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Pleural Mesothelioma

Pleural mesothelioma is an incurable, asbestos-related cancer that affects the lining of the lungs (pleura). It is the most common form of malignant mesothelioma. Symptoms include chest pain, chronic cough, and shortness of breath. Specialized treatments are available to help extend and increase the quality of a patient’s life.

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What Is Pleural Mesothelioma?

Pleural mesothelioma is a type of cancer that affects the chest cavity and the pleura — a thin layer of tissue surrounding the lungs.

Lining of lungs
Asbestos Fibers
Mesothelioma Cell
A person may develop pleural mesothelioma after breathing in asbestos fibers. Over time, these fibers can damage healthy cells, leading to malignant mesothelioma of the pleura.

It is by far the most common form of mesothelioma, making up around 80% of all cases, according to the American Cancer Society (ACS).

Quick Facts About Pleural Mesothelioma
  1. Pleural mesothelioma makes up roughly 80% of all mesothelioma cases.
  2. There are only about 2,500 cases of malignant pleural mesothelioma in the United States each year.
  3. According to the American Society of Clinical Oncology, the average age for a pleural mesothelioma diagnosis is 72.
  4. The average life expectancy for pleural mesothelioma is about 12 months.

Pleural mesothelioma is caused by inhaling tiny asbestos fibers. These fibers become lodged in the lungs and, 20-50 years later, can trigger the cancer’s rapid spread.


Pleural Mesothelioma Causes

Asbestos exposure is the main cause of mesothelioma, an aggressive disease that develops decades after asbestos fibers become stuck in a patient’s body.

Asbestos is a naturally occurring mineral made up of flexible and extremely durable fibers. For decades, these qualities made asbestos a popular fireproofing and insulation material in the military and many blue-collar industries.

Unfortunately, long after asbestos companies were warned of the mineral’s health risks, they kept the information secret and continued to expose millions of people.

Nearly anyone who inhaled the tiny shard-like fibers would get them lodged in the lining of their lungs, leading to diseases such as asbestosis, lung cancer, and malignant pleural mesothelioma.

How Pleural Mesothelioma Develops

According to the American Cancer Society, it takes 20-50 years or more for the symptoms of pleural mesothelioma to develop after initial asbestos exposure.

Pleural mesothelioma generally develops in the following way:

  1. Exposure: The patient inhales loose asbestos fibers while working, through secondhand exposure, or other means.
  2. Buildup: Too small to cough up and too strong to dissolve, the asbestos fibers become stuck in the lining of the lungs.
  3. Damage: Over time, the asbestos fibers can cause inflammation, scarring, and genetic damage to nearby cells.
  4. Cancer: Over the course of decades, this genetic damage can cause uncontrolled pleural cell division and the first symptoms of malignant pleural mesothelioma.

Pleural mesothelioma’s long latency period means patients are often diagnosed late in life, but it also increases the risk of a late diagnosis or misdiagnosis because patients may not think to mention a job that put them at risk for asbestos exposure decades ago.

Who Is at Risk for Pleural Mesothelioma?

Pleural mesothelioma overwhelmingly affects men with working-class and military backgrounds because, from the 1930s to the early 1980s, asbestos was heavily used in many blue-collar industries and in the United States military.

However, the loved ones of people exposed to asbestos, people who lived near asbestos mines, and others may also have a higher-than-average risk for pleural mesothelioma.

Pleural Mesothelioma Risk Factors

The American Society of Clinical Oncology (ASCO) describes a risk factor as “anything that increases a person’s chance of developing cancer.” Most risk factors for the disease directly relate to an increased risk of asbestos exposure.

The following groups have a higher risk of developing pleural mesothelioma:

  • Blue-collar workers
  • Veterans, especially those in the Navy
  • Loved ones of individuals exposed to asbestos

Other groups more likely to be diagnosed with pleural mesothelioma include people living near asbestos mines or natural deposits, people over 65, and men. Among these groups, veterans are particularly overrepresented.

Veterans and Pleural Mesothelioma

The U.S. Department of Veterans Affairs (VA) reports that veterans make up around 33% of all mesothelioma cases in the United States.

This shockingly high percentage is due to decades of heavy asbestos use by the United States military before the early 1980s.

Asbestos companies made millions selling the government their deadly products while hiding the truth about asbestos. By the time the military realized how dangerous asbestos was, millions of soldiers and military workers had been exposed.

Because asbestos was heavily used in ships, Navy veterans have the highest risk of developing mesothelioma of any military branch.

Pleural Mesothelioma Symptoms

Pleural mesothelioma symptoms are often difficult to diagnose because they are similar to many less serious illnesses.

In addition, they may develop 20-50 years or longer after a patient was exposed to asbestos, making it hard to connect a patient’s asbestos exposure to their current symptoms.

Pleural mesothelioma symptoms include:

  • Chest pain
  • Chronic cough
  • Feeling generally unwell
  • Fever
  • Pain in the upper back
  • Painful coughing
  • Shortness of breath
  • Shoulder and rib pain
  • Unexplained weight loss
  • Weakness

As pleural mesothelioma progresses, patients may develop additional symptoms.

Late-stage pleural mesothelioma symptoms include:

  • Anemia
  • Constant pain in the chest
  • Coughing up blood
  • Difficulty swallowing
  • Lumps on the chest
  • Night sweats
  • Painful breathing
  • Tightness in the chest

Many of the symptoms of pleural mesothelioma are caused by a condition known as pleural effusion — a buildup of fluid between the lining of the lungs. Many illnesses can cause this fluid buildup, but its presence may lead doctors to examine a patient’s lungs more closely in order to make a diagnosis.

Pleural Mesothelioma Diagnosis

Because it is a rare disease with vague symptoms, making a pleural mesothelioma diagnosis can be difficult. Often, it is a patient’s asbestos exposure history that prompts doctors to test for mesothelioma.

To get a proper diagnosis, patients should look to a mesothelioma specialist.

The process for diagnosing pleural mesothelioma generally follows these steps: 

  1. A patient goes to their doctor, complaining of flu-like symptoms
  2. The doctor performs a chest X-ray, revealing fluid buildup or tumors around the lung
  3. The doctor refers the patient to a specialist for further testing

Mesothelioma specialists rely heavily on imaging scans and biopsies to make a pleural mesothelioma diagnosis.

Imaging Tests

Once doctors suspect pleural mesothelioma, they usually turn to imaging tests first to investigate further.

Doctors may use the following imaging tests:

  • Chest X-rays
  • Computerized tomography (CT) scans
  • Magnetic resonance imaging (MRI) scans
  • Positron emission tomography (PET) scans
  • Echocardiograms

These tests may reveal tell-tale signs of pleural mesothelioma such as thickening of the pleural lining, pleural effusion, and tumors growing around the lung area.


To make a conclusive diagnosis of pleural mesothelioma, doctors must perform a biopsy.

A doctor may consider 3 types of biopsies for a pleural mesothelioma diagnosis:

  • Surgical biopsy: The doctor makes a surgical cut in the chest wall to remove a tumor or tumor sample. This is the most invasive but accurate procedure.
  • Endoscopic biopsy: The doctor inserts an endoscope — a slender tube-like instrument with a small camera — to examine and get samples of the pleural tissue, chest cavity, and lymph nodes.
  • Needle biopsy: The doctor inserts a needle into the patient’s chest, removing fluid build-up in the lungs (pleural effusion), a sample of the tumor, or lymph nodes.

If cancer cells are found, doctors can diagnose a patient with pleural mesothelioma. They may also be able to tell how far the cancer has progressed.

Getting a Second Opinion

A proper pleural mesothelioma diagnosis is a critical part of treatment. Unfortunately, most oncologists are not experienced with diagnosing pleural mesothelioma, and the illness is commonly misdiagnosed

To lower the risk of misdiagnosis, patients should seek a second opinion from an experienced mesothelioma specialist.

By getting a second opinion from an expert, a patient can:

  • Decrease the likelihood of a misdiagnosis
  • Better understand their mesothelioma
  • Connect with top mesothelioma specialists
  • Make sure they have a quality treatment strategy
  • Improve their survival outcome

However, patients should seek a second opinion quickly. Pleural mesothelioma progresses at a rapid pace, so every day without treatment counts.

Pleural Mesothelioma Stages

Staging describes the process of finding out how much cancer is in a patient’s body and how much it has spread. Pleural mesothelioma is the only type of mesothelioma that oncologists have sufficient information on to officially stage.

Doctors typically use the TNM Staging System for the 4 stages of pleural mesothelioma.

By knowing where the cancer has spread, doctors can decide which treatments will be most effective at removing the mesothelioma and managing the patient’s symptoms.

Stage 1Stage 1
Stage 1

The earliest stage of pleural mesothelioma. Cancer is localized to the layers of the pleura.


Curative treatments like surgery may improve life expectancy by several months or years.

Median Life Expectancy

21 months

Stage 2Stage 2
Stage 2

The cancer has spread just past the pleura and may have reached nearby lymph nodes. It has not reached the other side of the chest.


Patients still have many curative treatment options to increase life expectancy.

Median Life Expectancy

19 months

Stage 3Stage 3
Stage 3

The cancer has reached tissues, organs, or lymph nodes nearby.


Most patients are no longer eligible for curative treatments but can undergo palliative options.

Median Life Expectancy

16 months

Stage 4Stage 4
Stage 4

The final stage of pleural mesothelioma. Cancer has reached distant areas of the chest and the rest of the body.


Treatments are focused exclusively on palliative care.

Median Life Expectancy

12 months

Pleural Mesothelioma Prognosis

A mesothelioma prognosis describes the way the cancer will likely progress and affect a patient. Sadly, the prognosis for a pleural mesothelioma patient is poor. The cancer spreads rapidly, and even patients who get diagnosed early live for less than two years on average.

However, a prognosis only describes the average outcome. Many factors can affect how long an individual lives with pleural mesothelioma. Many patients go on to live far longer than the average.

Factors That Affect Prognosis

Multiple factors may influence the progression of pleural mesothelioma.

Factors that contribute to a pleural mesothelioma prognosis include:

  • Age: Younger patients often have a better prognosis than patients diagnosed later in life. They are more likely to be healthy enough to undergo life-extending surgeries.
  • Disease stage: Patients diagnosed at an earlier stage have more life-extending treatment options.
  • Mesothelioma cell type: Depending on the type of cancer cells that make up pleural mesothelioma tumors, the cancer may progress at a different rate. Epithelioid mesothelioma tends to carry the best prognosis because it responds best to aggressive treatment.
  • Sex: Women have a slightly better pleural mesothelioma prognosis than men. A 2010 study suggested that estrogen receptors may play a role in suppressing epithelioid tumor growth.

Improving Pleural Mesothelioma Prognosis

While many of the factors that determine a pleural mesothelioma prognosis are beyond a patient’s control, there are steps they can take to improve their mesothelioma outlook.

To improve their pleural mesothelioma prognosis, patients should:

  • Get treated early: Patients should seek curative treatments as early as possible. Surgeries often extend the lives of patients more than other mesothelioma treatment options but may only be available to early-stage patients.
  • Quit smoking: Smoking may worsen symptoms of pleural mesothelioma and bar patients from life-extending surgeries that can only be performed if their lungs are healthy enough. Smoking may also lead to an additional cancer diagnosis, decreasing life expectancy.
  • Manage stress: High stress levels may lower overall patient health, making recovery from treatments slower and decreasing a patient’s overall quality of life.
  • Eat well: Patients undergoing treatment need to keep their immune systems healthy to provide the best chance of surviving and recovering from invasive procedures.
  • Exercise: Even low-intensity exercise may have health benefits like decreased stress, improved blood flow, and the prevention of other health issues like bedsores.

While there are many ways patients can help improve their prognosis, few factors have as big an impact on average survival rates as treatment.

Pleural Mesothelioma Treatment

Patients typically have multiple pleural mesothelioma treatment options at every stage — either to increase life expectancy or to relieve symptoms.

The primary treatment options for mesothelioma are:

During earlier stages, patients may undergo surgeries and therapies to extend their lives. During later stages, the goal of pleural mesothelioma treatments is to control the disease and reduce pain and discomfort.


Performing mesothelioma surgery is the most effective way to control malignant pleural mesothelioma and prevent it from spreading. During surgery, pleural mesothelioma specialists attempt to physically remove all visible tumors and, in some cases, the surrounding tissues or organs.

Two of the most common types of pleural mesothelioma surgeries are the extrapleural pneumonectomy (EPP) and the pleurectomy with decortication (P/D).

Extrapleural Pneumonectomy

During an extrapleural pneumonectomy, a surgeon removes the affected lung, the lining of the heart and lungs, part of the diaphragm, and lymph nodes close to the affected area.

With chemotherapy or radiation, EPP may give a patient several more months to live.

Pleurectomy with Decortication

A pleurectomy with decortication involves the removal of the pleura, any tumors, and, in some cases, some affected lung tissue. The patient keeps both lungs.

While surgery is often effective at extending pleural mesothelioma patients’ lives, it can only be performed on patients who are strong enough to endure and recover from the operation. Surgery may also not be possible if the cancer has spread too much.

Most stage 3 and 4 pleural mesothelioma patients, older patients, and those in poor health may have other treatment options.


During chemotherapy, doctors administer multiple rounds of cancer-killing drugs intravenously through a patient’s body.

Patients may undergo chemotherapy alone, but it is most effective when combined with surgery or radiation therapy.


Radiation therapy treats cancer by using intense beams of energy to destroy the genetic material of cancer cells. Without this genetic material, mesothelioma cells cannot divide as quickly and often die.

Radiation therapy has few side effects and is often used to reduce the symptoms of late-stage pleural mesothelioma patients. However, it may also be used with chemotherapy or surgery to help extend a patient’s life.

Clinical Trials

Clinical trials test new treatments with the goal of increasing patient lifespans and quality of life — and ultimately curing mesothelioma.

In addition, they offer hope to patients with no remaining standard treatment options. Many pleural mesothelioma patients have responded well to clinical trial treatments while helping improve treatment options for future patients.

Emerging Treatment Options

Medical professionals are developing many promising new treatment options for pleural mesothelioma.

Some promising emerging treatment options include: 

  • Gene therapy: During gene therapy, a patient’s cancer cells receive new genes, which are injected into the cells through modified viruses. Doctors hope to slow or stop cancerous growth by changing the genetic makeup of the corrupted cells.
  • Immunotherapy: Immunotherapy trains a patient’s immune system to find and kill cancer cells more effectively. This is done using substances produced by the patient’s own body or in a lab.
  • Photodynamic therapy: Photodynamic therapy is a type of cancer treatment that uses light to kill cancer cells. It may allow for less drastic cancer surgeries, increasing survival rates and quality of life.

These new treatments may be less aggressive than current pleural mesothelioma treatment options, extend patient lifespans, and, perhaps one day, may even lead to a cure.

Palliative Treatment

Late-stage pleural mesothelioma patients may no longer be able to undergo life-extending treatments. However, they still have options for reducing pain and discomfort.

Palliative treatment options include: 

  • Chemotherapy: Doctors may perform chemotherapy on a patient to shrink tumors and relieve the symptoms of late-stage pleural mesothelioma. Although chemotherapy often causes negative side effects, supportive care interventions may reduce these effects.
  • Radiation: Like chemotherapy, radiation may help reduce the size of tumors, easing symptoms like chest pain. Radiation generally has fewer side effects than chemotherapy.
  • Low-risk surgeries: Surgeries may be performed to drain extra fluid in the lungs. These procedures reduce pain, ease coughing, and make breathing easier.

Palliative treatments play an essential role in helping mesothelioma patients enjoy the precious time they have left.

Top Pleural Mesothelioma Specialists

Pleural mesothelioma specialists are oncologists, pathologists, surgeons, and other medical professionals who specialize in pleural mesothelioma research and treatment.

Top pleural mesothelioma specialists include:

  • Dr. Abraham Lebenthal: Dr. Abraham “Avi” Lebenthal is a pleural mesothelioma specialist at Brigham and Women’s Hospital and director of Minimally Invasive Thoracic Surgery at the VA West Roxbury Medical Center in Boston, MA.
  • Dr. Jacques Fontaine: Dr. Jacquest Fontaine is a thoracic surgeon who specializes in mesothelioma and lung cancer. He practices at Moffitt Cancer Center in Tampa, FL.
  • Dr. Robert B. Cameron: Dr. Robert Cameron is one of the leading pleural mesothelioma surgeons in the country and the inventor of pleurectomy with decortication, a surgery used to treat pleural mesothelioma. He practices at Ronald Reagan UCLA Medical Center in Los Angeles, CA.
  • Dr. Taylor Ripley: Dr. Taylor Ripley is a nationally recognized thoracic oncologist specializing in mesothelioma. He is the director of the Mesothelioma Treatment Center where he practices at Baylor St. Luke’s Medical Center in Houston, TX.

Visit the UCLA Health website to learn more about Dr. Robert Cameron.

The Mesothelioma Justice Network has no affiliation with and is not endorsed or sponsored by Dr. Robert B. Cameron. The contact information above is listed for informational purposes only. You have the right to contact Dr. Cameron directly.

Mesothelioma is a rare, aggressive cancer that requires deep knowledge and experience to treat. Ideally, patients should seek a pleural mesothelioma specialist working at a National Cancer Institute (NCI) designated cancer center.

Pleural Mesothelioma Cancer Centers

Mesothelioma cancer centers are facilities that specialize in diagnosing, treating, and researching mesothelioma. They employ experienced mesothelioma doctors.

These centers often sub-specialize by mesothelioma type or stage. Many of these centers focus on treating pleural mesothelioma.

To increase their chances of receiving the best possible treatment, patients should look to these and other NCI-designated mesothelioma cancer centers.

Cost of Pleural Mesothelioma Treatment

In addition to the cost of tests, surgery, chemotherapy, radiation, and other medical expenses, pleural mesothelioma patients often face other associated expenses. These may include an inability to work and travel and lodging expenses required to access treatment at a top mesothelioma cancer center.

Did You Know?

The total estimated cost for mesothelioma treatment is $400,000-$600,000.

The cost of mesothelioma treatment may vary according to:

  • Caregiving needs
  • Healthcare providers
  • Individual treatment plan
  • Insurance coverage
  • Lodging needs
  • Lost income
  • Travel requirements
  • Veteran status

While insurance may greatly reduce the costs of mesothelioma treatment, the American Cancer Society (ACS) still cites the average annual cost of lung cancer treatment for insurance holders as $5,000-$10,000.

However, an experienced mesothelioma lawyer may be able to help mesothelioma victims and their families win compensation to cover many of the costs associated with their illness. This also helps hold the companies who put people at risk for this terrible disease accountable.

Support Options for Pleural Mesothelioma Victims

The main cause of mesothelioma is asbestos exposure. For years, many private employees, members of the U.S. military, and their loved ones were exposed to toxic asbestos fibers while asbestos companies kept the mineral’s deadliness a secret from the government and the public.

Eventually, the truth was exposed, and today, mesothelioma victims may have several financial support options for their treatment expenses.

Financial support options for pleural mesothelioma victims include:

  • Asbestos trust funds
  • Charities and donations
  • Medicare or Medicaid
  • Private insurance
  • VA benefits

Patients and loved ones struggling with pleural mesothelioma treatment costs should research their financial options and reach out to organizations like the Mesothelioma Applied Research Foundation for guidance.

Despite the grave challenges of a pleural mesothelioma diagnosis, it is not a hopeless situation.

While discussing pleural mesothelioma’s 5-year survival rate, Abramson Cancer Center stresses one point: “…this number is higher than it was 10 years ago and much higher than it was 20-30 years ago.”

As medical professionals improve their understanding of mesothelioma, they also improve the length and quality of their patients’ lives.

Mesothelioma Support Team
Reviewed by:Dr. Assuntina Sacco

Board-Certified Oncologist

  • Fact-Checked
  • Editor

Assuntina Sacco, MD is an Associate Professor of Internal Medicine at the University of California, San Diego (UCSD) Moores Cancer Center, where she also serves as the Medical Director of Infusion Services. She is a board-certified medical oncologist trained to treat all solid tumor types, with the use of chemotherapy, immunotherapy, targeted therapy, and clinical trials.

Dr. Assuntina Sacco is an independently paid medical reviewer.

Stephanie KiddWritten by:


Stephanie Kidd grew up in a family of civil servants, blue-collar workers, and medical caregivers. Upon graduating Summa Cum Laude from Stetson University, she began her career specializing in worker safety regulations and communications. Now, a proud member of the American Medical Writers Association (AMWA) and Editor-in-Chief of the Mesothelioma Justice Network, Stephanie serves as a voice for mesothelioma victims and their families.

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