Pleural mesothelioma is an asbestos-related cancer that forms in the lining around the lungs. It is the most common type of the disease, accounting for about 75 percent of mesothelioma cases. Treating pleural mesothelioma at an earlier stage improves prognosis.

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Last Updated on August 15, 2019.

What Is the Main Cause of Pleural Mesothelioma?

Asbestos exposure is the main cause of pleural mesothelioma. The heavier the asbestos exposure and the longer a person is exposed throughout their lifetime, the higher the risk for mesothelioma.

More than three-quarters of all pleural mesothelioma cases are directly related to asbestos. Most of this contact with asbestos has occurred in occupational settings.

Who Gets Pleural Mesothelioma?

The majority of mesothelioma patients have a history of working in an industry where contact with asbestos was common and frequent.

Occupational Asbestos Exposure

Up until the 1980s, many workers sustained long-term, high-dose asbestos exposures in occupations at contaminated worksites such as refineries, construction sites and power plants. These types of longer-term asbestos exposure placed these employees at risk for developing pleural mesothelioma.

Higher than average rates of pleural mesothelioma and other long-latency respiratory diseases are found among:

  • Miners
  • Plumbers
  • Quarrymen
  • Gas fitters
  • Shipyard workers, including veterans working on and around ships and navy yards
  • Dock employees

U.S. military veterans are at risk of developing mesothelioma because of time spent working at shipyards and shipbuilding and repair facilities. These locations have been sources of asbestos exposure in years past.

In rare instances, exposure to asbestos during home remodeling or handling loose-fill insulation is identified as the main cause for a mesothelioma diagnosis.

Secondhand & Environmental Asbestos Exposure

Some people have been exposed to asbestos through secondhand means. For example, asbestos carried home on the clothing or skin of an asbestos worker can result in secondhand exposure of family members or anyone else in the home.

Others are exposed to asbestos because they live near asbestos mines or naturally occurring asbestos deposits.

What Are the Symptoms of Pleural Mesothelioma?

Symptoms of pleural mesothelioma may be mistaken for less serious conditions. This makes them easy to ignore or misdiagnose. Early symptoms include wheezing, coughing, nonspecific chest pain and shortness of breath with physical exertion.

A 2019 paper in the medical journal Expert Review of Respiratory Medicine highlights this challenge to prompt and accurate diagnosis of mesothelioma.

The authors noted the clinical presentation of pleural mesothelioma is often nonspecific and includes progressive shortness of breath, weight loss and chest wall pain.

As the disease progresses, pleural mesothelioma symptoms become more serious and can include:

  • Fatigue
  • Weakness
  • Fever and night sweats
  • Trouble swallowing
  • Coughing up blood
  • Swelling in the arms and face
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How Is Pleural Mesothelioma Diagnosed?

Digital chest x-ray of advanced malignant mesothelioma on left
Chest x-ray showing mesothelioma

The diagnosis of pleural mesothelioma may take some time. Identifying the disease can require several tests and procedures. This may include X-rays, CT scans, MRIs, PET scans, biopsies and laboratory examination of fluids taken from around the lungs.

If symptoms are what brought you to the doctor, the path toward getting a diagnosis may start with an X-ray. Although an X-ray cannot give a diagnosis, a radiologist can note any abnormal-looking areas. They can schedule additional tests to learn more about what is causing your symptoms.

Once your health care team understands more about the nature of your disease, they will try to obtain a biopsy of potentially cancerous areas. A biopsy is the only way to definitively diagnose pleural mesothelioma.

Biopsies and Additional Tests to Diagnose Pleural Mesothelioma

Biopsies can take the form of solid tissue or fluid taken from around the lungs. Your doctor can obtain a biopsy through one or more of the following methods:

  • Fine-needle aspiration: Cells are withdrawn from the body with a long, thin hollow needle and syringe.
  • Thoracentesis: Fluids are removed from the small space between the lungs and the pleura, which is the membrane around the lungs.
  • Thoracoscopy: A camera-equipped probe is inserted through the chest wall and used to identify and obtain a sample of tissue from suspicious looking areas.
  • Mediastinoscopy: This procedure is similar to thoracoscopy, except the camera-equipped probe is inserted through the neck instead of the chest.

The ASCO 2018 pleural mesothelioma treatment guidelines recommend any cancerous cells from a biopsy be further classified by immunohistochemistry, which identifies the presence of cell markers specific to mesothelioma.

Markers not expected to be in a mesothelioma sample also should be tested. This can rule out other potential diseases.

Additional lab tests can confirm the cell. Currently, there are no routine genomic tests approved for clinical use.

What Are the Stages of Pleural Mesothelioma?

There are four stages of pleural mesothelioma. The higher the number, the more advanced the stage.

Stage 1 Mesothelioma Lungs
Stage 1 Mesothelioma

This stage is divided into two categories. In stage 1a, the cancer is localized on the outer layer of the pleura. In stage 1b, the cancer has grown into deeper layers of the chest wall and possibly to nearby structures. It has not spread to nearby lymph nodes.

Stage 2 Mesothelioma
Stage 2 Mesothelioma

The mesothelioma is in the pleura and may have spread into the lung or diaphragm. It may have spread into lymph nodes on the same side of the body but has not spread to distant organs or tissues.

Stage 3 Mesothelioma Lung
Stage 3 Mesothelioma

The cancer has grown into nearby structures and has spread to either the fatty tissue in the chest, a single location in a deeper chest layer, the lining of the abdomen or the first layer of the chest wall. It also has spread to nearby lymph nodes on the same side of the body or lymph nodes above the collarbone.

Stage 4 Mesothelioma Lung
Stage 4 Mesothelioma

Stage 4 is the most advanced stage of pleural mesothelioma. It may or may not have grown into nearby structures or lymph nodes, but it is found in distant organs such as bones, liver or the lung on the other side of the body.

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Mesothelioma Cell Types and Prognosis

There are two types of mesothelioma cells, plus a third category of disease that is a mix of the cell types.

Mesothelioma Cell Types and Prognosis

There are two types of mesothelioma cells, plus a third category of disease that is a mix of the cell types.

Epithelial (Epithelioid)

Epithelial cell mesothelioma is less aggressive than other cell types. It typically has a more positive prognosis compared with sarcomatoid and biphasic cell tumors.

Sarcomatoid

The sarcomatoid cell type is the least common form of the disease. Up to 20 percent of pleural mesothelioma diagnoses are the sarcomatoid tumor type. These cells are aggressive and more difficult to treat.

Biphasic or Mixed Pleural Mesothelioma

Biphasic mesothelioma is a mixture of epithelioid and sarcomatoid cells. In order to be classified as a mixed cancer, the tumor must contain at least 10 percent of each type of cell.

What Is the Best Treatment for Pleural Mesothelioma?

The most common treatment for pleural mesothelioma is a combination of surgery, chemotherapy and radiation therapy. This is known as multimodal treatment. Some patients turn to emerging treatments such as immunotherapy.

Surgery

Surgery aims to remove as much cancer tissue as possible. While it has proven to be the best treatment for long-term survival, many patients are not eligible for aggressive surgery because of extensive tumor spread or overall health issues.

Chemotherapy

Chemotherapy is the most common treatment option for pleural mesothelioma patients. Chemotherapy drugs aim to kill cancer cells and shrink tumors. It can be used in combination with surgery or on its own to control symptoms and improve quality of life.

Radiation Therapy

Radiation therapy damages DNA in cancer cells, which stops them from growing and multiplying. Radiation doesn’t carry the same harmful side effects of chemotherapy. It is sometimes used palliatively to ease symptoms when surgery is not an option.

Immunotherapy

Many oncologists and researchers consider immunotherapy the future of cancer treatment. Immunotherapy boosts your immune system to fight cancer. Although no immunotherapy drugs are approved by the U.S. Food and Drug Administration for the treatment of pleural mesothelioma, patients can access these therapies through clinical trials and compassionate use programs.

Palliative Care

With palliative care, the intent is to relieve symptoms to improve quality of life, not extend survival. Palliative care could include minimally invasive surgery, chemotherapy or radiation therapy.

The type of treatment that is right for you will depend upon many factors, including your:

  • Current level of health and any other medical conditions you may have.
  • Functional status, strength and ability to accomplish everyday tasks.
  • Pulmonary (lung) and cardiac (heart) function.
  • The extent of your cancer.
  • The type of mesothelioma.

Because pleural mesothelioma is so difficult to diagnose and treat, it is vital to seek a mesothelioma specialist if you suspect you may have the disease. A mesothelioma specialist will work with you to develop the best treatment plan for your cancer.

How Much Does Pleural Mesothelioma Treatment Cost?

The cost of treatment for pleural mesothelioma depends on several factors, including the type and duration of treatment, how much insurance will cover and costs associated with the cancer center you choose (inpatient care, doctor fees, etc.). The financial burden of mesothelioma is often compared to lung cancer treatment, which costs an estimated $60,000 for the first year, according to the National Cancer Institute.

Costs for chemotherapy — the most common treatment for pleural mesothelioma — are estimated as high as $30,000 over an eight-week period. These costs depend on the specific kind of chemotherapy drug used and the duration of treatment.

Radiation therapy can cost $10,000 to $50,000 or more for lung cancer. Costs for mesothelioma are comparable.

Occupational asbestos exposure is the main cause of pleural mesothelioma. Many of these workers were negligently exposed to the carcinogen by companies who knew of dangers of asbestos but failed to properly warn its employees.

Some people who develop pleural mesothelioma may be eligible for compensation from the company or companies responsible for their asbestos exposure. Compensation from mesothelioma personal injury lawsuits and asbestos trust funds can help cover costs of treatment, travel expenses and loss of income.

To learn more about this option, you should consult a qualified mesothelioma lawyer. Working with an experienced mesothelioma attorney is your best chance at receiving the most compensation possible for your asbestos case.