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. Pleural mesothelioma is a cancer of the tissue around the lungs.
- 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 made up of very small, needle-like fibers. These come loose from the material when disturbed. The fibers become part of the dust in the air and on surfaces. Anyone in the vicinity is likely to inhale those fibers, which can then lodge in the airway tissues.
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.
Where Is Asbestos Found?
The government has restricted the use of asbestos but not banned it outright. In the past, many industries used asbestos. Today, asbestos lingers in certain locations and materials:
- Automobile clutches and brakes
- Roofing materials
- Corrugated sheeting
- Cement pipe
- Industrial workplaces with past use
- Ships built before 1975
- Commercial, public, and residential buildings constructed before 1975
Who Is Most at Risk for Pleural Mesothelioma?
The risk of encountering asbestos and developing mesothelioma is much less today than in the past. The latency period is decades-long. If you worked in an industry with asbestos, even 50 years ago, you may still be diagnosed with pleural mesothelioma today.
Asbestos put many workers at risk in the past. Today, those most likely to be exposed to asbestos work in the repair, renovation, demolition, or maintenance of old buildings, ships, vehicles, and equipment with asbestos.
First responders still face exposure risks today. They respond to disasters that destroy old buildings and spread asbestos materials throughout the air. Workers in public buildings with poorly-maintained asbestos, such as teachers, can also still be exposed.
Secondary exposure is still a concern. Anyone living with someone exposed to asbestos on the job may inhale the fibers brought home on clothing. This can lead to pleural mesothelioma.
Pleural Mesothelioma in Veterans
Nearly one-third of diagnosed cases of pleural mesothelioma are in military veterans. The military used asbestos extensively. With the long latency period, veterans still receive diagnoses today. Those at greatest risk of developing pleural mesothelioma worked on ships in the U.S. Navy.
What Are the Warning Signs and Symptoms?
- 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.
Asbestos causes pleural mesothelioma, but it also causes similar conditions and symptoms in the respiratory system. These may occur along with mesothelioma or separately:
- Pleural plaques. Asbestos causes thickening of the pleural tissue. These spots, known as plaques, tell doctors a patient likely inhaled asbestos fibers. They may indicate an increased risk of developing
- Pleural thickening. Larger areas of thickening are known as pleural thickening. This causes worse symptoms than plaques and can significantly impair breathing.
- Asbestosis. This is a non-cancerous scarring of lung tissue caused by inhaled asbestos.
- Pleural effusion. Inhaled asbestos fibers irritate tissues, which can lead to a build up of fluid. Pleural mesothelioma also causes this condition, which makes breathing difficult.
What Does Advanced Pleural Mesothelioma Feel Like?
As any type of cancer advances to the later stages, symptoms worsen. For pleural mesothelioma, this means more coughing and wheezing. Breathing becomes very difficult and mobility limited. You may become fatigued, lose your appetite, and lose weight.
Another common complaint of advanced mesothelioma is pain. As tumors grow and metastasize, they push on nerves and tissues throughout the body. Patients can get significant relief with palliative care, but they must talk to their doctors about these symptoms and their options.
Should I See My Doctor if I Have Pleural Mesothelioma Symptoms?
Because this disease is so rare, chances are you do not have pleural mesothelioma. The symptoms it causes are similar to those of more common illnesses, like pneumonia.
See your doctor for an accurate diagnosis for your symptoms. This is the first step in determining the cause and ruling out common illnesses to get to a cancer diagnosis.
Talk to your doctor about the possibility of mesothelioma if you have certain risk factors and if your symptoms persist:
- You worked in an industrial job or in a workplace likely to have contained asbestos.
- You know that your workplace had asbestos or that you handled it.
- You served in the military, especially in the U.S. Navy.
- You worked on ships or in ship repair.
How Do Doctors Diagnose Pleural Mesothelioma?
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.
Staging Pleural Mesothelioma
- Stage I: Tumors are localized to pleural tissue around one lung.
- Stage II: The tumor cells have spread from the primary tumor but have not yet invaded the lymph nodes.
- Stage III: The cells have spread to other tissue near the pleura and to more distant lymph nodes.
- Stage IV: The cancer has metastasized, or spread to distant organs.
Questions to Ask Your Doctors
If you get a diagnosis of mesothelioma, you probably have a lot of questions. Take a day or two to brainstorm with loved ones and then talk to your medical team about all your concerns. These are some questions you may want to ask:
- How certain are you of the diagnosis, and should I get a second opinion?
- How did I get pleural mesothelioma? Does it seem to be connected to asbestos exposure?
- What is your experience with mesothelioma patients?
- Can you explain the diagnosis and all the evidence?
- What is the stage of my cancer, and where are the tumors?
- What is my prognosis?
- Is there any hope of remission?
- What can I do to improve my prognosis?
- What are my treatment options, and what do you recommend?
- What are the goals of your treatment recommendations? To cure or extend life?
- What can I do about my symptoms and discomfort?
- What will happen after completing treatment?
Keep asking questions throughout the process. You and your loved ones should be active decision-makers in your care and treatment.
Treatment Options for Pleural Mesothelioma
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 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. Patients are encouraged to participate in clinical trial research to gain access to treatment not yet approved by the Food and Drug Administration (FDA).
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 Mesothelioma Treatment Center director at Baylor St. Luke’s Medical Center, Dr. Ripley is a leading expert in this rare cancer. He is a thoracic oncology surgeon specializing in pleural mesothelioma and treats several 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 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 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.
Where Should I Go for Pleural Mesothelioma Treatment?
Your regular doctor is a good place to start, but you will need specialists. Your doctor may be able to recommend a local oncologist. This is an appropriate next step, but even this specialist in cancer may have little or no experience with mesothelioma.
For the best treatment options and outcomes, look for pleural mesothelioma specialists, including oncologists, thoracic surgeons, and radiologists. You may need to travel to find the best care at treatment centers specializing in pleural mesothelioma:
- MD Anderson Cancer Center, Houston, Texas
- Mount Sinai Hospital, New York City
- Mesothelioma Treatment Center, Baylor College of Medicine Lung Institute, Houston, Texas
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, California
- Dana Farber Cancer Institute, Boston, Massachusetts
- Swedish Medical Center Cancer Institute, Seattle, Washington
- Perlmutter Cancer Center, New York University, New York City
Treatment for Veterans
Veterans share a disproportionate share of the burden of pleural mesothelioma. Two Veterans Administration hospitals staff specialists in this disease. If you are a veteran, seek care from:
- West Los Angeles VA Medical Center, Los Angeles, California
- VA Boston Healthcare System, Boston, Massachusetts
Can I Get Help Paying for Treatment?
Treatment for a rare cancer like mesothelioma can be costly. Expenses include the actual treatments but also appointments with doctors, supportive care, therapy, travel, and more.
Consider these options for financial support while seeking treatment:
- Private health insurance
- Public health insurance, such as Medicare, or Social Security Disability
- Veterans Administration claims for asbestos exposure that occurred during active service
- An asbestos trust fund claim
- A lawsuit against the companies responsible for exposure.
What Is the Prognosis for Pleural Mesothelioma?
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.
Does Anyone Survive Pleural Mesothelioma?
Mesothelioma is considered incurable. Rather than trying to cure mesothelioma, patients and their medical teams work toward remission or extending life expectancy. Remission is not a cure, because there is always a possibility of cancer recurring.
This doesn’t mean there is no hope. Some people survive pleural mesothelioma for years. Those with the best chance of survival have an early-stage diagnosis, are generally healthy, and choose immediate and aggressive treatments.
What Determines Life Expectancy?
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.