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Pleural Mesothelioma

Pleural mesothelioma is the most common type of asbestos-related cancer. Though it’s an aggressive illness, ongoing advancements in chemotherapy, surgery and clinical trials are extending patients' lives years beyond their life expectancy.

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Malignant pleural mesothelioma is a rare, aggressive cancer that develops in the pleura, a thin layer of tissue surrounding the lungs.

Inhaling microscopic asbestos fibers is the primary cause of mesothelioma. Once these fibers enter the lungs, they can become lodged in the pleura, accumulating and causing cellular damage that can lead to cancer. This process often takes decades. Mesothelioma may not develop until 20-50 years after asbestos exposure, according to the American Cancer Society.

Pleural mesothelioma (PM) is the most common of the four types of mesothelioma. It accounts for nearly 75 percent of all cases diagnosed annually in the U.S., and the majority of cases are traced to occupational exposure to asbestos. Factory workers, shipyard workers, mechanics and construction workers have the highest risk of developing the disease.

We know that receiving a pleural mesothelioma diagnosis can be frightening and confusing, and our Patient Advocates are here to ease your burden. Take advantage of our resources to learn about the latest research and top doctors who can help you cope with this rare cancer.

Symptoms of Pleural Mesothelioma

The initial symptoms of pleural mesothelioma include chest pain, shortness of breath, slight fatigue and weight loss. Because these symptoms mirror those of less serious illnesses, such as pneumonia or the flu, doctors often misdiagnose the cancer in its early stages.

Unfortunately, many of the more serious symptoms, such as painful breathing, coughing blood and difficulty swallowing, aren’t noticeable until the cancer has reached its later stages, when treatment options are usually more limited.

Pleural mesothelioma 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, a 2018 case report published in the journal Occupational and Environmental Medicine shows people with pleural plaques (areas of fibrous thickening on the lung’s 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.

Asbestosis is a chronic respiratory disease characterized by scarring and inflammation in the lungs. Approximately 15 percent of people with asbestosis develop pleural mesothelioma.

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Diagnosing Pleural Mesothelioma

It’s important to discuss any exposure to asbestos with a physician as early as possible and seek out a specialist if your risk level is high. It can take months, and sometimes up to a year, to diagnose this rare cancer.

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 such as X-rays, CT scans or PET scans.

The most important step of the diagnostic process is the biopsy, in which a surgeon collects samples of the tumor through a minor outpatient surgical procedure known as a thoracoscopy or video-assisted thoracoscopic surgery (VATS). A pathologist then analyzes the samples to determine what kind of disease or cancer is present.

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

Most doctors use the following staging system to describe the severity of pleural mesothelioma:

Stage 1:

This stage is divided into two categories. During stage 1a, the cancer is localized to the outer layer of the pleura, which is closer to the chest wall. At stage 1b, the cancer is also located on the inner layer of the pleura, which is closer to the lung.

Stage 2:

The cancer has spread to the lung tissue, diaphragm and linings of the chest cavity.

Stage 3:

The cancer has advanced beyond the lining of the lungs and impacted other internal organs, lymph nodes near the main tumor, esophagus, trachea, fatty tissues and possibly other nearby areas.

Stage 4:

The cancer is possibly on both sides of the chest cavity, inside distant lymph nodes and in other organs such as the brain, spine and prostate. At stage IV, pleural mesothelioma cancer cannot be treated with surgery because metastasis (the spread of the cancer) is too extensive.

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Treatment Options for Pleural Mesothelioma

Conventional pleural mesothelioma treatment can involve surgery, chemotherapy, radiation or a combination of two or more of these, which is known as multimodal therapy. These treatment methods can be curative, reducing the cancer and extending life expectancy, or they can be palliative, which means they are performed to alleviate cancer-related pain.

In addition to these traditional methods of cancer treatment, researchers are developing emerging techniques to fight the cancer. Cancer centers specializing in PM host clinical trials to test new drugs, treatment methods and other medical advancements.


Extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) are two surgeries that can potentially eliminate the cancer. The EPP removes the affected lung, parts of the chest lining, heart lining, nearby lymph nodes and part of the diaphragm. The P/D spares the affected lung but takes out the lining around it and tumors inside the chest cavity.

Younger, healthier patients fare best with surgery, but it’s not effective for people with late-stage cancer or multiple tumors.


Chemotherapy involves treatment with a drug designed to kill cancer cells. It is usually administered by IV. Your physician will determine dosage and frequency based on your health, weight and cancer stage.

While the effects of chemotherapy are immediate, it has a poor success rate and causes discomfort during infusions.


Radiation therapy is commonly administered alongside chemotherapy and following surgery to kill any cancer cells the surgeon accidentally left behind. Radiation is most effective when used with other types of treatment, though it can provide some pain relief on its own.

Experimental Treatments

Although emerging and experimental treatments can be risky because they have not yet proven effective, they can lead to improvements of traditional cancer therapies.

For example, in recent immunotherapy clinical trials, researchers boosted the immune systems of some pleural mesothelioma patients to significantly minimize cancer symptoms and tumor progression.

Alternative Therapies

Many patients with PM also use integrative oncology or complementary and alternative treatments, such as massage and yoga, to relieve pain and other side effects of treatment. While these therapies cannot cure cancer, they can improve your quality of life and relieve stress.

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Alternative therapies include:

  • Manipulative and body-based methods
  • Energy therapies
  • Exercise therapies
  • Mind-body interventions
  • Spiritual therapies
  • Nutritional therapeutics

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Top Doctors and Treatment Centers

Your choice of doctor and treatment center can have a tremendous impact on your experience with pleural mesothelioma.

There is no one-size-fits-all treatment plan for this disease. You need a personalized approach from a specialist who understands the intricacies of PM and is up to date on the most modern and effective treatment options. This kind of doctor can only be found at a specialty center.

Most of the top pleural mesothelioma specialists practice at cancer centers in major metropolitan areas. If you do not live near a cancer center, traveling to one is worth the time and expense because these are the doctors who can give you years beyond your initial prognosis.

A few notable mesothelioma doctors:

  • Dr. Hedy Kindler is the director of the mesothelioma program at the University of Chicago Medical Center.

  • Dr. Abraham Lebenthal is a nationally renowned surgeon who specializes in treating mesothelioma at Boston’s Brigham and Women’s Hospital, which is a world leader in mesothelioma treatment.

  • Dr. Anne Tsao, director of the mesothelioma program at the University of Texas MD Anderson Cancer Center, is a national leader in the diagnosis and treatment of lung cancers and pleural mesothelioma.

  • Dr. Robert Cameron, a renowned thoracic surgeon and pioneer in mesothelioma treatment, practices at the VA Greater Los Angeles Healthcare System and the UCLA Medical Center.

  • Dr. J.F. Pingpank Jr. specializes in peritoneal mesothelioma at the University of Pittsburgh Medical Center, which is ranked as one of the top 25 best hospitals for cancer care in the U.S.

  • Dr. Jacques Fontaine is a thoracic surgeon at the Mesothelioma Research and Treatment Center at the Moffitt Cancer Center in Tampa, Florida.

Doctor Match Program

Our Doctor Match program will guide you to the right specialist based on your diagnosis and location. Our experienced Patient Advocates can provide a closer look at some of the nation’s best pleural mesothelioma doctors and help match you with the right provider for your needs.

Pleural Mesothelioma Specialty Cancer Centers

There are specialty cancer centers across the nation, and there may be one or two near where you live. When choosing a center, consider its doctors and location, your ability to travel and your preferred treatment method, as well as what you expect from your health care team.

Top cancer centers include:

  • Brigham and Women’s Hospital, Boston
  • Dana Farber Cancer Institute, Boston
  • University of Chicago Comprehensive Cancer Center
  • Barbara Ann Karmanos Cancer Institute, Detroit
  • MD Anderson Cancer Center, Houston
  • UCLA Jonsson Comprehensive Cancer Center, Los Angeles
  • Ochsner Cancer Institute, New Orleans
  • University of Florida Health Cancer Center at Orlando Health
  • Abramson Cancer Center at the University of Pennsylvania, Philadelphia
  • Fox Chase Cancer Center, Philadelphia
  • University of Pittsburgh Medical Center
  • H. Lee Moffitt Cancer Center, Tampa
  • University of Arizona Medical Center, Tucson

Veterans with Pleural Mesothelioma

Nearly 30 percent of pleural mesothelioma patients are military veterans. As in the construction industry, the U.S. armed forces made extensive use of asbestos for much of the twentieth century. Members of the military, especially Navy sailors, have often been at risk of hazardous occupational exposure.

The Veterans Department at the Pleural Mesothelioma Center will provide you with a curated list of mesothelioma specialists and centers that cater to veterans and their families.

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How You Can Improve Your Mesothelioma Prognosis

A prognosis is your doctor’s best estimate of how your cancer will affect your health and life expectancy. Prognosis is usually measured in terms such as “good,” “favorable” or “poor.”

Life expectancy is measured in months or years. The average life expectancy of patients with pleural mesothelioma is 12–21 months after diagnosis, but that’s not the case for everyone. Depending on certain factors, some patients may improve their initial prognosis and live years beyond their life expectancy.

While a patient cannot change factors such as age, cancer stage and cell type, they do have some control over their overall health, smoking habits, nutrition and level of exercise. Most importantly, a patient or caretaker can take the initiative in educating themselves about treatment options and seeking out the best health care professionals available.

Find a Specialist You Trust

Even an experienced oncologist can misdiagnose and incorrectly treat pleural mesothelioma. Finding an oncologist who specializes in malignant mesothelioma and has years of experience with this rare cancer will greatly improve your prognosis. Let our Patient Advocates find the best doctor for you.

Expand Your Treatment Plan

Research shows the most favorable treatment results arise from a multimodal approach — a combination of one or more traditional treatments such as surgery, chemotherapy and radiation therapy. Tell your doctor you are interested in exploring multimodal treatment.

Participate in Clinical Trials

When standard treatment isn’t enough, you may want to consider clinical trials. Because of an increase in pleural mesothelioma diagnoses, more and more clinical trials are seeking patients. While clinical trials test experimental therapies and new drug combinations, all participants still receive the best standard-of-care treatment.

Improve Your Diet and Lifestyle

Moderate exercise and good nutrition are the foundation of physical fitness. The healthier your immune system is, the better your body will respond to pleural mesothelioma treatment. Healthy choices about diet and exercise may improve your prognosis and your state of mind.

Snehal Smart, M.D.

Snehal Smart, M.D.

Snehal Smart is the Pleural Mesothelioma Center’s in-house medical doctor, serving as both an experienced Patient Advocate and an expert medical writer for the website. When she is not providing one-on-one assistance to patients, Dr. Snehal stays current on the latest medical research, reading peer-reviewed studies and interviewing oncologists to learn about advancements in diagnostic tools and cancer treatments.

Medically Reviewed By Dr. Joanne Getsy
Last Modified February 12, 2019

12 Cited Article Sources

  1. American Cancer Society. (2018, November 16). What Is Malignant Mesothelioma? (2011). Retrieved from
  2. Sartorelli, P. (2018, April 24). 1113 Pleural plaques: markers of asbestos exposure or indipendent risk factor for pleural mesothelioma? a case report. Retrieved from
  3. Hillerdal, G. (1994). Pleural plaques and risk for bronchial carcinoma and mesothelioma: A prospective study. Chest, 105(1):144-150.
  4. National Cancer Institute – Malignant Mesothelioma Treatment. (2011). Retrieved from
  5. Robinson, A., & Reilly, B. (1994). Localized pleural mesothelioma: the clinical spectrum. Chest Journal, 106(5), 1611-1615. Retrieved from
  6. Roggli, V., Oury, T., & Sporn, T. (2010). Pathology of asbestos-associated diseases. (2 ed.). New York, NY: Springer-Verlag.
  7. Van Schil, P., Carp, L., Hendriks, J., & Lauwers, P. (2008). Staging of malignant pleural mesothelioma. In A. Baldi (Ed), Mesothelioma from Bench Side to Clinic (pp. 357-366). New York, NY: Nova Science Publishers, Inc.
  8. Vorpahl, U. (1994). Localized benign pleural mesothelioma. Langenbecks Arch. Chir., 379(5), 307-309. Retrieved from
  9. National Institutes of Health. (2016, October 21). Malignant mesothelioma treatment (PDQ)–patient version. Retrieved from
  10. Papaspyros, S.C., & Papaspyros, S. (2014, February 3). Surgical management of malignant pleural mesothelioma: Impact of surgery on survival and quality of life—Relation to chemotherapy, radiotherapy, and alternative therapies. Retrieved from
  11. National Institutes of Health. (2016, October 21). Malignant mesothelioma treatment (PDQ)–patient version. Retrieved from
  12. Papaspyros, S.C., & Papaspyros, S. (2014, February 3). Surgical management of malignant pleural mesothelioma: Impact of surgery on survival and quality of life—Relation to chemotherapy, radiotherapy, and alternative therapies. Retrieved from

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