Pleural Mesothelioma

Summary

Pleural mesothelioma is a rare type of asbestos-caused cancer. It affects the protective tissues that line the lungs and chest (pleura). While the prognosis for pleural mesothelioma is poor, there are important treatment options that can extend life expectancy.

Pleural Mesothelioma Overview

If you’ve been diagnosed with pleural mesothelioma, or your or your doctor suspect you have it, then here is what you need to know about this disease:

  • Rare cancer caused by asbestos exposure that affects the lungs and chest
  • The most common form of mesothelioma, accounting for 80% of all new cases
  • Average life expectancy for pleural mesothelioma patients is 12-21 months but can be extended with aggressive treatments
  • Pleural mesothelioma is staged 1-4 based on how far cancer has spread
  • Standard treatments include surgeries, chemo and radiation therapies
  • New and novel therapies are being tested in clinical trials, which can give end-stage pleural mesothelioma patients new hope
  • Pleural mesothelioma can only be treated by specialists located at cancer centers across the country

What is Pleural Mesothelioma?

Pleural mesothelioma is a relatively new cancer, and its complexities are not yet fully understood by doctors.

With fewer than 3,000 new cases per year in the United States, pleural mesothelioma remains an extremely rare cancer that’s difficult for doctors to identify.

The other two main forms of pleural mesothelioma—peritoneal (abdomen) and pericardial (heart)—only account for 20% and less than 1% of all disease cases respectively.

Pleural mesothelioma forms in the tissue lining that covers the lungs and chest wall. Tissues that cover organs are called the mesothelium, and the mesothelium that covers the lungs and chest is called the pleura.

Pleural mesothelioma first forms on one side of the chest and can spread to distant sites if left untreated.

Pleural mesothelioma has a worse prognosis than peritoneal mesothelioma but patients can still fare better than pericardial mesothelioma patients. Highly technical surgical procedures can aggressively remove tumors and potentially extend patients lives by several months to years.

Symptoms of Pleural Mesothelioma

Symptoms of pleural mesothelioma are notoriously difficult to detect. Vague respiratory-related symptoms often get mistaken for other more common and less severe conditions.

Mesothelioma has a latency period of 10-50 years, meaning it can take decades for symptoms to develop after asbestos exposure.

Primary pleural mesothelioma symptoms include:

  • Chest pain
  • Difficulty breathing and shortness of breath
  • Persistent, dry cough
  • Fluid buildup in the lungs (pleural effusions)
  • Coughing up blood
  • Unexplained weight loss
  • Fever, night sweats, and fatigue

The most commonly reported symptoms in pleural mesothelioma patients are chest pain and chronic cough.

One of the leading signs of pleural mesothelioma is thickening and fluid buildup within the pleura, which occur due to pleural inflammation caused by metastasizing (spreading) tumors.

Because vague pleural mesothelioma symptoms can easily be mistaken for conditions like pneumonia or emphysema, it’s vital that you report your history of asbestos exposure to your doctor. This can help him or her identify your condition sooner so you can undergo the correct treatments.

What Causes Pleural Mesothelioma?

The only known cause of pleural mesothelioma is asbestos exposure. Used extensively during the 20th century, asbestos was a fireproof, insulation material installed in buildings and added to industrial products.

Anyone who worked extensively around asbestos is now at risk of developing pleural mesothelioma and other asbestos-related diseases.

Asbestos fibers are microscopic, yet indestructible. When they become airborne, asbestos particles can be inhaled by those nearby. Inhaled asbestos fibers lodge themselves into the lung’s protective lining (pleura) where they can never be expelled.

Here is what happens after asbestos fibers become trapped in the pleura:

  1. Irritation can trigger genetic mutations in healthy mesothelial cells.
  2. Healthy cells become cancerous mesothelioma cells and grow at abnormal rates.
  3. Mesothelioma cells lump together and form metastatic tumors (cancerous tissue) that can spread to distant sites.
  4. As mesothelioma tumors grow, they damage the lungs, the heart and the lymphatic system (the body’s filtration mechanism).

Left untreated, pleural mesothelioma becomes fatal due to complications resulting from the malignant (cancerous) tumors.

With treatment, patients can have pleural mesothelioma tumors removed or shrunk, which may increase life expectancy.

Who Gets Pleural Mesothelioma?

The majority of mesothelioma patients are males. Because mesothelioma is caused by asbestos, most of the people exposed to this toxin during the 20th century were men who occupied traditional male-oriented jobs.

Because of the peak time when asbestos was used most (1940s to 1980s), mesothelioma is a disease affecting predominantly older adults over the age of 60.

MJN Brief

Mesothelioma can affect people from all walks of life. Because it was used so extensively and contaminated anything and everything around it, women—including wives, mothers, daughters and sisters of asbestos workers—and even younger adults in their twenties and thirties can develop mesothelioma.

Pleural Mesothelioma Stages

With most cancer types, doctors apply a standard medical practice called staging, which tells doctors how far advanced the disease is. By know where the cancer has spread to, doctors can decide which treatments will be most effective either at resecting (removing) the mesothelioma or managing the patient’s symptoms (palliative).

Doctors use three different staging systems for pleural mesothelioma each with their own criteria.

In general, the four stages of pleural mesothelioma are:

  • Stage 1: Mesothelioma remains localized in one or both layers of the pleura.
  • Stage 2: Mesothelioma has metastasized slightly outside the pleura and possibly into nearby lymph nodes.
  • Stage 3: Mesothelioma has metastasized into nearby tissues, organs or lymph nodes.
  • Stage 4: Mesothelioma has invaded distant sites like the peritoneum, pericardium and/or the other side of the chest.

Most cases are diagnosed at stage 3 or 4 pleural mesothelioma. No matter how far advanced your condition is, there are pleural mesothelioma treatments available for every stage.

Pleural Mesothelioma Treatments

Mesothelioma specialists have developed effective treatments for pleural mesothelioma. The hope for increased life expectancy is much higher today compared to 20 years ago thanks to new methods and approaches to treating even late-stage patients.

Standard treatment for pleural mesothelioma includes a combination of surgery, chemotherapy, radiation therapy and palliative treatment.

For pleural mesothelioma treatments to be most effective, plans must involve:

  • Experienced pathologists capable of accurately diagnosing the cancer type
  • Multidisciplinary teams of specialists across a range of medical fields
  • Highly skilled surgeons who specialize in removing pleural mesothelioma

Pleural mesothelioma patients may be eligible for curative surgeries, which can either fully or partially resect tumors and improve survival.

The two standard curative surgeries for pleural mesothelioma are:

  1. Extrapleural Pneumonectomy: Surgeons remove the diseased lung, pleura, lymph nodes, pericardium and part of the diaphragm. Patients can live with only one lung, however, it may decrease the quality of life for certain people.
  2. Pleurectomy With Decortication: During a less radical surgery, surgeons remove the diseased pleura and all visible tumors nearby. Though this procedure allows patients to keep their lung, there’s debate over whether or not it leads to higher rates of recurrence (when cancer comes back).

Most patients also undergo chemotherapy or radiation therapy or both. These anti-cancer treatments help shrink tumors and kill of remaining microscopic mesothelioma cells left behind after surgery.

Seeing a Pleural Mesothelioma Specialist

Pleural mesothelioma patients should seek treatment from a specialist for their best chance at survival. General oncologists do not have the experience necessary to effectively treat mesothelioma. It’s rare cancer, and most doctors only see 1 or 2 cases in their careers. Since pleural mesothelioma also affects each person differently, personalized treatment plans from experienced specialists are vital.

By seeing a specialist, you’ll be treated by an entire team of mesothelioma experts who have dedicated their careers to researching and treating this disease.

Treatment teams include thoracic surgeons and medical and radiation oncologists who can provide the latest treatment technologies and approaches.

Our country has many of the world’s top pleural mesothelioma specialists including:

  • Dr. David Sugarbaker—Thoracic Surgical Oncologist, Baylor St. Luke’s Medical Center, Houston TX
  • Dr. Robert Cameron—Thoracic Surgical Oncologist, UCLA Medical Center and Los Angeles VA, Los Angeles CA
  • Dr. Anne Tsao—Thoracic Medical Oncologist, MD Anderson Cancer Center, Houston TX

Pleural mesothelioma can only be accurately diagnosed by a specialist. If you’ve received a diagnosis from a general oncologist, then it’s crucial to get a second opinion from a pleural mesothelioma specialist.

A second opinion can either confirm your diagnosis or provide you with a different one, which will alter your treatment plan.

It’s common for pleural mesothelioma to be misdiagnosed as another type of cancer. To avoid wasted time, be sure to contact a pleural mesothelioma specialist immediately before starting on any treatment plan.

Compensation for Pleural Mesothelioma

Treatments for pleural mesothelioma are available at top cancer centers across the country. All major cancer centers with mesothelioma programs accept health insurance plans. However, some plans won’t cover all costs associated with treatments. Patients often need to travel great distances to undergo treatment, which can incur significant costs.

A mesothelioma diagnosis is a major emotional and financial burden to patients and their families. By filing for legal compensation, you may be able to cover your pleural mesothelioma treatments costs, travel and accommodation expenses and any other damages you’ve suffered such as lost wages.

Veterans may also be eligible for medical benefits through the VA. If you can prove that your pleural mesothelioma was caused by asbestos exposure during your time as an active duty military member, then you may be able to receive monthly payments from the VA.

View Author and Sources
Sources
  1. Mayo Clinic, “Mesothelioma Overview.” Retrieved from: https://www.mayoclinic.org/diseases-conditions/mesothelioma/symptoms-causes/syc-20375022. Accessed on December 30, 2017.
  2. Medscape, “Malignant Pleural Mesothelioma Treatment Protocols.” Retrieved from: https://emedicine.medscape.com/article/1999348-overview. Accessed on December 30, 2017.

Last modified: February 3, 2018