Facts about Pleural Mesothelioma
Mesothelioma is a cancer that attacks the mesothelium. The mesothelium is a double layer of tissue surrounding most of the body’s organs.
- The pleura is the part of the mesothelium surrounding the lungs.
- The main risk factor for pleural mesothelioma is exposure to asbestos, which for most people occurred at work.
- It can take decades from initial exposure to asbestos for mesothelioma to develop.
- Symptoms include chest pain, a dry cough, shortness of breath, and fatigue.
- Pleural mesothelioma is rare. Only about 3,000 people are diagnosed each year.
- The pleural type is the most common form of mesothelioma.
- Most diagnoses are made in older men because of past workplace exposure to asbestos.
- Pleural mesothelioma can be treated with a combination of chemotherapy, radiation, and surgery. Some patients may undergo experimental therapies by participating in clinical trials.
- The prognosis is poor. Just 40 percent of patients survive a year after diagnosis.
How Asbestos Causes Malignant Pleural Mesothelioma
Asbestos is the number one risk factor for mesothelioma, but it is not necessarily the only cause. Genetics and lifestyle choices, like smoking, may also play a role in the development of this cancer.
Asbestos is made up of very small, needle-like fibers. These come loose from the material when disturbed. The fibers become part of the dust in air and on surfaces. Anyone in the vicinity is likely to inhale those fibers, which then can lodge in the tissues of the airway.
When the lodged fibers cause damage, including irritation and inflammation, to the pleura, it may develop into cancer. The pleura is a double layer of tissue around the lungs. When a tumor develops here it is known as pleural mesothelioma.
Pleural mesothelioma, lung cancer, or asbestosis can all be caused by asbestos fibers. When pleural mesothelioma develops, it spreads rapidly, often from one layer of the pleura to the next and then to the lung and other tissues.
- Chronic bronchitis
- Lung cancer
Symptoms of pleural mesothelioma may include:
- Shortness of breath
- Difficulty swallowing
- A persistent dry cough
- Coughing up blood
- Chest pain
- Painful breathing
- Lumps under the skin of the chest
As the cancer gets more advanced, patients may also experience unintentional weight loss and fatigue.
Diagnosing mesothelioma is difficult for many reasons. The early symptoms of pleural mesothelioma often mimic other illnesses and lead to a misdiagnosis. It may not be until after the symptoms persist and treatments don’t provide relief that a patient will get a cancer diagnosis.
Certain associated conditions may indicate that asbestos, and potentially mesothelioma are causing symptoms: pleural plaques, which are thick areas of the pleura; pleural effusion, a buildup of fluid between the pleural layers; and pleural thickening, large areas of thick tissue and scarring that makes it difficult to breathe.
The diagnostic process for symptoms that may indicate mesothelioma and past asbestos exposure usually follows these steps:
- A thorough physical examination to rule out other illnesses is the typical first step.
- The next step is to take imaging scans, including X-rays, to rule out pneumonia and other respiratory conditions, or a CT or MRI scan to search for soft tissue abnormalities.
- If the scans reveal an abnormality, the patient should be referred to a specialist.
- The specialist will perform a biopsy, the removal of a small amount of tissue from any abnormal areas indicated on scans.
- The next step is pathology of the biopsy sample. A pathologist will then look at cells under a microscope to identify malignancy and the type of cancer.
- Stage 1: Tumors are localized to pleural tissue around one lung.
- Stage 2: The tumor cells have migrated to nearby lymph nodes.
- Stage 3: The cells have spread to other tissue near the pleura and to more distant lymph nodes.
- Stage 4: The cancer has metastasized, or spread to distant organs.
Once the medical team understands the stage of pleural mesothelioma, cell subtype, and other medical conditions, they can develop an appropriate treatment plan. This should consider the patient’s input and preferences.
Treatment for pleural mesothelioma is typically aggressive. It is important the patient and medical care team have open communication about the expected outcomes of treatment and the risks and benefits of each treatment.
The standard treatment approach for mesothelioma includes one or more strategies, most often chemotherapy, surgery, and radiation therapy.
Treatment for pleural mesothelioma typically includes a combination of two or more of the standard chemotherapy drugs. These are drugs used to kill cancer cells, but they can also kill healthy cells causing side effects. Pemetrexed with cisplatin or carboplatin is a typical chemotherapy combination used to treat pleural mesothelioma.
More aggressive procedures remove as much of the visible disease as possible as well as additional nearby tissue to which the cancer may spread:
- Pleurectomy and decortication, also known as radical pleurectomy, is a procedure that removes the tumors and the pleural tissue.
- Extrapleural pneumonectomy is the most aggressive surgical option. It involves the removal of the pleura, an entire lung, part of the diaphragm, and other nearby tissue that may be affected.
Radiation therapy uses high-energy beams to target and kill cancer cells. It is not a curative treatment but can be helpful to reduce tumor size or eliminate any remaining cells before chemotherapy or after surgery. Radiation can also be used to relieve symptoms as a part of palliative care.
Clinical Trials and Experimental Therapies
Mesothelioma is a rare and aggressive cancer with fewer treatment options than many other cancer types. In order to gain access to treatment not yet approved by the Food and Drug Administration (FDA), patients are encouraged to participate in clinical trial research.
Some of the emerging therapies patients may access in clinical trials include immunotherapy, vaccines, surgical therapies, or new radiation techniques. Immunotherapy treatment targets the patient’s immune system to turn it against the cancer cells.
Photodynamic therapy is being tested as a way to use light energy to focus toxic drugs directly on tumor cells. Gene therapies use genetically-modified viral or bacterial cells to deliver treatments or alter cancer cells to self-destruct.
Who Are the Leading Pleural Mesothelioma Doctors?
Raphael Bueno, M.D.
Dr. Bueno is the director of the International Mesothelioma Program at Brigham and Women’s Hospital in Boston. A thoracic surgeon, he heads up the hospitals’ thoracic surgery department and is the Vice Chair of Surgery for Cancer and Translational Research. Dr. Bueno is one of the nation’s leading experts in pleural mesothelioma.
Working under the legendary Dr. David Sugarbaker, Dr. Bueno trained with the best experts in treating this difficult type of cancer. He now teaches, conducts research, and treats patients. One of his most important research discoveries was a way to distinguish between adenocarcinoma and mesothelioma, a cancer that is notoriously difficult to diagnose.
Robert Taylor Ripley, M.D.
As the director of the Mesothelioma Treatment Center at Baylor St. Luke’s Medical Center, Dr. Ripley is a leading expert in this rare cancer. He is a thoracic oncology surgeon who specializes in pleural mesothelioma but also treats a number of other lung-related conditions and cancers. He is currently an associate professor in Baylor College of Medicine’s Division of General Thoracic Surgery.
Dr. Ripley’s interest in pleural mesothelioma began during a thoracic surgery fellowship at the National Cancer Institute, where he conducted related research. He also specializes in using robotic surgical techniques for minimally invasive procedures used to treat pleural mesothelioma and other thoracic diseases.
Valerie W. Rusch, M.D.
Dr. Rusch has over twenty-five years of experience in thoracic surgery, specializing in related cancers, including pleural mesothelioma. She currently holds several positions at Memorial Sloan Kettering Cancer Center, including vice chair for Clinical Research in the Department of Surgery and the Miner family chair in Intrathoracic Cancers.
In addition to treating mesothelioma and other patients using advanced, minimally invasive technologies, Dr. Rusch is dedicated to research. Her personal projects include the genetics and treatment of pleural mesothelioma. One of her most important studies proved the efficacy and importance of bimodal treatment strategies for patients with pleural mesothelioma.
Raja Flores, M.D.
Dr. Flores was inspired to specialize in pleural mesothelioma after working with patients who came from a blue-collar background and were victims of asbestos exposure on the job. This was during his time training at Brigham and Women’s Hospital under a mentor who specialized in mesothelioma treatment.
As a thoracic surgeon, Dr. Flores now specializes in pleural mesothelioma as well. He is a professor and system chair in thoracic surgery at Mount Sinai in New York. Here he offers patients a minimally invasive lobectomy procedure he pioneered early in his career. It allows him to treat patients with pleural mesothelioma with fewer complications and an easier recovery.
The prognosis for pleural mesothelioma is usually negative, but it depends on individual factors. Survival rates for this type of cancer are comparatively low. Diagnosis typically comes after the cancer has reached a later stage and this means it is difficult to treat and nearly impossible to cure.
Some studies indicate that the median survival time for patients with pleural mesothelioma is just nine months, but this includes those who did not receive treatment.
Any kind of treatment, but especially a combination of therapies, extends survival times. Patients with pleural mesothelioma who undergo surgical procedures as part of treatment live longer after diagnosis on average.
Individual factors that can affect prognosis include:
- Age. Younger patients have better survival times.
- Cancer stage. This is one of the most important factors in prognosis. Early stage mesothelioma can be treated more aggressively, leading to longer survival times.
- Smoking status or history. Smoking adds to the risk of developing cancer.
- Extent and duration of exposure to asbestos. Not everyone exposed to asbestos develops mesothelioma, but more exposure can cause more damage to tissue.
- Gender. Life expectancy for women with mesothelioma is longer than for men.
- Overall health and fitness. Patients with better overall health and fitness can withstand more aggressive treatments and tend to live longer.
How to Improve a Mesothelioma Prognosis
Some factors related to prognosis cannot be changed, but others can. One of the most important things you can do is to be aware of any asbestos exposure and symptoms. Getting an earlier diagnosis, followed by aggressive treatment is the best way to improve prognosis.
Choose a specialist in mesothelioma to work with and seek second and third opinions if you are not satisfied with a diagnosis. Request access to clinical trials to benefit from emerging treatments. Lifestyle changes to improve overall health can also be beneficial.
A diagnosis of pleural mesothelioma can be a shock, and many people who develop this disease are victims. They experienced asbestos exposure without their knowledge or without being warned of the risks of being around asbestos. If you have been impacted by pleural mesothelioma because of workplace asbestos exposure, you have legal rights to seek compensation from your former employer or the manufacturer of asbestos-containing materials.
Frequently Asked Questions
Page Medically Reviewed and Edited byLuis Argote-Greene, M.D.
Luis Argote-Greene is an internationally recognized thoracic surgeon. He has trained and worked with some of the most prominently known thoracic surgeons in the United States and Mexico, including pioneering mesothelioma surgeon Dr. David Sugarbaker. He is professionally affiliated with University Hospitals (UH). His areas of interest and expertise are mesothelioma, mediastinal tumors, thoracic malignancies, lung cancer, lung transplantation, esophageal cancer, experimental surgery, and lung volume reduction. Dr. Argote-Greene has also done pioneering work with video-assisted thoracoscopic surgery (VATS), as well as robotic assisted minimally invasive surgery. He has taught the procedures to other surgeons both nationally and internationally.