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Pleural lung cancer, also known as pleural adenocarcinoma, forms as tumors in the fluid-filled space between the wall of the chest and the lungs. These tumors occur when lung cancer has spread, or metastasized, beyond the lungs where the primary tumors originated. When lung cancer metastasizes, the pleura (lining of the chest wall and lungs), due to its close proximity to the lungs, is often one of the first areas affected.
Pleural tumors present several serious issues. Because of their location, they are difficult to remove surgically. Another serious issue is misdiagnosis. A tumor in the pleural tissue can be the result of metastasis of another type of cancer, including lung cancer. However, pleural tumors could also be mesothelioma. Doctors often have difficulty determining if the cancer originated in the pleura and is mesothelioma or if it is metastatic lung cancer. An accurate diagnosis is crucial for proper treatment.
Metastatic Pleural Lung Cancer
The pleura are the two thin layers of tissue surrounding the lungs. There is fluid between these layers to lubricate. It is the fluid that prevents friction and pain as the lungs expand and contract. Most organs in the body are surrounded by this type of tissue, which is generally referred to as the mesothelium.
Cancer of the pleura can be the result metastasized of lung cancer. Metastasis is the process of cancer cells moving from the original tumor to other tissues in the body. As a result, other tumors develop in those areas. Usually, metastasis occurs in the later stages of cancer when it is difficult to treat and prognosis is poor.
With lung cancer, the pleural tissue is a common area affected by metastasis. Cancer cells from primary tumors migrate to the pleura through the blood stream or spread through the lymphatic system. Cancer cells may also transfer to the pleura through simple contact, as the lungs press directly against this tissue. Once in the pleura, 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, the more likely it is to produce noticeable symptoms. A common complication of pleural cancer is pleural effusion. Pleural effusion is an abnormal fluid buildup between pleural layers. This buildup 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 is often difficult. If the tumors in the pleura are primary tumors, the cancer is mesothelioma. Because mesothelioma is a rare cancer, most doctors will rule out other types of cancer first. They may even completely overlook the possibility of this asbestos-related cancer. Initial diagnostic steps are imaging scans, such as X-rays, MRIs, and CT scans. These images help doctors determine tumor locations. If there are tumors in the pleura and the lungs, pleural lung cancer may be suspected.
Another important diagnostic step is a thoracentesis. Thoracentesis uses a needle to draw a fluid sample from the pleural space. A pathologist then examines the sample under a microscope to look for specific chemical markers. These markers help determine the specific type of cancer in the tumors. If necessary, a thoracentesis is followed by a more invasive biopsy to remove a tissue sample for closer examination.
Misdiagnosis and Mesothelioma
Cases of mesothelioma are often misdiagnosed as pleural lung cancer. Many doctors will initially diagnose lung cancer because it is more common than mesothelioma. Even if there are tumors in the pleura and the lungs, mesothelioma is a possibility. Lung tumors may actually be the metastatic tumors.
A specialist may required for the most accurate diagnosis. Pathologists and oncologists experienced in mesothelioma are better equipped to distinguish mesothelioma from lung cancer. Mesothelioma is aggressive and spreads quickly. Therefore, misdiagnosis can shorten a patient’s life by delaying important treatment. Specific treatment 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, making treatment more difficult. Surgically removal of the tumors is invasive and nearly impossible. However, there may be exceptions depending on the overall health of the patient.
Chemotherapy or radiation therapy may be used to shrink primary tumors in the lungs and extend life expectancy. Otherwise, treatment largely focuses on reducing symptoms to increase patient comfort. This usually involves managing pleural effusion, which can be painful and limiting. Regular thoracentesis to remove fluid is a typical treatment option. In some cases, a catheter may be installed to regularly drain the fluid.
Pleural lung cancer, or pleural adenocarcinoma, is metastatic lung cancer. However, it can be misdiagnosed mesothelioma. It is not uncommon to misdiagnose this cancer, but with the right experts on hand it can be avoided. If you have symptoms of pleural tumors or have been diagnosed with pleural lung cancer, it is worth seeking the opinion of a mesothelioma specialist. This is especially important if you suspect you have been exposed to asbestos in the past. If are diagnosed with mesothelioma, consider letting an expert asbestos lawyer help you make a case for compensation for medical bills.
Page Edited by Patient Advocate Dave Foster
Dave has been a mesothelioma Patient Advocate for over 10 years. He consistently attends all major national and international mesothelioma meetings. In doing so, he is able to stay on top of the latest treatments, clinical trials, and research results. He also personally meets with mesothelioma patients and their families and connects them with the best medical specialists and legal representatives available.