Pleural mesothelioma is a rare cancer of the outer lung lining and chest wall called the pleura. Asbestos is the primary cause of pleural mesothelioma. It accounts for 70% of all mesothelioma cases. Survival is about 1 year with treatments, including surgery, chemotherapy, immunotherapy and radiation.
Learn more about pleural mesothelioma and the steps you can take to fight this disease.
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Pleural mesothelioma is a rare cancer that forms in the pleura. This is the thin tissue around your lungs and lining your chest cavity. It is the most common of the four mesothelioma types. It causes respiratory symptoms, including cough, shortness of breath, chest pain and fatigue.
We asked Dr. Jacques Fontaine, director of the Mesothelioma Research and Treatment Center at Moffitt Cancer Center, how asbestos exposure leads to pleural mesothelioma. He said, “Inhaled asbestos fibers can go to the [edges] of the lung and start causing inflammation. Over many years, it can turn into a cancer called pleural mesothelioma.”
The best treatments for pleural mesothelioma include surgery, chemotherapy and radiation therapy. Doctors may also use a multimodal approach that combines two or more of these therapies. Immunotherapy is also gaining prominence. Doctors may use emerging treatments in clinical trials.
Key Facts About Pleural Mesothelioma
Pleural mesothelioma makes up 70% to 79% of all mesothelioma cases.
Symptoms can take 20 to 60 years to appear after asbestos exposure.
Doctors diagnose about 2,250 new cases of pleural mesothelioma each year.
Most pleural mesothelioma patients are, on average, 72 years old at diagnosis.
About 12% of pleural mesothelioma patients live for 5 years or longer.
The pleura is vital for your normal lung function. It protects the lungs and allows them to move within the chest cavity as needed. If air or fluid enters your pleural space, it can harm breathing. It may also prevent the lungs from inflating.
What Causes Pleural Mesothelioma?
Pleural mesothelioma is caused by inhaling asbestos fibers. The sharp and pointed asbestos fibers are like needles that can become stuck in the tissues of the body.
Asbestos fibers can reach the pleural lining over time. They cause severe, ongoing irritation. The resulting scar tissue, along with DNA mutations within cells, can lead to cancer.
This graphic shows how pleural mesothelioma develops.
Occupational asbestos exposure is the No. 1 cause of the disease. Several occupations pose the highest risk, including blue-collar workers and military veterans. These workers often handled products containing asbestos. They would bring home asbestos fibers on their clothes. This was the main cause of secondary exposure to their families and others in their homes.
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The most common symptoms of pleural mesothelioma are back and chest pain, fatigue and trouble breathing. Our research in the State of Mesothelioma: 2023 report shows 74% of mesothelioma survivors had shortness of breath. Many people do not display symptoms of mesothelioma until it has progressed.
Common Pleural Mesothelioma Symptoms
Chest pain or painful breathing
Coughing up blood
Difficulty swallowing
Dry, persistent cough
Fatigue
Fever or night sweats
Hoarseness
Lumps under the skin on the chest
Muscle weakness
Pain in the lower back or ribs
Shortness of breath or difficulty breathing
Swelling of the face or arms (edema)
Unexplained weight loss
Pleural effusions, fluid around your lungs, are a sign of pleural mesothelioma. They are one of the first signs of the disease. Pleural thickening and pleural plaques, areas of thickened pleura, are other signs. Mesothelioma usually develops several decades after asbestos exposure.
If you have a history of asbestos exposure, it’s important to know the symptoms of pleural mesothelioma. This can help you and your doctor recognize the disease and confirm a diagnosis as early as possible.
Survivor Story
Survivor Story
Joey BarnaDiagnosis: Pleural Mesothelioma, 2018
Early Symptoms Lead to Pleural Mesothelioma Diagnosis
Six years after his pleural mesothelioma diagnosis, 61-year-old Joey Barna of Massachusetts tells The Mesothelioma Center at Asbestos.com that he feels great. But Joey didn’t always feel so great, especially after his first symptoms started. For Joey, it was fluid buildup that resembled pneumonia.
Doctors use several tests to diagnose pleural mesothelioma. These include imaging scans and a biopsy. If you have chest pain and trouble breathing, your doctor may order a CT scan or chest X-ray. The scans can show fluid buildup or pleural thickening. These symptoms are early signs of mesothelioma.
Your primary care physician will then order a biopsy for analysis. This is a short surgery. You may get anesthesia or a sedative. Your doctor will remove a small piece of tissue from the chest cavity. Then, a pathologist will review your biopsy. They will check for cancer cells to confirm the diagnosis and find the right treatment.
Diagnostic Tools
Biopsy: Biopsies are tissue samples that can confirm your pleural mesothelioma cancer diagnosis.
Blood Tests: Blood tests can find cancer biomarkers. But, they can’t diagnose cancer.
Imaging Scans: X-rays, MRIs, CT scans and PET scans help spot the location of tumors.
Physical Exam: Your doctor will check for abnormalities, like a skin bump. They will also check tender or painful areas.
“A mesothelioma diagnosis may show a pleural effusion. It is fluid buildup in the lining of the lungs,” said Dr. Snehal Smart, medical doctor and Patient Advocate at The Mesothelioma Center. “They drain the fluid and perform a cytology exam. This test studies the cells to find any abnormal cancer cells in the fluid. Any presence of mesothelial cancer cells would show a diagnosis of mesothelioma.”
This helps doctors assess your stage and prognosis. Different cell types and mesothelioma locations respond to treatments differently. They can have different outcomes, too. A diagnosis of pleural mesothelioma is a life-changing event. But with the right support, you can cope with the stress of a mesothelioma diagnosis.
The Journal of Clinical Medicine published a study in 2023 about promising experimental diagnostic tools. The report mentioned the potential of using breath analysis for the diagnosis of pleural mesothelioma.
Pleural Mesothelioma Staging & Progression
Pleural mesothelioma stages show how far the cancer has progressed. Stages range from the earliest, known as stage 1, to the latest, called stage 4. Doctors will base treatment options for mesothelioma on patient’s stage and health.
Biopsies and imaging studies are important tools in the staging process. These tools help doctors determine the size and location of tumors.
The International Mesothelioma Interest Group uses the TNM staging system. It stands for tumor, node and metastasis. It’s the most used staging system for pleural mesothelioma. Stages 1 and 2 are early stages with localized tumors. Stages 3 and 4 are more advanced stages where tumors have spread.
Free Mesothelioma Nutrition Guide
Eating the right diet throughout mesothelioma treatment can ease your symptoms.
Treatment for pleural mesothelioma includes surgery, radiation therapy, chemotherapy and immunotherapy. Doctors often prescribe a combination of these treatments, known as multimodal therapy.
Discussing Treatments With Your Doctor
Chemotherapy: This is the most common type of pleural mesothelioma treatment. It usually uses a mix of cisplatin or carboplatin and Alimta (pemetrexed). This kills cancer cells or stops their reproduction.
Emerging Treatments: Novel therapies include gene therapy and photodynamic therapy. Researchers are refining these treatments. They aim to fight the disease better with fewer side effects.
Immunotherapy: The U.S. Food and Drug Administration approved the Opdivo (nivolumab) and Yervoy (ipilimumab) combination immunotherapy for pleural mesothelioma in 2020.
Palliative Care: This treatment is vital to managing pleural mesothelioma symptoms. Palliative therapies improve quality of life at all stages of mesothelioma care.
Radiation: Targeted radiation can destroy cancer cells and decrease tumor size. Radiation therapy can manage chest pain and help prevent recurrence after your surgery.
Surgery: Doctors use surgery for diagnosis and to relieve symptoms. Early-stage pleural mesothelioma patients benefit the most from tumor-removing surgery. Procedures include extrapleural pneumonectomy and pleurectomy and decortication.
New pleural mesothelioma treatments are being developed and tested. You may be able to join clinical trials. Some patients may be eligible for emerging treatments through compassionate use programs.
Doctors and patients must collaborate to find the best treatment. It must meet their needs and have a high chance of success. There is no one-size-fits-all treatment for pleural mesothelioma. Doctors consider the tumor’s cell type and location. They also review your medical history and health. They use this to recommend treatments for mesothelioma patients.
Ultimately, you decide on your treatment. Your treatment goals can also vary. They depend on your health and views on quality of life. Ensure you outline your wishes and goals for treatment with your mesothelioma specialist.
When Should I See a Doctor About Pleural Mesothelioma?
If you’ve been exposed to asbestos, talk to your doctor. Discuss your risk of pleural mesothelioma and other diseases. Mesothelioma can take decades to develop. Serious symptoms may not appear until late in the disease. Early detection and treatment of pleural mesothelioma are vital for the best outcomes.
Doctors diagnosed Joey Barna with pleural mesothelioma in 2018. In an interview, Joey told us he decided to see a doctor when he thought he was having a heart attack. “I woke up one morning and thought I was having a heart attack because my left arm hurt. So I went to the hospital, and they thought I had pneumonia because they saw fluid on my lung,” Joey said.
“A week later, I had a follow-up X-ray. They saw the fluid was still there,” Joey told us. “My primary doctor sent me for a CT scan. Fluid had built up and was pressing against my lung. It was preventing me from breathing properly.”
Finding a Top-Rated Pleural Mesothelioma Specialist
Pleural mesothelioma specialists come from many different medical disciplines. They include oncologists, surgeons, and other experts with years of experience in mesothelioma. Many specialists offer unique services such as clinical research trials and support resources.
We interviewed Dr. Jacques Fontaine, a pleural mesothelioma surgeon at Moffitt Cancer Center in Tampa. He said, “With this disease, finding a specialist is critical. You need someone who truly understands it. They must know how to treat it aggressively for the best outcome.”
Working with a top specialist can improve your prognosis for pleural mesothelioma. Specialized treatments, available at top cancer centers nationwide, can improve symptoms and survival.
Expertise: Pleurectomy and Decortication, Clinical Trials
Languages: English, Spanish, Vietnamese
Prognosis for Pleural Mesothelioma
Pleural mesothelioma prognosis is poor. But predicting it is complex and challenging. Prognosis depends on many factors. These include cell type, stage and location. Also, how well the patient can handle surgery. Finally, their response to treatment and other health issues.
Pleural Mesothelioma Prognosis Factors
Age: Younger patients tend to live longer.
Cancer Recurrence: A recurrence of mesothelioma is associated with a poorer prognosis.
Cell Type: The cell type of mesothelioma tumors also greatly influences prognosis.
Gender: Women tend to live longer with the disease than men.
Patient Activity Level: More active patients have a better prognosis.
Pleural Fluid: More pleural fluid in the chest means a worse prognosis.
Stage: The most important factor in a mesothelioma prognosis. An early-stage cancer may lengthen survival more than a late-stage cancer.
Specific biomarkers correlate with patient prognosis, including calcium and platelet count. Talk to your medical team. These factors may affect your pleural mesothelioma prognosis.
Life expectancy is often less than 18 months. It has a median survival of 8 to 14 months. Pleural mesothelioma progresses fast. It’s also resistant to many existing therapies. However, no doctor can determine your life expectancy based only on a diagnosis of pleural mesothelioma.
Survivor Story
Survivor Story
Michael ColeMesothelioma Survivor
A Brave Fight Against Pleural Mesothelioma
In 2015, doctors diagnosed Michael Cole with malignant pleural mesothelioma. He then sought help from thoracic surgeon Dr. David Sugarbaker. Aggressive surgery and heated chemo aimed to remove as much cancer as possible. It began his treatment journey. Cole believes this aggressive approach was key to his chance at life.
A better diet, exercise, and stress management can improve your pleural mesothelioma prognosis. Some patients have lived for years with few symptoms after treatment. They have also maintained their health.
Improving Your Pleural Mesothelioma Prognosis
Find a Mesothelioma Specialist: A specialist knows the best treatments for your type of mesothelioma. This can improve your outlook.
Join a Support Group: Support groups can help with anxiety, distress, fatigue and pain.
Make Healthier Lifestyle Choices: Light exercise and a healthy diet can help. They can ease symptoms and side effects.
Seek a Clinical Trial: Clinical trials test new therapies. Some patients respond better to them. They may improve your prognosis.
We often interview pleural mesothelioma survivors. They tell us their inspiring stories. These survivors have confronted the disease and its poor prognosis. Tim Crisler is a pleural mesothelioma survivor who was diagnosed in 2002. He is one of America’s longest-living mesothelioma survivors. We interviewed him about his long life and prognosis. He told us, “It’s certainly not something I deserved or earned by any stretch. But God kept me alive. He healed me.”
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Asbestos exposure causes mesothelioma. Avoiding it is the best way to prevent cancer and other asbestos-related diseases. Awareness of mesothelioma and its link to asbestos may help prevent future cases.
Legacy asbestos can still be found in older construction materials, machinery and brakes. If you work around asbestos, wear personal protective equipment such as a respirator. Don’t bring home work clothes or equipment. It may expose your family.
How common is pleural mesothelioma?
Pleural mesothelioma affects about 70% of all mesothelioma patients. It is the most common type of mesothelioma. It affects about 3,000 people diagnosed each year.
What are the complications of pleural mesothelioma?
Mesothelioma can cause severe complications. They include blood clots, bleeding in the pleural space, and a higher risk of infection. Cancer symptoms and treatments can cause malnutrition. Advanced disease may spread cancer cells. Pleural effusions cause fluid buildup. This restricts lung function and may collapse the lung.
Is pleural mesothelioma curable?
Malignant pleural mesothelioma is incurable at all four stages. Clinical trials are testing new treatments like immunotherapy and gene therapy. They provide hope for a cure.
How does asbestos affect the lungs?
Damage to asbestos-containing materials releases asbestos fibers as dust. When inhaled, these fibers become trapped in the pleural lining of the lungs. The asbestos fibers trigger the immune system to launch an inflammatory response. Over decades, this process causes tissue scarring and DNA damage. It leads to mesothelioma.
What questions should I ask my doctor about pleural mesothelioma?
A diagnosis of pleural mesothelioma is just the beginning of your mesothelioma journey. You will have many questions for your doctor. Making a list of questions will help ensure that you get the answers you need.
Suggested Questions
What type of mesothelioma do I have?
How advanced is my cancer? What stage is it at?
What are my chances of survival? What is my prognosis?
How will mesothelioma change my day-to-day life?
Do you have experience with pleural mesothelioma?
What tests do I need before deciding on treatment?
What are my treatment options?
What are the downsides of these treatment options?
What kind of support services do you offer?
Please list all your questions about your mesothelioma. Ask about treatment options, prognosis, and what to expect in the coming months and years. Being prepared helps make the most of the time you have to speak with your doctors.
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Dr. Jacques Fontaine is a thoracic surgeon at Moffitt Cancer Center in Tampa, Florida, where he heads up the Mesothelioma Research and Treatment Center. He specializes in minimally invasive robotic surgery and aggressive surgeries for mesothelioma.
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