Pleural Mesothelioma Cancer

Pleural mesothelioma (sometimes referred to as Mesothelioma of the Pleura) is a rare, aggressive cancer that develops in the thin layer of tissue surrounding the lungs. The disease is caused primarily by the inhalation of microscopic asbestos fibers, which can become lodged in the lining around the lungs and trigger a chain of physiological reactions that eventually can lead to cancer.

Pleural is one of four types of mesothelioma and is the most common. There are more than 2,000 cases of pleural mesothelioma diagnosed annually in the United States, and a majority of them are traced to an occupational exposure to asbestos.

The name of the disease comes from the mesothelial cells within the pleura lining around the lungs. Benign pleural tumors also can develop, but these cases are extremely rare and typically not related to asbestos. On average, 10 patients are diagnosed with malignant pleural mesothelioma for every one patient with benign pleural mesothelioma.

A large percentage of those diagnosed are older men, which is due to a combination of industrial workplace exposure to asbestos and a lengthy latency period (10-50 years) between that exposure and the diagnosis. Yet woman also are diagnosed, too, either from secondhand exposure (for example, from the clothes a husband was wearing when he came home), or from spending considerable time in a structure where asbestos was in the air.

This form of cancer can take decades to develop after someone is exposed to asbestos, but once pleural mesothelioma tumors form, cancer cells usually spread rapidly across the lining of the lung. The most successful way to treat it is a combination of surgery, chemotherapy and radiation, which is known as a multimodal approach. Although there is no definitive cure, effective therapies are being developed now that can slow, or even stop, its growth if diagnosed early enough.

Pleural Mesothelioma Symptoms

Early symptoms of pleural mesothelioma often mirror those of less serious illnesses, which is one reason it is tough to diagnose before it has metastasized. Symptoms can include a raspy cough, shortness of breath, fatigue, chest pain or unexplained weight loss. The symptoms usually are related to the presence of small tumors and to a slow thickening of the pleural membrane.

Unfortunately, many of the more serious symptoms don't present until the cancer has reached its later stages, which usually limits the potential treatment options. Painful breathing, coughing up blood, difficulty swallowing and pain in the lower back become more common as it progresses.

Diagnosing Pleural Mesothelioma

Pleural mesothelioma can be difficult to diagnose. The process can take months, and sometimes up to a year, before a definitive diagnosis is made. Part of the problem is the rarity of the disease, which many medical professionals rarely see. It's important for a patient to discuss known exposure to asbestos early with a physician. If pleural mesothelioma is suspected, it's crucial to see a specialist who has experience with the disease and its intricacies.

It's challenging even for an experienced oncologist to distinguish between pleural mesothelioma and a more common lung cancer. The early symptoms often are confused with pneumonia or influenza.

After a medical and occupational history review, a patient is typically sent for imaging tests. It might start with X-rays, then move to CT scans to provide a closer, more advanced look at the problem.

A PET scan (positron emission tomography) often is the next step, using gamma rays and radioactive materials to create a three-dimensional image of the body. A PET scan can show biological movements that occur within cancerous cells.

If imaging tests indicate the presence of cancer, then more invasive procedures usually are requested. A thoracentesis can collect pleural fluid from around the lung so that cell samples can be inspected. Other biopsies can collect different tissue samples. Usually a series of tests and biopsies can confirm the presence of pleural mesothelioma.

Treating Pleural Mesothelioma

Surgery, chemotherapy and radiation therapy are the primary treatments for pleural mesothelioma. Early-stage mesothelioma patients are the best candidates for potentially curative surgery, which offers the longest extension of life. Surgery is rarely considered once malignant cells break off from the original tumor and spread beyond the pleural lining. Instead, chemotherapy and radiation therapy may be given when surgery is not an option.

If surgery is an option, there are two types that are potentially curative, and both are considered major. There is the Extrapleural Pneumonectomy (EPP) and the Pleurectomy/Decortication (P/D). The EPP involves the removal of the affected lung, the lining around it and part of the diaphragm. The P/D is considered lung-sparing, but it involves the removal of the entire lining around the lung. It is more detailed and also has a high risk of post-surgical complications.

Chemotherapy for pleural mesothelioma may include drugs such as Alimta or Cisplatin, with doses determined by a patient's health, weight and stage of the cancer. Radiation therapy is commonly administered alongside chemotherapy, although it may be used on its own. Many pleural mesothelioma patients also use alternative treatments like massage and breathing techniques to relieve pain and treat symptoms. Regardless of which type of treatment is selected, therapy should start soon after diagnosis because of the cancer's tendency to progress quickly.

Doctors and Treatment Centers

One of the biggest and most important decisions a patient will make is the selection of a specialist and a treatment center to handle their care. With a rare disease like pleural mesothelioma, treatment can vary widely from place to place. This is not a disease with a one-size-fits-all treatment approach. It needs a personalized approach from a specialist who understands the intricacies involved and who appreciates all the latest advancements that have been made.

The Pleural Mesothelioma Center has a Doctor Match program to help you find the right fit, based on the patient's location, willingness to travel and insurance situation. Our Patient Advocates can provide a closer look at some of the nation's best doctors.

Pleural Mesothelioma Prognosis

The prognosis for pleural mesothelioma is typically less than one year for patients diagnosed in a later stage. Patients diagnosed before the cancer spreads to other organs have the best prognosis, and many live for extended periods. With proper care, these patients can live five and sometimes even 10 years after initial treatment.

The National Institutes of Health found that the stage, cell type and the overall health and age of a patient can figure prominently in how well a patient responds to treatment. Patients with epithelial cell type (instead of sarcomatoid or biphasic cell types) typically have responded better to treatment.