Pleural mesothelioma is a malignant cancer that develops on the lining of the lungs called the pleura. It is the most common type of mesothelioma. Although the prognosis is typically poor, finding a pleural cancer specialist can diversify your treatment options and help improve your prognosis.
Pleural mesothelioma accounts for about 75 percent of all mesothelioma cases. Like other types of mesothelioma, this particular form of the disease gets its name because of where it is formed — in the pleura, a soft tissue that surrounds the lungs. In almost all cases, pleural mesothelioma is caused by asbestos exposure.
The first symptoms of pleural mesothelioma typically include chest pain and shortness of breath. You may experience no symptoms at all in the first few stages of the cancer’s progression.
The life expectancy of someone with pleural mesothelioma is less than 18 months, but some patients live much longer. It often takes decades (20 to 50 years) for mesothelioma to develop after someone is first exposed to asbestos. This lag time — called a latency period — explains why the disease usually affects older people.
The first symptoms of pleural mesothelioma typically include chest pain and shortness of breath. You may experience no symptoms at all in the first few stages of the cancer’s progression.
The life expectancy of someone with pleural mesothelioma is less than 18 months, but some patients live much longer. It often takes decades (20 to 50 years) for mesothelioma to develop after someone is first exposed to asbestos. This lag time — called a latency period — explains why the disease usually affects older people.
What Are Pleural Mesothelioma Symptoms?
Symptoms of pleural mesothelioma include persistent dry or raspy cough, coughing up blood (hemoptysis), shortness of breath (dyspnea), and difficulty swallowing (dysphagia). There are four stages of mesothelioma that doctors use to describe how far the cancer has progressed. For many people, unfortunately, symptoms are not noticeable until the cancer is in a later stage — stage III or IV.
Pleural Effusion Diagram
Asbestos fibers can cause excess fluid to build up between the two layers of the pleura, a condition called pleural effusion. While a little fluid in your pleural space is important, too much can make breathing difficult. The extra fluid puts pressure on the lungs, causing chest pain that gets worse when you cough or take deep breaths.
Symptoms of pleural mesothelioma include persistent dry or raspy cough, coughing up blood (hemoptysis), shortness of breath (dyspnea), and difficulty swallowing (dysphagia). There are four stages of mesothelioma that doctors use to describe how far the cancer has progressed. For many people, unfortunately, symptoms are not noticeable until the cancer is in a later stage — stage III or IV.
Pleural Effusion Diagram
Asbestos fibers can cause excess fluid to build up between the two layers of the pleura, a condition called pleural effusion. While a little fluid in your pleural space is important, too much can make breathing difficult. The extra fluid puts pressure on the lungs, causing chest pain that gets worse when you cough or take deep breaths.
In their first meeting with a doctor, a majority of pleural mesothelioma patients report chest pain and shortness of breath. Patients rarely mention weight loss and fatigue during their initial doctor visit, but these symptoms may be present if the cancer is in a later stage.
Diagnosis
Two layers of tissue make up the pleura. These tissues protect and support the lungs and other important structures of the chest. They also produce lubricating fluid between to help the lungs move smoothly as we breathe. The outer layer, the parietal pleura, lines the entire inside of the chest cavity. The inner layer, or visceral pleura, covers the lungs.
Mesothelioma commonly affects both layers of the pleura. The cancer generally forms in one layer of the pleura and rapidly invades the other pleural layer, diaphragm, chest wall or lung. If the cancer reaches nearby glands called lymph nodes, it can metastasize, or spread, to other parts of the body.
Non-cancerous conditions like pleural plaques and atelactasis can develop on the surface of the pleura as a result of asbestos exposure and these conditions are not associated with pleural mesothelioma. They don’t develop into cancer and they don’t increase the risk of developing lung cancer or pleural mesothelioma.
Diagram of Healthy Lung vs Diseased Lung
Pleural mesothelioma can be difficult to diagnose, since symptoms usually do not arise until long after the first exposure to asbestos. Since many diseases of the lungs and respiratory system have the same symptoms as pleural mesothelioma, doctors may mistake it for the flu or pneumonia.
Two layers of tissue make up the pleura. These tissues protect and support the lungs and other important structures of the chest. They also produce lubricating fluid between to help the lungs move smoothly as we breathe. The outer layer, the parietal pleura, lines the entire inside of the chest cavity. The inner layer, or visceral pleura, covers the lungs.
Mesothelioma commonly affects both layers of the pleura. The cancer generally forms in one layer of the pleura and rapidly invades the other pleural layer, diaphragm, chest wall or lung. If the cancer reaches nearby glands called lymph nodes, it can metastasize, or spread, to other parts of the body.
Non-cancerous conditions like pleural plaques and atelactasis can develop on the surface of the pleura as a result of asbestos exposure and these conditions are not associated with pleural mesothelioma. They don’t develop into cancer and they don’t increase the risk of developing lung cancer or pleural mesothelioma.
Diagram of Healthy Lung vs Diseased Lung
Pleural mesothelioma can be difficult to diagnose, since symptoms usually do not arise until long after the first exposure to asbestos. Since many diseases of the lungs and respiratory system have the same symptoms as pleural mesothelioma, doctors may mistake it for the flu or pneumonia.
With the introduction of the PET scan in the early 1960s, doctors could better distinguish between cancerous and non-cancerous growths on the pleura. While imaging plays an important role in staging mesothelioma and guiding treatment, it cannot be used to diagnose the cancer on its own.
Cytology and Biopsy
Other tests are needed to diagnose mesothelioma with a high level of confidence. One test is thoracentesis, in which doctors insert a hollow needle into the lungs to collect pleural fluid.
Doctors look at the cell samples from the fluid under a microscope. They look for substances called biomarkers that indicate the presence of cancer. Specialists can use this analysis to make an accurate diagnosis in 80 percent of malignant mesothelioma cases.
Doctors look at the cell samples from the fluid under a microscope. They look for substances called biomarkers that indicate the presence of cancer. Specialists can use this analysis to make an accurate diagnosis in 80 percent of malignant mesothelioma cases.
Sometimes, however, a thoracentesis isn't enough, or there may be no pleural fluid to study. In these cases, doctors perform biopsies to collect pleural tissue samples. During a biopsy, doctors remove a tissue sample and look for cancerous cells. A thoracoscopic biopsy produces an accurate diagnosis in 98 percent of mesothelioma patients.
If a series of tests or biopsies confirm the presence of mesothelioma, doctors develop a treatment plan based on the results.
Similar diagnostic tests will be performed on different parts of the body for other forms of mesothelioma. For example, even though similar imaging scans and biopsies are used to diagnose all types of mesothelioma, the part of the body that undergoes imaging or biopsy will differ for each type of mesothelioma.
If a series of tests or biopsies confirm the presence of mesothelioma, doctors develop a treatment plan based on the results.
Similar diagnostic tests will be performed on different parts of the body for other forms of mesothelioma. For example, even though similar imaging scans and biopsies are used to diagnose all types of mesothelioma, the part of the body that undergoes imaging or biopsy will differ for each type of mesothelioma.
Treatment Options
Because mesothelioma locally invades the body cavity in which it develops before spreading, doctors rarely have a hard time differentiating one form of mesothelioma from another. Only in late stage IV cases may there be enough spreading to or from the lung to the abdomen to question whether the cancer originated in the lining of the lungs or abdomen.
Historically, doctors have treated pleural mesothelioma with traditional cancer treatments like surgery, chemotherapy and radiation therapy. Most treatment plans used a combination of the three which is called multimodal therapy.
Depending on how far your mesothelioma has progressed, these therapies can be either either cytoreductive (meaning reduction of tumor cells) or palliative (meaning control of symptoms).
Cytoreductive treatments aim to control the cancer, while palliative treatments only address the symptoms and try to improve the quality of life for patients.
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