Pleural Lung Cancer
Pleural lung cancer, also known as pleural adenocarcinoma, is a tumor or multiple tumors in the fluid-filled space between the wall of the chest and the lungs. It occurs when lung cancer has spread, or metastasized, beyond the location in which the primary tumor developed, in the lungs. When lung cancer metastasizes it is not unusual for the pleura to be one of the first places a new tumor will form because of its proximity to the lungs.
There are several serious issues with having pleural tumors, including the fact that they are difficult to operate on and treat. Another important issue is misdiagnosis. A tumor in the pleural tissue can be the result of metastasis of another type of cancer, including lung cancer but also other types of cancer, but it can also be mesothelioma. It can be difficult to diagnose a pleural tumor and to determine if it originated in the pleura and is mesothelioma or if it is metastatic lung cancer. An accurate diagnosis is crucial for treatment and prognosis.
Metastatic Pleural Lung Cancer
The pleura are two layers of thin tissue that surround the lungs. There is fluid between the two layers to lubricate them and prevent pain from friction occurring as the lungs move in and out with breathing. Most organs in the body are covered in this kind of tissues, which in general is referred to as the mesothelium.
Cancer of the pleura can be the result of the metastasis of lung cancer. Metastasis refers to the process of cancer cells moving from the original, primary tumor to other tissues and organs in the body. The result is that tumors develop in those other areas. Metastasis is something that occurs in the later stages of cancer, and at this point it can be very difficult to treat and the prognosis is poor.
With lung cancer, the pleural tissue is one of the common areas to which new tumors will spread. Cancer cells from the primary tumors can move to the pleura through the blood stream, but they may also spread through the lymphatic system. The cancer cells may also transfer to the pleura simply be the fact that the lungs press directly against the tissue. Once in the pleura, the cancer cells may develop into one or multiple tumors.
Symptoms of Pleural Tumors
Tumors that form in the pleura may or may not cause symptoms. The more advanced the cancer is, the more likely it is to produce symptoms that a person will notice. A common symptom or complication is pleural effusion. This is an abnormal buildup of fluid between the two pleural layers and it can cause chest pains, especially when breathing deeply, shortness of breath, and coughing. Other potential symptoms of pleural tumors include general discomfort, fatigue, and unintended weight loss.
Diagnosing Pleural Lung Cancer
Diagnosis of pleural tumors can be tricky. If they are the primary tumors it is mesothelioma, but this is a rare cancer and most doctors will rule out other types of cancer first and may even completely overlook the possibility that it could be this asbestos-related cancer. The initial diagnostic steps are imaging scans, such as X-rays, MRIs, and CT scans. These help doctors see where tumors are located. If there are tumors in the pleura and the lungs, pleural lung cancer may be suspected.
Another important diagnostic step is a thoracentesis. This involves using a needle to withdraw a sample of fluid from the pleural space. A pathologist can then look at the fluid under a microscope to examine cancer cells and to look for signs or chemical markers of particular types of cancer, like lung cancer or mesothelioma. If necessary, this will be followed by a more invasive biopsy to remove a piece of pleural or lung tissue for examination.
Misdiagnosis and Mesothelioma
Cases diagnosed as pleural lung cancer may actually be mesothelioma. Mesothelioma is often misdiagnosed because it is so rare. Many doctors will turn to lung cancer first, a much more common disease. Even if there are tumors in the pleura and the lungs, mesothelioma is a possibility. The lung tumors may be the metastatic tumors and those in the pleura the primary tumors.
It is often necessary to turn to specialists in mesothelioma or lung cancer to get an accurate diagnosis. Pathologists and oncologists experienced in studying and treating mesothelioma are better equipped to find the signs of this type of cancer and to distinguish it from lung cancer. Mesothelioma is aggressive and spreads quickly, so a misdiagnosis can shorten a patient’s life by delaying important treatment. How the cancer should be treated depends on the type of primary tumor.
Treating Pleural Lung Cancer
If pleural tumors are genuinely caused by metastatic lung cancer, treatment options may be limited. Metastasis is an indication that the cancer is advanced, and this makes treatment more difficult. Removing the tumors surgically is often not done because of the invasiveness and because it is nearly impossible to remove all metastatic tumors that way. There may be exceptions to this depending on the overall health of the patient.
Chemotherapy or radiation therapy may be used to shrink the primary tumors in the lungs and to extend life expectancy. Otherwise treatment is largely focused on reducing symptoms and helping the patient feel more comfortable and enjoy a better quality of life. This usually involves managing pleural effusion, which can be very painful and limiting. Regular thoracentesis to remove fluid is a typical way to treat this complication. In some cases a patient may have a catheter installed to regularly drain the fluid.
Pleural lung cancer, or pleural adenocarcinoma, is metastatic lung cancer, but too often it can be misdiagnosed mesothelioma. It is not uncommon to misdiagnose this cancer or to get a delayed diagnosis, but with the right experts on hand it can be avoided. If you have any symptoms of pleural tumors or you have been diagnosed with pleural lung cancer it is worth asking to see a mesothelioma specialist to make sure you get the right diagnosis and the right treatment. This is especially important if you know or suspect you have been exposed to asbestos in the past. If you do get diagnosed with mesothelioma, consider letting an expert asbestos lawyer help you make a case and get compensation to help with medical bills.
Page edited by Dave Foster
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