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Pleural Mesothelioma

Pleural mesothelioma is the most common form of this type of cancer, which is rare and caused by asbestos exposure. The pleural type accounts for about 75 percent of all diagnosed cases. This particular type of mesothelioma attacks the pleura, the lining around the lungs and is easily confused with lung cancer during diagnosis. Pleural mesothelioma is typically only diagnosed decades after exposure. It is a scary diagnosis, usually with a poor prognosis.

Symptoms of pleural mesothelioma, including a cough and chest pains, are often mistaken for other conditions, like pneumonia or bronchitis, which delays diagnosis for many people. Treatment is aggressive to match the disease, but rarely can cure the cancer. Treatments like chemotherapy, surgery, and radiation are used to slow the progression of the disease and to make patients more comfortable. Aggressive surgery in the early stages of the disease provides the best chance of curing it.

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Facts about Pleural Mesothelioma

Mesothelioma is a cancer that attacks the mesothelium. This is made up of two thin layers of tissue and surrounds most organs in the body. Nearly every diagnosed case of mesothelioma is caused by exposure to asbestos. Pleural mesothelioma is the most common form.

  • The pleura is the lining that surrounds the lungs, and when cancer begins here it is called pleural mesothelioma.
  • The number one risk factor is exposure to asbestos.
  • Most people diagnosed with pleural mesothelioma worked in an environment that exposed them to asbestos regularly.
  • Other less common risk factors include genetics, a family history of pleural mesothelioma, and living with someone who worked around asbestos.
  • Although the most common type of mesothelioma, pleural mesothelioma is still rare. Only about 3,000 people are diagnosed with any type of cancer each year. About 75 percent or more of those have the pleural form of the cancer.
  • Most of these cases are seen in older men, reflecting the fact that workplace exposure to asbestos is the leading risk factor.

Asbestos and Pleural Mesothelioma

Asbestos was used extensively in construction, shipbuilding, and other industries for many years and was only regulated beginning in the 1970s when health concerns became obvious. People who unknowingly inhaled fibers of asbestos on the job are at risk for being diagnosed with pleural mesothelioma. But, only about five percent of those exposed will actually develop the disease. Mesothelioma is a terrible illness, but it is also rare.

The fibers of asbestos easily become airborne when not contained correctly or when improperly disturbed. When inhaled these fibers lodge in the lungs and pleura, causing damage. That damage can trigger illnesses like pleural effusion and asbestosis, and in some cases lung cancer or mesothelioma. The latency period, the time between initial asbestos exposure and diagnosis of mesothelioma is long, on average 30 to 40 years.

Symptoms

One reason that the diagnosis for pleural mesothelioma usually comes decades after asbestos exposure is the nature of the symptoms. They don’t develop right away, they are often mild initially, and when they do get worse they mimic symptoms of other illnesses that are much more common, including:

  • Chronic bronchitis
  • Asthma
  • Pneumonia
  • Lung Cancer

Typical symptoms of pleural mesothelioma include:

  • Shortness of Breath
  • Trouble Swallowing
  • Persistent Dry Cough
  • Coughing Up Blood
  • Chest Pains
  • Pain When Breathing
  • Lumps Under the Skin of the Chest
  • Fatigue
  • Weight Loss
  • Fever

Diagnosis

Diagnosing mesothelioma can be challenging for several reasons. Most doctors simply don’t have experience with it and are looking for other causes of symptoms, diseases that are much more common. The early symptoms of pleural mesothelioma often lead to a misdiagnosis with a less serious, lung related condition. It may not be until after the symptoms persist and treatments have no effect that a patient will be tested further and given a cancer diagnosis.

A physical exam is the first step in determining the cause of symptoms. The next step in diagnosing pleural mesothelioma is usually to do imaging scans. X-rays can usually rule out pneumonia, and can also pinpoint locations where tissues look abnormal. A CT or MRI can then look at those areas in better detail. From there a biopsy can be done on any suspected tumors.

A biopsy is a procedure that removes a small amount of tissue or fluid for examination. By looking at cells from the sample under a microscope a pathologist can determine if the cells are malignant. If they are malignant, or cancerous, the next step is to confirm that they are mesothelioma cells and not lung cancer cells. This last step can be tricky and may require an expert in pleural mesothelioma to make a final determination and diagnosis.

Staging and Treating Pleural Mesothelioma

Once a diagnosis of pleural mesothelioma has been made, the next step is to assign a stage for the disease. This means looking at the original tumor, determining how far it has grown, and looking at how, if at all, the cancer has spread to other tissue outside the pleural lining or to more distant parts of the body.

Pleural mesothelioma grows and metastasizes, or spreads, aggressively and quickly. It often spreads to the chest wall, the diaphragm, the lungs, and ultimately to the lymph nodes. From there it can spread even further. The more the original tumor has grown and the more the cancer has spread, the higher the staging will be.

Developing a Treatment Plan
When a medical team knows what the stage of the cancer is, they can develop an appropriate treatment plan along with the input of the patient. Treatment for pleural mesothelioma is typically aggressive and may include a combination of chemotherapy, radiation therapy, and surgery. The choice of treatments depend on the state of the cancer and an individual’s age and health as well as preferences.

Clinical Trials
Because mesothelioma is rare and aggressive, clinical trials are possible for treatment for many patients given this diagnosis. Clinical trials are studies of new medications and therapies that are not yet approved by the Food and Drug Administration. By the time a new medication reaches this point it has been tested on laboratory animals and is considered mostly safe. Patients with deadly types of cancer like pleural mesothelioma are often accepted into these trials, although the treatments are riskier than those that are already approved.

Prognosis and Survival Rates

The outlook for a diagnosis of pleural mesothelioma depends on each individual but is generally not very good. Survival rates for this type of cancer are very 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. Individual factors that affect prognosis include age, the stage of the cancer, whether the patient smokes, extent of exposure to asbestos, and gender.

With such a poor prognosis for this diagnosis, most patients need to consider how treatment will make them more comfortable or extend their lives. Some patients choose aggressive treatment in the hopes living longer, while others want to feel more comfortable in the time they have left. If the disease is very advanced, palliative or hospice care may be the best option.

It is very upsetting to receive a diagnosis of pleural mesothelioma. So many people who develop this disease were exposed to asbestos without their knowledge or without realizing what the risks were of being around asbestos. Workplace asbestos exposure has led to many diagnoses of this otherwise rare disease. If you have been impacted by pleural mesothelioma because of workplace asbestos exposure, you legal rights to seek compensation from your former employer or the manufacturer of asbestos-containing materials.

Page edited by Dave Foster

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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.

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