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Pleural Mesothelioma

Pleural Mesothelioma Definition: Pleural mesothelioma is a cancer caused by asbestos exposure, affecting the pleura lining around the lungs, and it is the most common type of mesothelioma.

Pleural mesothelioma accounts for nearly 75 percent of all diagnosed cases of mesothelioma. It is often not diagnosed until decades after exposure to asbestos. This type of mesothelioma is easily confused with lung cancer because it affects tissue around to the lungs. It is a difficult diagnosis, usually with a poor prognosis.

Symptoms of pleural mesothelioma, such as coughing and chest pains, are often mistaken for more common conditions, like pneumonia or bronchitis. This delays diagnosis for many people and in turn delays treatment. 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.

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Facts about Pleural Mesothelioma

Mesothelioma is a cancer that attacks the mesothelium. This is a double layer of tissue surrounding most of the body’s organs. Asbestos exposure is the leading cause of mesothelioma.

  • The pleura is the mesothelium around the lungs.
  • The main risk factor for pleural mesothelioma is exposure to asbestos.
  • Most people diagnosed with mesothelioma experienced asbestos exposure at work.
  • Other risk factors include genetics, a family history of mesothelioma, and living with someone who worked around asbestos.
  • Pleural mesothelioma is connected to asbestos but is rare. Only about 3,000 people are diagnosed with any kind of mesothelioma each year.
  • About three-quarters of people diagnosed with mesothelioma have the pleural type.
  • Most of these cases are seen in older men. This is because workplace exposure is the leading risk factor and cause.

Asbestos and Pleural Mesothelioma

Many industries and workplaces used asbestos for decades. Construction, shipbuilding, and industrial manufacturing companies used asbestos the most. Many workers in these and other industries inhaled or ingested fibers on the job, mostly without knowing about it. Some were later diagnosed with related illnesses. It was only in the 1970s that federal laws limited the use of this harmful mineral.

Asbestos consists of very small, sharp fibers. These come loose from the material when handled or 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 pleura, lungs, and other tissue.

The lodged fibers cause damage, and eventually this can trigger serious illnesses. Mesothelioma, lung cancer or asbestosis may be diagnosed later. The latency period between inhaling the fibers and getting sick is decades, up to 40 years.

Symptoms

The symptoms of mesothelioma make it difficult to diagnose. They don’t always develop right away, or if they do they are not obvious. Symptoms are often mild initially. When symptoms do get worse they mimic those of other illnesses that are more common, like:

  • Chronic bronchitis,
  • Asthma,
  • Pneumonia, and
  • Lung Cancer.

Symptoms of pleural mesothelioma include:

  • Shortness of breath
  • Difficulty swallowing
  • A persistent dry cough
  • Coughing up blood
  • Chest pains
  • Painful breathing
  • Lumps under the skin of the chest
  • Fatigue
  • Weight loss
  • Fever

Diagnosis

Diagnosing mesothelioma is difficult for several reasons. Most doctors have little or no experience with this rare caner. They are more likely to diagnose common conditions first, especially if the doctor is unaware of any asbestos exposure.

The early symptoms of pleural mesothelioma often lead to a misdiagnosis of a less serious condition. It may not be until after the symptoms persist and treatments don’t provide relief that a patient will be tested further and given a cancer diagnosis.

  • The first step in determining the cause of symptoms is a thorough physical examination.
  • The next step is to take imaging scans. X-rays can rule out pneumonia and other respiratory conditions. A CT or MRI can find soft tissue abnormalities.
  • Doctors will then remove a small amount of tissue for a biopsy on any abnormal areas.
  • Pathologists look at cells from the biopsy under a microscope to determine if they are malignant, or cancerous.
  • If the cells are malignant, the next step is to confirm that they are mesothelioma cells and not lung cancer cells.

Staging and Treating Pleural Mesothelioma

Once a diagnosis of pleural mesothelioma has been made, the next step is to assign a stage. Stage describes how far the cancer has progressed.

For staging, doctors look at the original tumor and determine how large it has grown. They also look for any spread of tumors to other tissue outside the pleural lining or to more distant parts of the body.

Developing a Treatment Plan
Once the medical team understands the stage of the cancer, they can develop an appropriate treatment plan considering the patient’s input and preferences.

Treatment for pleural mesothelioma is typically aggressive. It includes some combination of chemotherapy, radiation therapy, and surgery. The treatment depends on the stage of the cancer and an individual’s age and health as well as individual preferences. Some patients prioritize comfort over extending life expectancy, and this impacts treatment choices.

Clinical Trials
Because pleural mesothelioma is rare and spreads aggressively, many patients want to participate in clinical trials. 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 thoroughly tested in a lab setting and is considered to be mostly safe. However, the purpose of the trials are to determine effectiveness as well as any unintended adverse events. There may be negative side effects.

Patients with aggressive and deadly types of cancer like pleural mesothelioma are often accepted into clinical trials and are willing to take the risks of potential adverse effects. The results may not be what are expected, but the trials offer hope for patients with few other options.

Prognosis and Survival Rates

The outlook for a diagnosis of pleural mesothelioma is usually negative, but ultimately it depends on individual factors. 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, the extent and duration of exposure to asbestos, and gender.

With such a poor prognosis for pleural mesothelioma, most patients need to consider how treatment will make them more comfortable or extend their lives. Some patients choose an aggressive treatment plan in the hopes of living longer or in the hopes of going into remission. Others prefer to feel more comfortable in the time they have left and choose milder treatments.

A diagnosis of pleural mesothelioma is devastating. Many people who develop this disease were victims. They were exposed to asbestos 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 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. Connect with Patient Advocate Dave Foster

Page Medically Reviewed and Edited by
Luis Argote-Greene, MD

Luis Marcelo Argote-Greene, MD
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.
Sources
  1. Mayo Clinic. (n.d.) Mesothelioma - Symptoms and Causes.
    Retrieved from: https://www.mayoclinic.org/diseases-conditions/mesothelioma/symptoms-causes/syc-20375022
  2. American Cancer Society. (2018, July 30). Malignant Mesothelioma Symptoms, Tests, Prognosis, and Stages (PDQ)-Patient Version.
    Retrieved from: https://www.cancer.gov/types/mesothelioma/patient/about-mesothelioma-pdq
  3. American Cancer Society. (2017, June 7). Asbestos Exposure and Cancer Risk.
    Retrieved from: https://www.cancer.gov/about-cancer/causes-prevention/risk/substances/asbestos/asbestos-fact-sheet
  4. Scherpereel, A. (2017). Malignant Pleural Mesothelioma: New Treatments, New Hopes? European Respiratory Journal, 2017 49: 1700319.
    Retrieved from: https://erj.ersjournals.com/content/49/3/1700319

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