Pleural Mesothelioma: Causes, Symptoms, Treatment, Prognosis and Survival
Pleural Mesothelioma
Pleural mesothelioma is a cancer of the lining of the lungs, known as the pleura. It is caused by inhaling asbestos fibers. Malignant pleural mesothelioma accounts for 80 to 90% of all mesothelioma diagnoses. The symptoms include shortness of breath, dry cough and chest pain.
Malignant pleural mesothelioma is a rare cancer of the lining around the lungs, called the pleura. It is caused by asbestos fibers. After inhalation, the fibers can embed in the pleura, causing inflammation and scarring. Over time, these processes can lead to the development of mesothelioma tumors.
Facts
- Pleural malignant mesothelioma is the most common form of mesothelioma cancer.
- Symptoms of this cancer include chest pain, dry cough, fatigue and shortness of breath.
- Some patients have achieved long-term survival after aggressive treatment, but it is not considered to be a curable cancer.
- A patient’s prognosis will vary depending on their individual case, with an average life expectancy of about 18 months.
- Each year, about 2,500 people are diagnosed with pleural mesothelioma.
- Diagnosis typically consists of multiple tests, including scans and biopsies.
- Pleural mesothelioma is often treated with chemotherapy, surgery, radiation therapy and immunotherapy.
What Is the Prognosis for Pleural Mesothelioma?
As with all types of malignant mesothelioma, prognosis for pleural malignant mesothelioma depends on a number of factors. For patients who do not receive treatment, the median survival time is six months. However, certain types of treatment can improve life expectancy, such as surgery combined with chemotherapy.
Pleural Mesothelioma Survival Rates
- 1 year after diagnosis: 73%
- 3 years after diagnosis: 23%
- 5 years after diagnosis: 12%
- 10 years after diagnosis: 4.7%
The most important mesothelioma prognosis factors are:
- Cell type (histopathology)
- Stage of mesothelioma
- Patient’s gender and age
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Most pleural mesothelioma patients are diagnosed with the epithelioid cell type, which is the most common. Epithelioid cells typically form in solid sheets or cord arrangements, meaning they adhere closely together and don’t metastasize as quickly. They are also the most responsive to treatment. Typically, pleural mesothelioma patients with the epithelioid cell type survive 19 months.
The other cell types, sarcomatoid and biphasic, are less common and indicate a worse prognosis than epithelioid. Sarcomatoid mesothelioma doesn’t respond well to treatment and often metastasizes, leaving patients a prognosis of about eight months.
Patients with biphasic pleural mesothelioma experience an intermediate life expectancy, depending on whether epithelioid or sarcomatoid cells are more dominant.
According to recent data, within the last decade, malignant pleural mesothelioma patients have been surviving longer overall as available treatments and diagnostic methods improve. Some patients are now becoming long-term survivors. Heather Von St. James was diagnosed with pleural mesothelioma in 2005 with an initial prognosis of 15 months. Following her treatment, she is now a survivor of more than a decade and a half.
What Causes Pleural Mesothelioma?
Malignant pleural mesothelioma is caused by inhalation of asbestos fibers. The mineral slivers can travel through lung tissue and lodge in the pleura. Over time, asbestos fibers cause inflammation. The fibers can also activate biological pathways that lead to DNA damage. As a result, mesothelioma tumors may develop.
Other factors may contribute to the development of mesothelioma, including:
- Erionite exposure: Erionite is a natural mineral similar to asbestos. It has been linked to mesothelioma and lung cancer.
- Radiation exposure: Radiation treatments for cancer can damage healthy cells, potentially leading to cancer. Prior radiation therapy has been tentatively linked to mesothelioma.
What Are the Symptoms of Pleural Mesothelioma?
After asbestos exposure, it can take 10 to 50 years for pleural mesothelioma symptoms to present. Symptoms typically first present in the chest cavity and respiratory system.
Pleural Mesothelioma Symptoms
- Chest pain
- Coughing up blood
- Difficulty swallowing
- Dry cough
- Fatigue
- Fever
- Fluid in the lung (pleural effusion)
- Night sweats
- Shortness of breath (dyspnea)
- Weight loss
As the disease becomes more advanced, new and worsening symptoms may arise. For instance, stage 4 pleural mesothelioma symptoms may include coughing up blood and difficulty swallowing.
Patients may be diagnosed with a co-occurring asbestos-related condition, which can impact symptom onset.
Pleural Mesothelioma Diagnose
Diagnosing pleural mesothelioma often consists of multiple tests. One or more imaging scans, such as an X-ray or CT scan, may be performed first to identify tumors or metastasis (spreading of disease). If a tumor is detected, blood tests may be performed to look for certain biomarkers (high levels of specific substances in the blood), which can help differentiate mesothelioma from other conditions.
Currently, a biopsy is the only way to verify a malignant pleural mesothelioma diagnosis. Tests like a thoracentesis or thoracoscopy may be performed to take a tissue or fluid sample for analysis. For a thoracentesis, a doctor will insert a fine needle to remove fluid buildup in the chest.
A thoracoscopy is more invasive. Doctors insert a viewing tube called a thoracoscope into the chest to inspect the lungs and surrounding pleura. They can then remove a tissue sample or draw fluid for analysis. After the biopsy, a pathologist will study the cells to make a definitive diagnosis, including cell type and how the disease is expected to progress.
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