Pleural Mesothelioma

Receiving a pleural mesothelioma diagnosis can be a frightening and confusing time for families. Learn the need-to-know information that will help you treat and cope with this rare cancer.

Lung Diagram of Pleural Mesothelioma

Malignant pleural mesothelioma is a rare, aggressive cancer that develops in the thin layer of tissue surrounding the lungs known as the pleura. The disease is caused primarily by the inhalation of microscopic asbestos fibers. Once these fibers are inhaled, they can become lodged in the lining around the lungs. The fibers accumulate in the body, and cause cellular and genetic damage that can ultimately lead to cancer.

It's the most common of the four types of mesothelioma, accounting for about 75 percent of all cases diagnosed annually in the U.S. More than 2,000 people are diagnosed with this pleural cancer each year.

A majority of these cases are traced to occupational exposure to asbestos, which put factory workers, shipyard workers, mechanics and construction workers at the highest risk. Keep in mind, it can take anywhere from 10 to 50 years after exposure for the cancer to develop.

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Steps to Take After Receiving a Pleural Mesothelioma Diagnosis

It’s hard to know exactly what to say or do after a cancer diagnosis. You need to know that each day counts, especially with an aggressive cancer like pleural mesothelioma (PM). The next steps you take are important for your health and well-being. That is why we are here to help.

Find a Specialist

Many cancer doctors (oncologists) have never seen a case of malignant pleural mesothelioma. That’s why it’s important to find a qualified physician to oversee your care. You may need to travel to find the right specialist.

Mesothelioma specialists diagnose and treat this disease regularly, so they know how to deal with it. They can make more knowledgeable decisions on the best course of treatment for your case.

Having an experienced doctor can make all the difference. To fight this cancer, it will take someone who understands not only what you are going through, but what it takes to help you live longer.

Confirm Your Diagnosis

It’s OK to get a second opinion after you’ve been diagnosed. In fact, it’s pretty typical. This may also give you some piece of mind knowing you are in good hands with whichever specialist you decide to handle your care.

Once you have decided on a specialist, he or she will confirm your diagnosis, which is generally done by a biopsy (minor surgery). This will give your doctors better insight into your specific type of cancer and other factors that are vital to the treatment process.

The specialist will then suggest different forms of treatment.

Educate Yourself About Treatment Options

Specialists provide their expert opinion on treatment options, but patients can decide for themselves which path to take. Make sure you understand how each treatment option may affect you. To make informed decisions about your own care, including treatment options, you need to understand as much as you can upfront.

Determine the Best Course of Treatment for You

Based on your diagnosis, stage of cancer, overall health and other factors, your physician will offer you treatment options. Before you make a decision, you may want to first consider what kind of treatment would be best for you. Make sure to ask your doctor questions about their proposed treatment plan before making any final decisions.

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Don’t worry if these steps seem overwhelming.

Our team of Patients Advocates can provide you with free guidance throughout the process. Whether it's helping you select a specialist or determining the best course of treatment, we are here to help.

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Treatment Options

These are based on diagnosis, stage of cancer and other factors. The primary treatment options available are chemotherapy, surgery and radiation, or a combination of these options, known as a multimodal approach.


Surgery generally offers the best chance for long-term survival; however, early-stage malignant mesothelioma patients are usually the only candidates who qualify for surgery. If this is an option, there are two surgeries that can potentially remove the cancer. 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 the heart, and part of the diaphragm.
  • The P/D involves the removal of the lining around the lung, but not the lung itself.


Chemotherapy involves treatment with a drug that is designed to kill cancer cells. It is usually given through an IV. Your physician will determine the dosage and frequency based on your health, weight and stage of the cancer.

Radiation Therapy

Radiation therapy is commonly administered alongside chemotherapy, and it is most effective when used with other types of treatment. It may also be used on its own as a pain reliever.

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Alternative Treatments

Many pleural malignant mesothelioma patients also use complementary and alternative treatments such as massage and yoga to relieve pain and ease side effects of treatment. These therapies cannot cure the cancer, but they can improve your quality of life and relieve stress.

Many people with cancer take an integrative approach that unites traditional cancer treatment with complementary therapies. Known as integrative oncology, this approach empowers patients with therapies that help them control symptoms and side effects.

  • Alternative Medical Systems
  • Manipulative & Body-Based Methods
  • Energy Therapies
  • Exercise Therapies
  • Mind-Body Interventions
  • Spiritual Therapies
  • Nutritional Therapeutics


The initial symptoms of pleural mesothelioma symptoms of pleural mesothelioma include chest pain, shortness of breath, slight fatigue and weight loss. They are often confused with less serious illnesses like pneumonia or the flu. This can contribute to a delay in diagnosis.

Unfortunately, many of the more serious symptoms, such as painful breathing, coughing up blood, difficulty swallowing and pain in the lower back, aren’t noticeable until the cancer has reached its later stages, which usually limits the treatment options. The range of symptoms can include:

  • Shortness of breath
  • Cough
  • Hoarseness
  • Pain in the lower back or side of the chest
  • Fatigue
  • Fever
  • Sweating
  • Weight Loss
  • Difficulty swallowing
  • Swelling in the face and arms

Other signs of mesothelioma can include certain benign asbestos-related diseases. For example, research shows that people with pleural plaques (areas of fibrous thickening on the lung lining that can become calcified) are at an increased risk of developing pleural mesothelioma. Pleural thickening is another benign condition that sometimes develops before PM. Approximately 15 percent of people with asbestosis will develop pleural mesothelioma.

Diagnosing the Disease

It can be difficult to diagnose, and it can take months, and sometimes up to a year, before a definitive diagnosis is made. That is why it's important for you to discuss any exposure to asbestos with a physician as early as possible. You also need to seek out a specialist.

To ensure a definitive diagnosis, your doctor will first conduct a full medical and occupational history review. Then you will typically undergo multiple imaging tests to make a more accurate diagnosis, such as X-rays, CT scans or PET scans.

Step Diagnostic Method
Step 1 Body scans (X-ray, CT, PET, or MRI)
Step 2
  • Thoracentesis
  • Needle biopsy
  • Open surgical biopsy or video-assisted thoracic surgery
Optional Step Blood tests using biomarkers

These imaging scans help determine the stage of the cancer. There are four stages. In the first stage, tumors are limited to the pleural lining and remain small. In stage II, the tumors begin to spread to the lung or diaphragm, but haven’t yet reached any lymph nodes. By the third stage, tumors have spread to the chest wall or heart lining and have reached nearby lymph nodes. In the fourth stage, tumors have spread throughout the chest cavity, including lymph nodes, and may have spread to the spine or other distant locations in the body.

The most definitive step of the diagnostic process is the biopsy. Samples of the tumor are collected with a minor outpatient surgical procedure known as a thoracoscopy or video-assisted thoracoscopic surgery (VATS). The samples are analyzed by a pathologist, who will determine what kind of disease or cancer is present. This is the most important step in confirming a mesothelioma diagnosis.

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Improve Your Prognosis

A prognosis is your doctor’s best guess of how the cancer may affect your health and life span. There are many factors that determine your prognosis, but pleural mesothelioma typically comes with an unfavorable one. Most patients have a life expectancy ranging from four to 18 months. People who qualify for aggressive treatment may live more than three years and long-term survivors are not unheard of.

Although you can’t change factors such as your age, the stage of your cancer or the cell type you have, there are some factors that you can take into your own hands that may improve your prognosis.

Catch the Cancer Early

If you have been exposed to asbestos, tell your physician immediately so they know to keep an eye out for anything that may indicate mesothelioma. If the cancer is caught early, your prognosis is much better.

Seek a Second Opinion

Since this disease is rare, even experienced oncologists can estimate the stage of your cancer wrong. You need to see a specialist.

Find a Specialist

These doctors have years of experience with mesothelioma. They know this disease better than anyone, and they can give you the best chance at improving your prognosis.

Expand Your Treatment Plan

Research suggests that a multimodal approach, or a combination of one or more treatment options such as surgery, chemotherapy and radiation therapy, gives the most favorable treatment results.

Participate in Clinical Trials

When standard treatment isn’t enough, you may want to consider clinical trials. Every FDA-approved drug started in a clinical trial.

Change Your Diet

The healthier your immune system is, the better your body will respond to treatment. Making the right choices about diet and exercise after your diagnosis may help improve your life expectancy.

Doctors & Treatment Centers

One of the most important decisions you can make after diagnosis is choosing a doctor and treatment center.

This is not a disease with a one-size-fits-all treatment option. You need a personalized approach from a specialist who understands the intricacies involved in treating this disease and who is up-to-date on the latest and most effective treatment options, which can only be found at a specialty center.

Pleural Mesothelioma Specialist

Specialty Centers

There are specialty cancer centers spread across the U.S. You will need to consider the location of the center, your ability to travel, your preferred treatment method and what you are looking for in your health care team.

Doctor Match Program

Our Doctor Match program is designed to help you sort out all of these deciding factors and find the right specialist to oversee your care. Our experienced patient advocates can provide a closer look at some of the nation's best doctors and answer any questions you may have about your diagnosis.

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