pleural mesothelioma is exposure to asbestos. This mineral was prized for its durability and heat resistance during the 20th century. Industries used asbestos for engineering and to construct buildings. However, asbestos is cancerous, and people exposed to the mineral can develop pleural mesothelioma.
Asbestos products are usually found in homes and businesses built prior to the 1980s. Occupational asbestos exposure is the most common cause of mesothelioma.
When loose and sharp asbestos fibers are inhaled, they can enter the lining around the lungs. These microscopic fibers irritate cells and cause them to mutate into cancer.
Development of Pleural Mesothelioma
Pleural Mesothelioma Symptoms
Pleural mesothelioma symptoms include:
- Shortness of breath
- Coughing
- Chest pain
- Pain in the lower back
- Fatigue
- Unexplained weight loss
- Swelling of the face or arms
- Fluid buildup in the pleural space
- Night sweats
- Hoarseness
- Trouble swallowing
Early Signs of Pleural Mesothelioma
Some of the early signs of pleural mesothelioma include pleural effusions and pleural thickening.
Detection of pleural mesothelioma is important but also challenging. Not many know the symptoms of mesothelioma, and some disregard them as more common health issues.
If you react quickly and get diagnosed soon enough, you may be eligible for surgery and other aggressive treatment.
Pleural Effusions
Pleural effusions is a symptom of pleural mesothelioma. Pleural effusions are buildup of fluid in the lining of the lungs between the two tissue layers on either side of the lining.
When tumors form, they take up the space in the lining and push fluid into pockets that press against the lungs and chest wall. This causes discomfort for patients.
Doctors can notice pleural effusions on imaging scans, such as an X-ray or computed tomography (CT) scan.
Pleural effusions can be one of the first diagnostic signs of pleural mesothelioma. A report in ScienceDirect found 60% of diagnosed pleural mesothelioma cases had this symptom.
Pleural Thickening
Pleural thickening is a symptom of pleural mesothelioma. Pleural thickening results from chronic inflammation, infection or injury in the lining of the lungs.
Exposure to asbestos can cause inhalation of small asbestos fibers that get into the respiratory system. The fibers penetrate tissue in the lining of the lungs and cause them to thicken.
Thickened pleural tissue can be detected through a chest X-ray or CT scan. The ScienceDirect report found pleural thickening in 88% of diagnosed cases.
Pleural Mesothelioma Diagnosis
Receiving a pleural mesothelioma diagnosis involves multiple steps, including imaging tests and a biopsy.
The first step in diagnosing pleural mesothelioma is imaging tests, such as an X-ray or CT scan. If the test results show abnormalities or possible cancerous tumors, doctors will recommend a tissue biopsy.
A biopsy involves taking small pieces of tissue to test for cancer cells. A biopsy also helps doctors determine details about the cell histology and possibly the stage of the disease (if the biopsy is of a lymph node).
Pleural Mesothelioma Patients
Most pleural mesothelioma patients are older males who worked in blue collar jobs that involved asbestos exposure.
According to the American Society of Clinical Oncology, the median age of patients with pleural mesothelioma is 72. This is at the time of their diagnosis.
According to another study, around 80% of patients are male. Most people who worked jobs where asbestos exposure occurred were male.
Can Pleural Mesothelioma Spread to Other Organs?
Malignant pleural mesothelioma can spread to other organs. Pleural mesothelioma forms near the lungs, which are usually the first organ that tumors reach.
Tumors can spread to the lymph nodes, which can cause cancer to spread throughout the body. The disease also spreads to the nearby lung, heart and diaphragm.
The 4 Stages of Pleural Mesothelioma
Stage 1 is an early stage of pleural mesothelioma. Tumors are only found in the pleural cavity, which is the disease’s point of origin. The cancer likely just developed and has not had enough time to spread to other tissue. Detection at this stage is difficult.
Stage 2 is still an early stage of pleural mesothelioma. The disease is mostly limited to the point of origin, but some localized lymph node involvement begins. Tumors may begin spreading into the lung cavity.
Stage 3 is an advanced stage of pleural mesothelioma. The disease is no longer localized, metastasizing to the nearby lung, the diaphragm and lymph nodes is likely.
Stage 4 is the most advanced stage of pleural mesothelioma. Tumors have spread to nearby structures like lungs, heart, major blood vessels, or spine. The cancer has also spread to at least one distant area.
Pleural Mesothelioma Treatment Options
Pleural mesothelioma treatment includes:
- Surgery
- Chemotherapy
- Immunotherapy
- Radiation therapy
- Tumor treating fields
Treatment depends on the stage, cell type, patient health and more.
Some doctors are best at treating this cancer. These doctors are called mesothelioma specialists. Find an experienced mesothelioma doctor near you using Mesothelioma Guide’s free Doctor Match program.
Surgery
There are two surgeries for malignant pleural mesothelioma: extrapleural pneumonectomy and pleurectomy with decortication.
Chemotherapy
Chemotherapy is approved by the U.S. Food and Drug Administration (FDA) for malignant pleural mesothelioma are pemetrexed and cisplatin.
Immunotherapy
Immunotherapy is approved by the FDA for pleural mesothelioma.
Tumor Treating Fields
Tumor treating fields are FDA-approved for pleural mesothelioma.
Surgery for Pleural Mesothelioma
Surgery for pleural mesothelioma can remove most or all tumors from the patient’s body and help them beat this cancer. The two surgeries for pleural mesothelioma are extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D). The EPP removes the entire affected lung while the P/D surgery preserves this organ.
There are surgeries for pleural mesothelioma to relieve symptoms and make patients feel more comfortable. Thoracentesis and pleurodesis are used to drain fluid from the pleura and improve comfort.
Chemotherapy for Pleural Mesothelioma
Chemotherapy is an FDA-approved treatment for pleural mesothelioma. The chemotherapy drugs approved are pemetrexed and cisplatin.
Doctors may substitute cisplatin with carboplatin if needed. Chemotherapy is often used in combination with other treatments.
Doctors may use chemotherapy during surgery by delivering drugs directly into the lung cavity. This method is called hyperthermic intrathoracic chemotherapy (HITHOC).
Immunotherapy for Pleural Mesothelioma
Immunotherapy is an FDA-approved treatment for malignant pleural mesothelioma. The FDA has approved Keytruda (pembrolizumab), Opdivo (nivolumab) and Yervoy (ipilimumab). All three are approved for unresectable cases, which means the patients do not qualify for surgery.
The FDA approved Opdivo and Yervoy for mesothelioma as a combination in 2020. The FDA approved Keytruda for mesothelioma in 2024.
All three are immune checkpoint inhibitors, which is a type of immunotherapy drug that can target specific types of cancer.
Radiation for Pleural Mesothelioma
Radiation for pleural mesothelioma is one of the oldest treatment options. Radiation sends electromagnetic beams into the patient’s chest to damage cancer cells. The damage causes them to stop multiplying and die.
Radiation is best used with other treatment options, such as surgery. Radiation can shrink the size of tumors before surgery or reduce the chance of recurrence after surgery. It can also be used to relieve symptoms as a palliative treatment.
Tumor Treating Fields for Pleural Mesothelioma
Tumor treating fields is an FDA-approved treatment for pleural mesothelioma. The FDA approved a tumor treating fields device called Optune Lua in 2019. It was originally called NovoTTF-100L System.
The device sends electric fields into the patient’s chest region where the cancer is located. These waves disrupt the growth and division of cancer cells in the pleura and around the lungs to kill cancer.
The device is for non-surgical cases of malignant pleural mesothelioma. It must be used along with chemotherapy.
Pleural Mesothelioma Prognosis
Pleural mesothelioma prognosis is usually 1-2 years but depends on several factors. Some can lead to a better prognosis.
Many factors play a role in a patient’s pleural mesothelioma prognosis:
- Cell type
- Stage of cancer
- Age
- Overall health
- Treatment plan
Pleural Mesothelioma Survival Rates
Pleural mesothelioma survival rates are: 70% for one year of survival; 23% for three years of survival; and 12% for five years of survival. Survival rates are the percentage of people with a disease who reach a specific survival length.
Patients who undergo treatment of malignant pleural mesothelioma can live longer. One study published in the Annals of Thoracic Surgery reported that 50% of patients lived for at least three years after P/D surgery.
Fortunately, more patients have access to and are receiving treatment for pleural mesothelioma. In 2004, only 34% of patients received treatment for their cancer. In 2014, the number rose to 54%. The survival rates increased significantly during that same time.
Surgery is not an option for many people with malignant pleural mesothelioma. Chemotherapy, immunotherapy and tumor treating fields are often the best options for those patients. The average survival for people receiving immunotherapy is 18 months.
The most effective way to improve your prognosis is starting treatment immediately. If you have been diagnosed with this form of mesothelioma, then you should find a mesothelioma specialist for a consultation or second opinion. You may learn your disease is at an earlier stage than you originally were told, and you could have more treatment options available.
Veterans With Pleural Mesothelioma
There are many veterans with pleural mesothelioma. Veterans are the largest group of people diagnosed with mesothelioma.
Asbestos was an insulant in military vehicles, naval vessels and army bunkers. The mineral was so widely used in the military that avoiding airborne asbestos fibers was close to impossible.
Due to the high prevalence of veteran mesothelioma patients, the U.S. Department of Veterans Affairs (VA) provides financial benefits to people with pleural mesothelioma:
- Receive disability benefits, if their disease is service-related
- Find a mesothelioma specialist for treatment within the VA health care system
- Receive pension if their mesothelioma is not service-related
- Set up their loved ones to receive benefits if they die from mesothelioma
Learn more about what veterans can do to support their families and live longer in our free Veteran’s Support Guide.
Frequently Asked Questions About Pleural Mesothelioma
How can you tell if you have malignant pleural mesothelioma?
You can tell if you have malignant pleural mesothelioma by looking for symptoms, seeing a doctor, and getting imaging tests and a biopsy. Identifying the symptoms of mesothelioma is the first step. Typical signs and symptoms of pleural mesothelioma include:
- Persistent cough
- Chest pain
- Night sweats
- Difficulty breathing
- Fluid buildup around the lungs
- Weight loss
How long do people live with pleural mesothelioma?
People with pleural mesothelioma usually live for 1-2 years. The prognosis for mesothelioma varies based on the stage of the cancer and health of the patient. Treatment is the best way to extend survival.
How is pleural mesothelioma diagnosed?
Pleural mesothelioma is diagnosed with a biopsy. This procedure removes samples of tissue from the lining of the lungs where tumors first show up. Before a biopsy, physicians perform different imaging scans to look for signs of cancer. If the scans detect abnormalities then the next step is a tissue biopsy. A tissue biopsy is the only way to get a definitive diagnosis of mesothelioma.
What causes pleural mesothelioma?
Asbestos is the only cause of pleural mesothelioma. Sharp, microscopic asbestos fibers can get stuck in the lining of the lungs, which is called the pleura. Pleural mesothelioma forms in the pleura after asbestos fibers irritate cells and cause them to mutate into cancer.
Who is most likely to get pleural mesothelioma?
People most likely to get pleural mesothelioma are older men who worked blue collar jobs during the 20th century. Men make up 80% of all cases, and the average age at diagnosis is 72. Blue collar jobs such as construction and electrical work were more likely to involve handling or being near asbestos. Men are most likely to have worked these jobs.
How is pleural mesothelioma treated?
Pleural mesothelioma is treated with surgery, chemotherapy, immunotherapy and radiation. Surgery is the first option considered. If people cannot receive surgery, then they will likely receive FDA-approved chemotherapy or immunotherapy.
Are there doctors for pleural mesothelioma?
There are doctors who treat pleural mesothelioma. These doctors are called mesothelioma specialists. People with pleural mesothelioma are recommended to find specialists for treatment. This improves their chances of longer survival as the doctor is more likely to succeed with surgery or other treatment options.
Do military veterans get pleural mesothelioma?
Yes, military veterans get pleural mesothelioma. Veterans account for the largest group of people with mesothelioma cancer. The U.S. Department of Veterans Affairs (VA) offers several benefits to help veterans with pleural mesothelioma. VA benefits for mesothelioma include compensation, burial reimbursement, health care and more.
Sources & Author
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- Life Expectancy in Pleural and Peritoneal Mesothelioma. Lung Cancer International. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292397/. Accessed: 03/19/19.
- 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?topicRef=4625&source=see_link. Accessed: 03/19/19.
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- Extended pleurectomy decortication: the current role. Translational Lung Cancer Research. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6204414/. Accessed: 08/27/19.
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