Pleural mesothelioma is a rare malignancy that affects a patient’s pleura, the protective lining of the lungs. Malignant pleural mesothelioma is caused by asbestos. Over 75% of mesothelioma cases are pleural. Pleural symptoms may not appear until the late cancer stages, which can limit treatment options and shorten survival.
What Is Pleural Mesothelioma?
Malignant pleural mesothelioma (MPM) is a cancer that develops in the lungs. Almost 75% of diagnosed mesothelioma cases form in the pleura, making it the most common of the four types.
The cause of pleural mesothelioma is exposure to asbestos fibers, which are inhaled into the lungs. It usually takes from 20 to 50 years for mesothelioma to develop after a person’s first exposure to asbestos. Because of this latency period, the disease usually affects people older than 75.
The average life expectancy for pleural mesothelioma is often less than 18 months, but it depends on many factors.
Although there is no cure for mesothelioma, some patients live much longer with treatments. Combining several treatments, such as surgery, chemotherapy and radiation therapy, has helped some people live for years. Clinical trials offer access to new treatments such as immunotherapy.
Pleural Mesothelioma Facts
Most common type of mesothelioma
Forms on soft tissue covering the lungs
Symptoms: Shortness of breath, chest pain, dry cough and fatigue
Diagnostic Tools: Imaging scans and tissue biopsies
Treatments: Chemotherapy, surgery, radiation therapy, immunotherapy and experimental therapies
Life Expectancy: About 40% live at least one year
What Causes Pleural Mesothelioma?
Asbestos causes pleural mesothelioma. After inhaling the mineral’s needle-like fibers, they tend to lodge in the lungs and gradually migrate into the pleural lining.
Over a long period of time, these fibers cause irritation, chronic inflammation and genetic changes that turn cells cancerous.
These cancerous cells grow fast and uncontrollably, threatening the organs around them.
Two layers make up the pleural lining. The outer layer lines the entire inside of the chest cavity (inside the ribs), and the inner layer covers the lungs.
A malignant tumor can develop on either layer and quickly spread to the other layer. As tumors develop on the pleural surface, they grow to form a mass around the affected lung. They also cause pleural fluid to accumulate in the chest cavity.
The combination of tumor mass on the lung and collection of pleural fluid prevents the lung from expanding, which causes breathing difficulties.
Symptoms of Pleural Mesothelioma
For many people, mesothelioma symptoms are not noticeable until the cancer is in a later stage.
Shortness of breath
Chest pain or painful breathing
Persistent dry or raspy cough
Coughing up blood
Pain in the lower back or rib area
Unexplained weight loss and fatigue
Swelling of the face or arms
Night sweats or fever
Lumps under the skin on the chest
Patients rarely mention weight loss and fatigue during their initial doctor visit. These symptoms may show if the cancer is advanced. Some patients develop swelling of the face or arms, back pain or nerve pain.
Pleural Mesothelioma Treatment Options
Standard pleural mesothelioma treatment options can include surgery, radiation therapy and chemotherapy.
Chemotherapy is the most common type of pleural treatment. A combination of treatments can be used, which is known as multimodal therapy, if a patient is diagnosed early. These treatments can improve symptoms, such as chest pain and breathing difficulties, and improve survival.
Patients can access these therapies at top cancer centers across the nation that specialize in pleural mesothelioma treatment.
The most common pleural mesothelioma treatment is chemotherapy. It uses one or more drugs, usually a combination of cisplatin or carboplatin and pemetrexed (Alimta), to kill cancer cells or prevent them from reproducing. Recent advances have improved how well patients respond to chemotherapy, but success rates remain low overall.
Pleural mesothelioma patients diagnosed in the early stages benefit the most from surgery. The goal of surgery is to remove the cancer and prevent it from recurring as long as possible.
The two most common surgeries for pleural mesothelioma are the extrapleural pneumonectomy and pleurectomy and decortication. A pleural mesothelioma specialist can determine if you are eligible for surgery and advise you on which procedure may be the best option for your diagnosis.
A more aggressive surgical option, the extrapleural pneumonectomy removes the pleura, the entire cancerous lung, the diaphragm and the heart sac (pericardium).
Pleurectomy and Decortication
A pleurectomy and decortication, or radical pleurectomy, involves removing the tumors and affected pleura (lining of the lung).
Targeted radiation can destroy cancer cells and decrease tumor size. Radiation therapy cannot cure pleural mesothelioma, but it is an effective way to manage chest pain. Radiation can also help prevent cancer recurrence after surgery.
External beam radiation therapy is the most common form of radiation therapy for pleural mesothelioma. Sessions are fast, painless and only take a few minutes.
Emerging treatments include the use of immunotherapy, gene therapy and photodynamic therapy to treat pleural mesothelioma. These treatments are designed to fight cancer more effectively, while causing fewer side effects for the patient.
You may be able to receive an experimental therapy through a pleural mesothelioma clinical trial. Some patients may be eligible for immunotherapy drugs and other emerging treatments through compassionate use programs.