Malignant Pleural Mesothelioma
Malignant pleural mesothelioma is the most common type of mesothelioma and is almost always caused by the inhalation of asbestos fibers. The malignancy begins in the pleural tissue that surrounds the lungs. This cancer is aggressive, spreads readily, and causes symptoms like shortness of breath, coughing, and chest pains.
Facts about Pleural Mesothelioma
Mesothelioma is a cancer that attacks the mesothelium. The mesothelium is a double layer of tissue surrounding most of the body’s organs.
- The pleura is the part of the mesothelium surrounding the lungs.
- The main risk factor for pleural mesothelioma is exposure to asbestos, which for most people occurred at work.
- It can take decades from initial exposure to asbestos for mesothelioma to develop.
- Symptoms include chest pain, a dry cough, shortness of breath, and fatigue.
- Pleural mesothelioma is rare. Only about 3,000 people are diagnosed each year.
- The pleural type is the most common form of mesothelioma.
- Most diagnoses are made in older men because of past workplace exposure to asbestos.
- Pleural mesothelioma can be treated with a combination of chemotherapy, radiation, and surgery. Some patients may undergo experimental therapies by participating in clinical trials.
- The prognosis is poor. Just 40 percent of patients survive a year after diagnosis.
How Asbestos Causes Malignant Pleural Mesothelioma
Asbestos is the number one risk factor for mesothelioma, but it is not necessarily the only cause. Genetics and lifestyle choices, like smoking, may also play a role in the development of this cancer.
Asbestos is made up of very small, needle-like fibers. These come loose from the material when disturbed. The fibers become part of the dust in air and on surfaces. Anyone in the vicinity is likely to inhale those fibers, which then can lodge in the tissues of the airway.
When the lodged fibers cause damage, including irritation and inflammation, to the pleura, it may develop into cancer. The pleura is a double layer of tissue around the lungs. When a tumor develops here it is known as pleural mesothelioma.
Pleural mesothelioma, lung cancer, or asbestosis can all be caused by asbestos fibers. When pleural mesothelioma develops, it spreads rapidly, often from one layer of the pleura to the next and then to the lung and other tissues.
Symptoms
- Chronic bronchitis
- Asthma
- Pneumonia
- Lung cancer
- Symptoms of pleural mesothelioma may include:
- Shortness of breath
- Difficulty swallowing
- A persistent dry cough
- Coughing up blood
- Chest pain
- Painful breathing
- Lumps under the skin of the chest
- Fever
As the cancer gets more advanced, patients may also experience unintentional weight loss and fatigue.
Diagnosis
Diagnosing mesothelioma is difficult for many reasons. The early symptoms of pleural mesothelioma often mimic other illnesses and lead to a misdiagnosis. It may not be until after the symptoms persist and treatments don’t provide relief that a patient will get a cancer diagnosis.
Certain associated conditions may indicate that asbestos, and potentially mesothelioma are causing symptoms: pleural plaques, which are thick areas of the pleura; pleural effusion, a buildup of fluid between the pleural layers; and pleural thickening, large areas of thick tissue and scarring that makes it difficult to breathe.
The diagnostic process for symptoms that may indicate mesothelioma and past asbestos exposure usually follows these steps:
A thorough physical examination to rule out other illnesses is the typical first step.
The next step is to take imaging scans, including X-rays, to rule out pneumonia and other respiratory conditions, or a CT or MRI scan to search for soft tissue abnormalities.
If the scans reveal an abnormality, the patient should be referred to a specialist.
The specialist will perform a biopsy, the removal of a small amount of tissue from any abnormal areas indicated on scans.
The next step is pathology of the biopsy sample. A pathologist will then look at cells under a microscope to identify malignancy and the type of cancer.
Staging
Once a diagnosis of pleural mesothelioma has been made, doctors assign a stage. This describes how far the cancer has progressed:
- Stage 1: Tumors are localized to pleural tissue around one lung.
- Stage 2: The tumor cells have migrated to nearby lymph nodes.
- Stage 3: The cells have spread to other tissue near the pleura and to more distant lymph nodes.
- Stage 4: The cancer has metastasized, or spread to distant organs.
Treatment
Once the medical team understands the stage of pleural mesothelioma, cell subtype, and other medical conditions, they can develop an appropriate treatment plan. This should consider the patient’s input and preferences.
Treatment for pleural mesothelioma is typically aggressive. It is important the patient and medical care team have open communication about the expected outcomes of treatment and the risks and benefits of each treatment.
The standard treatment approach for mesothelioma includes one or more strategies, most often chemotherapy, surgery, and radiation therapy.
Chemotherapy
Treatment for pleural mesothelioma typically includes a combination of two or more of the standard chemotherapy drugs. These are drugs used to kill cancer cells, but they can also kill healthy cells causing side effects. Pemetrexed with cisplatin or carboplatin is a typical chemotherapy combination used to treat pleural mesothelioma.
Surgery
Early-stage patients may benefit from cytoreductive surgeries, procedures to remove as much cancerous tissue as possible. The goal is to slow the spread of the disease and prolong life expectancy.
More aggressive procedures remove as much of the visible disease as possible as well as additional nearby tissue to which the cancer may spread:
Pleurectomy and decortication, also known as radical pleurectomy, is a procedure that removes the tumors and the pleural tissue.
Extrapleural pneumonectomy is the most aggressive surgical option. It involves the removal of the pleura, an entire lung, part of the diaphragm, and other nearby tissue that may be affected.
Radiation Therapy
Radiation therapy uses high-energy beams to target and kill cancer cells. It is not a curative treatment but can be helpful to reduce tumor size or eliminate any remaining cells before chemotherapy or after surgery. Radiation can also be used to relieve symptoms as a part of palliative care.
Clinical Trials and Experimental Therapies
Mesothelioma is a rare and aggressive cancer with fewer treatment options than many other cancer types. In order to gain access to treatment not yet approved by the Food and Drug Administration (FDA), patients are encouraged to participate in clinical trial research.
Some of the emerging therapies patients may access in clinical trials include immunotherapy, vaccines, surgical therapies, or new radiation techniques. Immunotherapy treatment targets the patient’s immune system to turn it against the cancer cells.
Photodynamic therapy is being tested as a way to use light energy to focus toxic drugs directly on tumor cells. Gene therapies use genetically-modified viral or bacterial cells to deliver treatments or alter cancer cells to self-destruct.
Prognosis
The prognosis for pleural mesothelioma is usually negative, but it depends on individual factors. Survival rates for this type of cancer are comparatively low. Diagnosis typically comes after the cancer has reached a later stage and this means it is difficult to treat and nearly impossible to cure.
Some studies indicate that the median survival time for patients with pleural mesothelioma is just nine months, but this includes those who did not receive treatment.
Any kind of treatment, but especially a combination of therapies, extends survival times. Patients with pleural mesothelioma who undergo surgical procedures as part of treatment live longer after diagnosis on average.
Individual factors that can affect prognosis include:
- Age. Younger patients have better survival times.
- Cancer stage. This is one of the most important factors in prognosis. Early stage mesothelioma can be treated more aggressively, leading to longer survival times.
- Smoking status or history. Smoking adds to the risk of developing cancer.
- Extent and duration of exposure to asbestos. Not everyone exposed to asbestos develops mesothelioma, but more exposure can cause more damage to tissue.
- Gender. Life expectancy for women with mesothelioma is longer than for men.
- Overall health and fitness. Patients with better overall health and fitness can withstand more aggressive treatments and tend to live longer.
How to Improve a Mesothelioma Prognosis
Some factors related to prognosis cannot be changed, but others can. One of the most important things you can do is to be aware of any asbestos exposure and symptoms. Getting an earlier diagnosis, followed by aggressive treatment is the best way to improve prognosis.
Choose a specialist in mesothelioma to work with and seek second and third opinions if you are not satisfied with a diagnosis. Request access to clinical trials to benefit from emerging treatments. Lifestyle changes to improve overall health can also be beneficial.
A diagnosis of pleural mesothelioma can be a shock, and many people who develop this disease are victims. They experienced asbestos exposure without their knowledge or without being warned of the risks of being around asbestos. If you have been impacted by pleural mesothelioma because of workplace asbestos exposure, you have legal rights to seek compensation from your former employer or the manufacturer of asbestos-containing materials.
Frequently Asked Questions
How Do You Get Pleural Mesothelioma?
It is not always possible to determine the cause of pleural mesothelioma, but the leading risk factor is exposure to asbestos. Most exposure occurs in the workplace, but asbestos in older homes and buildings can also cause harm. Additional risk factors for mesothelioma include family history and radiation treatment to the chest.
What are the Symptoms of Pleural Mesothelioma?
Pleural mesothelioma symptoms include shortness of breath, coughing, difficult swallowing, hoarseness, and pain in the chest or back. It can also cause unplanned weight loss, fatigue, and lumps under the skin on the chest.
How is Pleural Mesothelioma Diagnosed?
Diagnosis begins with a physical examination followed by imaging tests, such as a chest X-ray and a CT scan. If anything suspicious is seen in the diagnostic images, doctors will perform a biopsy to remove a small amount of tissue. A pathologist examines the cells to determine if they are cancerous and if they originated in the pleural cells.
Is Pleural Mesothelioma Curable?
Pleural mesothelioma is not considered curable, although in rare cases patients go into remission with treatment. The best chances for remission are for patients diagnosed in an early stage of the cancer, who are young and healthy, and who opt for aggressive treatments. Treatment for most mesothelioma patients is used to extend life expectancy and relieve symptoms, and for palliative care.
How Long Do You Live after Being Diagnosed with Pleural Mesothelioma?
The outlook for pleural mesothelioma depends on several factors: patient age and health, the stage of the cancer at diagnosis, the cancer cell type, and treatment chosen. The median survival times for pleural mesothelioma at each stage are: Stage I – 22 months; Stage II – 20 months; Stage III – 18 months; Stage IV – 15 months.
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