Pleural Mesothelioma

What Is Pleural Mesothelioma?

Pleural mesothelioma is a form of cancer that develops in the cells that form the protective lining of the lungs (known as the pleura). It is the most common type of mesothelioma and usually affects people who are older than 75.

Symptoms of Pleural Mesothelioma

Chest pain and shortness of breath are the top symptoms of pleural mesothelioma. A buildup of fluid around the lungs (known as pleural effusion) is a common symptom of pleural mesothelioma. Effusion can make breathing painful and difficult. Additional symptoms include:

• Anemia
• Difficulty swallowing
• Fatigue
• Fever
• Persistent dry cough
• Weight loss

Symptoms are similar to other conditions, often leading to a misdiagnosis. Common misdiagnoses include:

• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Emphysema
• Influenza
• Laryngitis
• Lung cancer
• Pneumonia
• Pulmonary fibrosis
• Synovial sarcomatoid carcinoma
• Tuberculosis

If you are experiencing any of the symptoms above, talk to your doctor right away, especially if you think you’ve exposed and inhaled asbestos fibers.

Causes

Pleural mesothelioma is caused by exposure to asbestos – a cancer-causing fiber that was used in insulation, fireproofing sprays, construction materials, and more. Once asbestos fibers are inhaled or ingested, they become lodged in the lining chest or abdominal cavities.

Over several years, these fibers cause inflammation and scarring. Then, the cells of the mesothelium (a membrane formed around internal body cavities) mutate and form malignant tumors. Today, asbestos exposure is still a problem in many commercial, residential, and school and military buildings.

How Is Pleural Mesothelioma Diagnosed?

Because of the long latency period without symptoms, it takes decades for pleural mesothelioma to manifest after initial exposure. For those who have been exposed to asbestos, it’s vital to tell your doctor. With this information, they prescribe the correct tests in the diagnosis process. As such, it is important to see a doctor as soon as symptoms develop.

Common ways a doctor may diagnose pleural mesothelioma include:

• Imaging tests –  A series of imaging tests usually start the diagnostic process. Lower-resolution images such as X-rays are first before working up to higher-resolution images such as CAT scans, PET scans, and MRIs. The images can show pleural thickening, fluid building, tumors, and irregularities in lung size, illustrating signs of mesothelioma.
• Blood tests – Blood tests look for specific protein biomarkers (such as antigen 125 and fibulin-3) often present in mesothelioma cancer cells. MesoMark® was the first approved in 2007, making it the first blood test to be used for mesothelioma diagnosis.
• Biopsies – A cytology test is a procedure that removes fluid or tissue from the tumor through a needle to determine the presence of the disease. Biopsies allow doctors to determine what cell type is present in the tumor and where the cancer has spread. Also, patients typically have biopsies to remove excess fluid from the chest cavity.

Common biopsy procedures used for diagnosing pleural mesothelioma:

• Pleural biopsy – Patients experiencing fluid buildup, called pleural effusion, between their lungs and chest have this procedure. A needle is inserted into the chest cavity to collect pleural fluid and tissue. This biopsy checks for the presence and extent of mesothelioma.
• Thoracentesis – Similar to a pleural biopsy, this test collects pleural fluid from the chest with a needle. It also relieves the discomfort caused by the buildup.
• Thoracoscopy – This procedure involves a camera to see inside the chest cavity while taking a diagnostic sample and drain excess fluid. The camera is inserted through a small incision in the chest.
• Mediastinoscopy – A camera is used to examine the mediastinum (i.e., the space behind the breastbone). The purpose of this test is to see if tumors have spread to the lymph nodes around the mediastinum.
• Thoracotomy – This is a surgical procedure used for diagnostic purposes. During the process, the surgeon collects a sample of the tumor from the chest cavity. Patients may also use this treatment to remove as many tumors as possible.

Stages of Pleural Mesothelioma

The stages of pleural mesothelioma range from 1 to 4. There are three different staging systems (TNM, Butchart, and Brigham). Most mesothelioma doctors use the TNM system to determine the stage. Other types of mesothelioma like peritoneal and pericardial aren’t common enough to have a formal staging system.

The TNM system uses the size and extent of the tumor to determine the stage of cancer. The “T” represents the tumor, the “N” represents whether the cancer has reached the lymph nodes, and the “M” represents the presence and extent of metastasis (which is the spread of cancer to other parts of the body).

TNM staging system for pleural mesothelioma:

• Stage 1: The tumor is confined to the site of origin, usually in the inner lining of the chest wall or in the tissue around the lung. The lymph nodes are unaffected and there is no spread to other parts of the body. The tumor may still be removable.
• Stage 2: The tumor is still localized to one side of the body but is spreading into the lung or diaphragm on that side. Cancer starts extending into nearby lymph nodes but no distant metastasis.
• Stage 3: The tumor is still confined to one side of the body and spreads more extensively to the lymph nodes, chest wall, heart lining, or diaphragm. Doctors may still be able to surgically remove the primary tumor.
• Stage 4: The primary tumor is no longer localized or removable. Metastasis has affected organs in other areas of the body. Cancer has likely reached the lymphatic system, which is used to fight unwanted materials through white blood cells.

Prognosis

The prognosis (or, expected outcome) for pleural mesothelioma patients depends on different elements. Early stages of pleural mesothelioma may be treated with surgery, chemotherapy, and radiation, which could significantly extend life expectancy.

Because the cancer is so complex, patients react differently to treatment options. The average life expectancy for pleural mesothelioma patients is between 8 and 21 months.

Pleural mesothelioma survival rate by year:

• One year after diagnosis: 40%
• Two years after diagnosis: 20%
• Three or more years after diagnosis: 10%

Factors that affect prognosis:

• Age
• Amount of pleural fluid
• Cancer recurrence
• Cell type
• Gender
• Patient activity level
• Stage

Early diagnosis and treatment are crucial because pleural mesothelioma progresses quickly.

Treatment for Pleural Mesothelioma

There are different treatment options for patients that can prolong life expectancy and improve pain and breathing. Treatment options usually depend on the type of cell present in the tumors, the stage, and demographics like gender and age.

Standard treatment options for patients can include surgery, chemotherapy, radiation, immunotherapy, or a combination of treatments. Doctors also use palliative care, which focuses on the relief of symptoms like pain and stress.

Surgery

Pleurectomy with decortication and extrapleural pneumonectomy are two main surgical options for patients. A pleurectomy with decortication removes the lining of the lung and chest with any visible tumors. An extrapleural pneumonectomy removes the pleural linings of the chest and heart, portions of the diaphragm, and the entire affected lung.

Through a pleurodesis surgery, fluid may be removed from the chest cavity to relieve pain.

Chemotherapy

Chemotherapy is often done before surgery in an attempt to shrink the tumors. The treatment is also done afterward to destroy any remaining cancer cells.

It is common for pleural mesothelioma patients to replace surgery with aggressive curative chemotherapy treatment. The most common chemotherapy treatment is a combination of the medications Cisplatin and ALIMTA®.

Radiation

Radiation is used as a treatment to shrink tumors or reduce the spread of cancer in pleural mesothelioma patients. The treatment can be used before or after surgery. Radiation may also reduce chest pain and breathing difficulties if used as a palliative treatment.

Immunotherapy

This treatment is used to boost the immune system’s ability to fight off the growth and spread of cancer. Immunotherapy medications are a common treatment for pleural mesothelioma patients so that the body’s immune system can better fight against unwanted cancers.

What’s Next?

If you have pleural mesothelioma, compensation for medical costs may be available to you. Reach out through our free case evaluation to be connected with an attorney that can help you.