Pleural Mesothelioma

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.

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What Is Pleural Mesothelioma?

Pleural mesothelioma is a cancer of the pleural cavity, which is a thin membrane between the chest wall and lung cavity. This specific disease makes up approximately 80% of all mesothelioma cases.

When the disease is called “malignant pleural mesothelioma,” this means it is cancerous and will spread. The average life expectancy of a malignant pleural mesothelioma patient is between 11 and 20 months, with discrepancies depending on how advanced the disease is and which treatments are available.

Some patients have lived for multiple years due to evolving surgical techniques for removing malignant pleural mesothelioma from the body.

Causes

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Pleural Mesothelioma Causes

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

When asbestos fibers are inhaled, they often travel toward the lungs. However, instead of reaching the lungs, these fibers sometimes enter the pleural space, where cellular mutation occurs and cancer forms. Asbestos fibers are more likely to enter the pleural space than they are other areas with mesothelial cells.

The pleura has two walls: the parietal and the visceral. The parietal layer lines the chest wall. The visceral layer lines the lung cavity. Asbestos fibers, which are sharp, enter the narrow passageway and lodge into either the parietal or visceral lining, each of which includes mesothelial cells.

While these cells often absorb unwanted particles, they struggle to expel asbestos fibers. The irritable substance can cause the mesothelial cells in the pleura to mutate.

Treatment

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How Is Pleural Mesothelioma Treated?

surgery

Surgery

There are two primary surgical options for malignant pleural mesothelioma patients: extrapleural pneumonectomy and pleurectomy with decortication. The former removes the affected lung while the latter preserves this organ.

chemotherapy

Chemotherapy

As of 2019, the chemotherapy drugs approved by the U.S. Food and Drug Administration (FDA) for malignant pleural mesothelioma are pemetrexed and cisplatin. Chemotherapy is often used in combination with other treatment options.

radiation

Radiation

Scientists are developing radiation techniques to specifically target tumors, leaving healthy lung tissue unharmed. Radiation is the least-invasive treatment option for this cancer and is also used for palliative purposes.

Symptoms

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Pleural Mesothelioma Symptoms

Pleural mesothelioma patients may experience symptoms like fever, shortness of breath and persistent coughing. Although these symptoms are common for multiple diseases, people who interacted with asbestos during their lives should consult a physician.

Other pleural mesothelioma symptoms include:

  • Pain in the lower back or chest
  • Shortness of breath
  • Unexplained weight loss
  • Swelling of the face or arms
  • Fluid buildup in the pleural space
  • Sweating
  • Hoarseness
  • Trouble swallowing

Since mesothelioma is a rare cancer, general practitioners may not consider this disease as a possible diagnosis. Fortunately, researchers are studying more effective ways to detect and diagnose mesothelioma.

Diagnosis

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Pleural Mesothelioma Diagnosis

The first step in diagnosing mesothelioma is imaging tests, such as an X-ray or a computed tomography (CT) scan. If the test results determine the possible presence of cancerous tumors, doctors likely will perform a biopsy.

A biopsy involves taking a small tissue sample to determine if cancer cells are present. A biopsy also helps doctors determine the type of cancer, the cell histology and possibly the stage of the disease (if the biopsy is of a lymph node).

Doctors may also extract a fluid sample to look for cancerous cells. However, this method is less reliable than a tissue biopsy.

Tests also help determine if the disease is malignant or a less-dangerous version of the cancer.

Who Gets Pleural Mesothelioma?

According to one study published in the American Society of Clinical Oncology, the median age of diagnosis for pleural mesothelioma patients is 72. The disease’s latency period — meaning how long it takes to develop — is between 20 and 50 years. This lengthy development time is why many patients are elderly.

According to another study, one published in Lung Cancer International, around 80% of patients with this disease are male. The high percentage of male patients is largely due to occupational exposure to asbestos.

Can Pleural Mesothelioma Spread to Other Organs?

This type of mesothelioma forms in the pleura, but this area’s location means the disease can spread to other organs or cavities. Cancer spreading beyond the point of origin is called metastasis. This disease metastasizes quicker than most other types of cancer.

Malignant pleural mesothelioma can spread to the lymph nodes, which can cause cancer to spread throughout the body more quickly. The disease also regularly metastasizes to the nearby lung, heart and diaphragm.

Depending on the results of the biopsy and how much the cancer has spread, the patient is diagnosed with a stage between 1 and 4.

The 4 Stages of Pleural Mesothelioma

stage one

Stage 1 - The tumors are only 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 appealing but also difficult.

stage two

Stage 2 - The cancer is mostly limited to the point of origin, but some localized lymph node involvement begins. The malignant pleural mesothelioma may also begin spreading into the lung cavity and approach the nearby lung.

stage three

Stage 3 - The disease is no longer localized, metastasizing to the nearby lung, the diaphragm and more lymph nodes. Many patients first learn of their mesothelioma when it has reached this stage.

stage four

Stage 4 - The cancer has spread well beyond the pleura and has invaded the lung cavity, affecting the nearby lung, the diaphragm and possibly even the heart. Many treatment options are unavailable due to how far-reaching mesothelioma is at Stage 4.

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Find out where you may have been exposed to asbestos

A nation wide list of sites where you or a loved one may have come in contact with asbestos.

Surgery

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Extrapleural Pneumonectomy (EPP)

Extrapleural pneumonectomy is a common surgical treatment for malignant pleural mesothelioma. During EPP, a surgeon removes the diseased lung as well as the pleura. The surgeon also removes part of the diaphragm and the pericardium, which is the protective layer around the heart.

The goal of EPP is to remove as much, if not all, of the cancerous tissue as possible. Mesothelioma tumors are microscopic, which is why removing the entire cancer is challenging for surgeons.

However, patients can undergo chemotherapy following their operation to focus on the remnant tumors still inside the body. Using chemotherapy after surgery is called adjuvant cancer treatment.

Chemotherapy may also be used as a pre-surgery precaution to shrink the tumors and make the operation more effective. Using chemotherapy before surgery is called neoadjuvant treatment.

Dr. David Sugarbaker perfected EPP. Until his death in 2018, he was one of the leading mesothelioma specialists in the country.

Pleurectomy With Decortication (P/D)

Pleurectomy with decortication is an alternative to EPP. It was developed for malignant pleural mesothelioma after EPP was already widely used for treating the disease.

P/D is most effective for early stage pleural mesothelioma patients because it spares their lungs. The operation only involves taking out the pleura, where most of the cancer is located.

Some patients may need their pericardium and part of their diaphragm taken out during P/D. When these two parts are removed, the surgery is called an “extended pleurectomy with decortication.” The extended form of this operation is effective when the cancer has spread beyond the pleural space and reached the diaphragm and pericardium (but not the lungs).

Patients may also undergo chemotherapy before or after P/D to shrink or contain the tumors or attack any remaining ones not found during surgery.

Chemotherapy

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Pemetrexed and cisplatin are the two FDA-approved chemotherapy drugs for treating malignant pleural mesothelioma. These drugs are often administered intravenously, like most chemotherapy treatment.

Patients could undergo hyperthermic intrapleural chemotherapy. This form of treatment involves a hot form of the chemotherapy drugs delivered directly into the pleural cavity or lung cavity, wherever doctors believe they should target to rid the body of the tumors.

Radiation

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Radiation alone is rarely curative for people with mesothelioma. This therapy may be used before or after surgery to shrink the size of tumors prior to operation or reduce the possibility of recurrence afterward.

Doctors may also use radiation for late-stage malignant pleural mesothelioma patients to help ease pain caused by fluid buildup or tumor pressure. This therapy can shrink the tumor, which should 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. If you are a mesothelioma patient, you can find the right specialist for your specific disease by using our free Doctor Match program.

Common Questions About Pleural Mesothelioma

How long do pleural mesothelioma patients live?

Pleural mesothelioma patients usually live a little less than one year after their diagnosis. A combination of surgery, chemotherapy and radiation can extend survival to multiple years.

What are the symptoms of pleural mesothelioma?

The symptoms of pleural mesothelioma include shortness of breath, fever, fluid buildup in the pleura, chest and lower back pain, sweating, trouble swallowing, weight loss, and swelling of the face or arms.

Is pleural mesothelioma curable?

Pleural mesothelioma is not curable, but there is hope for patients. Doctors are investigating new treatment methods in hopes of finding a permanent cure.

What causes pleural mesothelioma?

Exposure to asbestos is the only proven cause of pleural mesothelioma. If it’s swallowed or inhaled, asbestos can irritate cells in the pleura, which is the thin membrane between the lung cavity and chest wall.

How is pleural mesothelioma treated?

Pleural mesothelioma is usually treated with a combination of surgery, chemotherapy and radiation.

Prognosis

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Pleural Mesothelioma Prognosis

Mesothelioma prognosis is an estimate of a particular patient’s outlook and life expectancy based on the experience of past patients with a similar disease.

Many factors play a role in a patient’s pleural mesothelioma prognosis, including:

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

The type of treatment the patient receives depends on their personal diagnosis. The most successful treatments for improving prognosis involve a multimodal approach, which utilizes a combination of chemotherapy and surgery.

Since surgery involves directly removing tumors from the body, this treatment option is considered the most effective at improving life expectancy for people with this type of mesothelioma. However, some patients cannot undergo surgery due to numerous factors, and undergoing an operation could lead to additional health concerns.

Approximately 40% of malignant pleural mesothelioma patients live for at least one year following their diagnosis. However, patients who undergo P/D can live for multiple years.

One study published by the Annals of Thoracic Surgery had around 49% of patients live for three years following their diagnosis.

The most effective way to improving prognosis is starting treatment immediately. If you were diagnosed with this form of mesothelioma, then you should receive a second opinion from a specialist. You may learn your disease is at an earlier stage than you originally were told, and you could have more treatment options available.

We at Mesothelioma Guide can help you find that specialist, get a second opinion, and either confirm your diagnosis or receive an updated one. We also have more content about mesothelioma, the available treatment options, how to improve your prognosis and more. You can get this information delivered directly to you with our free Complete Mesothelioma Guide book.

Veterans

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Veterans With Pleural Mesothelioma

The largest group (around 33%) of people diagnosed with mesothelioma is military veterans. Asbestos was applicable as 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 for many armed forces members.

Due to the high prevalence of veteran mesothelioma patients, the Veterans Affairs (VA) provides financial benefits to victims of this disease. Veterans who have this cancer can:

  • Receive disability benefits, if their disease is service-related, to offset the costs of treatment, travel and missed work
  • Find a specialist within the VA who is adept at treating this rare disease
  • Receive pension payments from the VA if their mesothelioma is not service-related
  • Set up their surviving loved ones to receive benefits in the event that they die from their mesothelioma

If a veteran passes away due to their mesothelioma, then their survivors may be eligible to receive VA benefits. Learn more about what veterans can do to support their families and live longer in our free Veteran’s Support Guide.

Last Edited: March 31, 2020.

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