Frequently Asked Questions About Pleural Mesothelioma

Some of the questions we're most commonly asked about pleural mesothelioma are below. If your question isn't answered here, or you'd like a more detailed explanation, please give us a call at 833-4-ASBESTOS and we'll do our best to help you and your family.

What are the symptoms of pleural mesothelioma?

Pleural mesothelioma, a type of cancer that affects the lining of the lungs, can present with various symptoms. These may include:

Chest pain or discomfort: This is a common symptom, often described as dull or diffuse pain that can worsen as the disease progresses. In some cases, the pain may be pleuritic, meaning it worsens with breathing or coughing.
Shortness of breath: This is frequently reported and is often associated with pleural effusion (fluid buildup in the pleural space) or the tumor encasing the lung, leading to reduced lung capacity.
Persistent cough: A chronic cough may occur, sometimes accompanied by sputum or hemoptysis (coughing up blood) in rare cases.
Unexplained weight loss: Many patients experience significant weight loss, which is often accompanied by general ill-health or fatigue.
Fatigue: A sense of persistent tiredness or lack of energy is commonly reported.
Lumps under the skin on the chest: In some cases, visible or palpable masses may develop on the chest wall, indicating tumor growth.
Other symptoms: Additional symptoms may include pleural effusion, night sweats, or systemic symptoms like fever and abdominal discomfort, though these are less common.
It is essential to recognize that these symptoms can also be caused by other conditions. However, individuals with a history of asbestos exposure should be particularly vigilant. If you experience any of these symptoms, consulting a healthcare provider promptly is crucial. They can perform diagnostic tests, such as imaging studies or biopsies, to determine the cause and recommend appropriate treatment options

Our office also offers free asbestos health tests to individuals who were exposed to asbestos.

How is pleural mesothelioma diagnosed?

Diagnosing pleural mesothelioma is a multi-step process that requires a combination of clinical evaluation, imaging, and pathological testing. Due to the disease's rarity and nonspecific symptoms, a thorough and systematic approach is essential. Here are the key steps involved:

Medical History and Physical Examination
A detailed medical history is critical, particularly focusing on potential asbestos exposure, which is the primary risk factor for mesothelioma.
During the physical exam, doctors may look for signs such as lumps on the chest, fluid buildup (pleural effusion), or other abnormalities that could indicate the disease.
Imaging Tests
Chest X-rays: Often the first imaging test performed, X-rays can reveal pleural thickening, effusions, or other abnormalities.
CT Scans: Computed tomography (CT) scans provide more detailed images of the chest and are crucial for identifying the extent of the disease.
PET Scans: Positron emission tomography (PET) scans can help distinguish between malignant and benign pleural diseases, with high sensitivity and specificity in some cases.
MRI Scans: Magnetic resonance imaging (MRI) may be used to assess the invasion of nearby structures, such as the diaphragm or mediastinum, which is important for surgical planning.
Biopsy
A definitive diagnosis of pleural mesothelioma requires a biopsy, where a tissue sample is taken for microscopic examination.
Thoracoscopic Biopsy: This is considered the gold standard, with a diagnostic sensitivity of 98%. It allows direct visualization of the pleura and collection of adequate tissue samples.
Needle Biopsy or Thoracentesis: These less invasive methods may be used to collect tissue or fluid samples, but they are less reliable for a definitive diagnosis.
Pathology and Immunohistochemistry Testing
The biopsy sample is analyzed by a pathologist to confirm the presence of mesothelioma.
Immunohistochemistry (IHC) is used to identify specific markers that are positive in mesothelioma (e.g., calretinin, keratins 5/6, WT1) and negative in other cancers (e.g., CEA, TTF-1). This helps differentiate mesothelioma from other malignancies, such as adenocarcinoma.
Staging and Additional Tests
If mesothelioma is confirmed, further tests are conducted to determine the stage of the disease. This may include additional imaging or procedures like laparoscopy to assess peritoneal involvement or echocardiography to rule out pericardial involvement.
Staging helps guide treatment decisions and provides insight into the prognosis.
Diagnosing mesothelioma can be challenging due to its nonspecific symptoms and the difficulty in distinguishing it from other pleural diseases. Negative results from pleural biopsies or cytology do not exclude mesothelioma and should prompt further investigation or follow-up. Consulting a specialist with experience in mesothelioma is crucial for accurate diagnosis and management.

What treatments are available for pleural mesothelioma?

Treatment options for pleural mesothelioma vary depending on the stage of the disease, the patient’s overall health, and other individual factors. Here is an overview of the available treatments:

1. Surgery
Surgery is a potential option for patients with early-stage pleural mesothelioma (stages I–IIIa). It aims to remove the tumor and affected tissues to improve survival or alleviate symptoms.
Types of Surgery:
Pleurectomy/Decortication (P/D): Involves removing the pleural lining of the lung while sparing the lung itself. This is less invasive and may preserve lung function.
Extrapleural Pneumonectomy (EPP): A more extensive procedure that removes the affected lung, pleura, diaphragm, and pericardium. This is typically reserved for highly selected patients due to its complexity and associated risks.
Surgery is often combined with other treatments, such as chemotherapy or radiation therapy, as part of a multimodal approach.
2. Radiation Therapy
Radiation therapy uses high-energy beams to target and kill cancer cells.
Applications:
Adjuvant Therapy: Delivered after surgery to eliminate residual cancer cells.
Palliative Therapy: Used to relieve symptoms such as pain or difficulty breathing.
Advanced techniques like Intensity Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT) allow for precise targeting, minimizing damage to surrounding healthy tissues.
3. Chemotherapy
Chemotherapy is a reliable treatment for pleural mesothelioma, especially in advanced stages.
Standard Regimen: The combination of pemetrexed and cisplatin is the most commonly recommended chemotherapy protocol. This regimen has shown improved survival compared to cisplatin alone.
Chemotherapy can be used as a standalone treatment or in combination with surgery and/or radiation therapy.
4. Immunotherapy
Immunotherapy is an emerging treatment that enhances the body’s immune system to fight cancer.
It is particularly beneficial for patients who are not candidates for conventional chemotherapy. Ongoing research is exploring its potential to improve survival and quality of life.
5. Targeted Therapy
Targeted therapies focus on specific genes, proteins, or pathways involved in cancer growth.
Anti-angiogenesis agents like bevacizumab and nintedanib are being investigated as adjuncts to chemotherapy, showing promise in clinical trials.
6. Multimodal Therapy
Combining surgery, chemotherapy, and radiation therapy (trimodal therapy) has shown improved outcomes in selected patients.
For example, lung-sparing surgery combined with novel radiation techniques and effective chemotherapy regimens may offer significant survival benefits.
7. Palliative Care
For advanced-stage mesothelioma, palliative treatments focus on symptom management and improving quality of life. This may include procedures to drain pleural effusions, pain management, and supportive care.
8. Clinical Trials
Participation in clinical trials provides access to innovative therapies, including experimental drugs, immunotherapies, and novel combinations of treatments.
Ongoing trials are exploring the role of anti-mesothelin agents, molecular therapies, and other cutting-edge approaches.
The choice of treatment depends on the stage of the disease, the patient’s overall health, and their preferences. A multidisciplinary team approach is essential to tailor the treatment plan to the individual’s needs.

For the latest updates on treatment options, visit our prognosis and treatment page for pleural mesothelioma.

Why are Navy veterans at higher risk for pleural mesothelioma?

Navy veterans are at a higher risk for pleural mesothelioma due to their past exposure to asbestos. Asbestos was widely used in the Navy, especially in shipbuilding, because of its exceptional heat resistance, durability, and insulating properties. These qualities made it an ideal material for use in high-temperature and high-pressure environments commonly found on naval ships. Asbestos was extensively incorporated into boilers, insulation, pipes, gaskets, valves, fireproofing materials, and even in protective gear, ensuring the safety and functionality of ships during operations.
However, the very properties that made asbestos valuable also made it hazardous. During maintenance, repair, or demolition work, asbestos fibers could easily become airborne. When inhaled, these microscopic fibers could lodge into the lining of the lungs (the pleura), causing inflammation and scarring over time. This prolonged exposure could eventually lead to pleural mesothelioma, a rare and aggressive cancer. The risk was particularly high for those who worked in confined spaces, such as engine rooms or boiler rooms, where asbestos-containing materials were abundant and ventilation was limited.
Shipyard workers and personnel on certain types of ships, such as aircraft carriers, destroyers, and submarines, faced even greater exposure due to the high concentration of asbestos-containing materials in these vessels. The long latency period of mesothelioma—often 20 to 40 years—means that many Navy veterans are only now being diagnosed with this disease, decades after their initial exposure.
It's important for veterans with a history of asbestos exposure to inform their healthcare provider and monitor for symptoms such as chest pain, shortness of breath, or unexplained weight loss. Early detection can lead to more effective treatment options.

Certain occupations and industries were more likely to expose workers to asbestos than others, but Navy veterans shipyard workers, and maritime workers had some of the highest exposures to asbestos.

What is the prognosis for someone diagnosed with pleural mesothelioma?

The prognosis for someone diagnosed with pleural mesothelioma depends on several factors, including the stage of the disease, the patient’s age, overall health, and the specific characteristics of the cancer. While pleural mesothelioma is an aggressive cancer, advancements in treatment and early detection can influence outcomes. Below are the key factors that affect prognosis:

1. Stage of the Disease
Early Stage (Stages 1 and 2): Patients diagnosed at an early stage generally have a more favorable prognosis. Median survival rates range from 1 to 2 years, as the cancer is more localized and may respond better to treatment.
Late Stage (Stages 3 and 4): In advanced stages, the cancer has typically spread to other parts of the body, leading to a median survival rate of approximately 12 months. Treatment at this stage is often palliative, focusing on symptom management and quality of life.
2. Age and Overall Health
Younger patients and those in good overall health tend to have better outcomes. A stronger immune system and fewer underlying health conditions can improve the body’s ability to tolerate treatments and recover.
3. Cancer Characteristics
The type of mesothelioma cells significantly impacts prognosis:
Epithelioid Cells: These are the most common and respond better to treatment, offering a more favorable prognosis.
Sarcomatoid Cells: These are more aggressive and less responsive to treatment, leading to a poorer prognosis.
Biphasic (Mixed) Cells: Prognosis depends on the ratio of epithelioid to sarcomatoid cells.
4. Treatment Options
Surgery: Procedures like pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP) can extend survival in eligible patients, especially when combined with other therapies.
Chemotherapy: Drugs like pemetrexed and cisplatin are standard treatments that can slow disease progression.
Radiation Therapy: Often used to manage symptoms or as part of a multimodal treatment plan.
Clinical Trials: Participation in clinical trials may provide access to innovative therapies, such as immunotherapy or targeted treatments, which could improve outcomes.
5. Individual Variability
It’s important to note that these are general estimates, and individual prognoses can vary greatly. Factors such as genetic markers, response to treatment, and access to specialized care can all influence outcomes.
While pleural mesothelioma remains a challenging diagnosis, treatments can extend survival and improve quality of life. Patients are encouraged to work closely with their healthcare team to explore all available options, including clinical trials, and to receive personalized information about their prognosis.

For the latest information, visit our page on pleural mesothelioma treatments and prognosis.

When did they discover that asbestos causes pleural mesothelioma?

The connection between asbestos exposure and pleural mesothelioma was firmly established in the 1960s and 1970s, following decades of accumulating evidence. Below is a timeline of key discoveries and developments:

1. Early Observations
The first case report linking asbestos exposure to pleural neoplasms appeared in 1933. This marked the beginning of medical interest in the potential carcinogenic effects of asbestos.
Additional cases were documented in the 1940s, and by 1954, a peritoneal tumor linked to asbestos exposure was reported.
2. Groundbreaking Study in 1960
In 1960, South African researcher J.C. Wagner published a pivotal study that demonstrated a strong correlation between asbestos exposure and pleural mesothelioma. This study examined 33 patients from the North Western Cape Province, an area with significant asbestos mining activity, and provided compelling evidence of the link.
3. Further Research in the 1960s and 1970s
Subsequent studies in the 1960s and 1970s reinforced Wagner’s findings. For example:
Research by Selikoff, Churg, and Hammond in 1965 further confirmed the relationship between asbestos exposure and mesothelioma in occupational settings.
Studies in the United Kingdom and other regions also documented increased cases of mesothelioma among workers exposed to asbestos, both occupationally and non-occupationally.
4. Regulatory Recognition
By the late 1970s, regulatory bodies such as the Occupational Safety and Health Administration (OSHA) in the United States began implementing standards to limit asbestos exposure in workplaces, acknowledging its role in causing mesothelioma and other diseases.
5. Modern Understanding
Today, asbestos exposure is recognized as the primary cause of pleural mesothelioma. However, it is important to note that mesothelioma is a rare and complex disease, and in some cases, no clear asbestos exposure can be identified.
The discovery of the link between asbestos and pleural mesothelioma was a gradual process, with the 1960 study by J.C. Wagner serving as a landmark moment. This was followed by extensive research in the 1960s and 1970s, leading to widespread recognition of asbestos as a carcinogen and the implementation of safety regulations to protect workers.

Learn more about Dr. J.C. Wagner's study here.

What is pleural effusion, and how is it treated in pleural mesothelioma?

Pleural effusion is a condition characterized by the accumulation of excess fluid in the pleural space, the area between the two layers of the pleura (the thin membrane surrounding the lungs). This condition is commonly associated with pleural mesothelioma, a cancer that affects the pleura.

Symptoms of pleural effusion include:
Chest pain
Shortness of breath (dyspnea)
Coughing
Fatigue
In pleural mesothelioma, pleural effusion occurs due to the irritation and inflammation caused by the tumor, which leads to fluid leakage into the pleural space.
Treatment Options for Pleural Effusion in Pleural Mesothelioma
The primary goal of treating pleural effusion in mesothelioma patients is to relieve symptoms, improve quality of life, and prevent complications. Below are the common treatment methods:
1. Thoracentesis
Description: A minimally invasive procedure where a needle is inserted into the pleural space to drain the excess fluid.
Purpose: Provides temporary relief from symptoms like shortness of breath and chest pain.
Limitations: Fluid may reaccumulate, requiring repeated procedures.
2. Pleurodesis
Description: A procedure where a chemical agent (e.g., talc) is introduced into the pleural space to cause inflammation and scarring. This seals the pleural layers together, preventing further fluid accumulation.
Indication: Recommended for patients with recurrent pleural effusion.
Effectiveness: Reduces the need for repeated fluid drainage.
3. Indwelling Pleural Catheter (IPC)
Description: A small tube is surgically placed into the pleural space, allowing patients to drain fluid at home as needed.
Advantages: Provides long-term management of pleural effusion and reduces hospital visits.
Considerations: Requires proper care to prevent infection.
4. Pleurectomy
Description: A surgical procedure that involves removing part or all of the pleura to prevent fluid build-up.
Indication: Typically considered for patients who are good surgical candidates and have localized mesothelioma.
Limitations: It is a more invasive option and may not be suitable for all patients.
Additional Considerations
While these treatments address pleural effusion, they do not cure pleural mesothelioma. Comprehensive treatment for mesothelioma may include:
Surgery: To remove tumors.
Chemotherapy: To target cancer cells.
Radiation therapy: To shrink tumors and alleviate symptoms.
Pleural effusion is a common and challenging complication of pleural mesothelioma. Treatment options such as thoracentesis, pleurodesis, indwelling pleural catheters, and pleurectomy aim to manage symptoms and improve quality of life. Patients should work closely with their healthcare team to determine the most appropriate treatment plan based on their condition and overall

How does pleural mesothelioma affect breathing?

Pleural mesothelioma significantly impacts breathing due to its effects on the pleura, the lining of the lungs. Here are the primary ways it affects respiratory function:

1. Tumor Growth
The cancerous growth thickens the pleura, reducing lung flexibility. This limits the lungs' ability to expand and contract during breathing, leading to shortness of breath (dyspnea).
2. Pleural Effusion
Pleural mesothelioma often causes pleural effusion, where fluid accumulates in the pleural space. This fluid exerts pressure on the lungs, restricting their movement and further contributing to breathing difficulties.
3. Pain
Tumor growth and fluid buildup can irritate the pleura, causing chest pain. This pain can make deep breathing uncomfortable, further impairing respiratory function.
Management of Breathing Difficulties
To alleviate breathing issues, treatment options include:
Thoracentesis: Draining excess fluid to relieve pressure on the lungs.
Pleurodesis: Preventing fluid reaccumulation.
Chemotherapy or Radiation Therapy: Shrinking tumors to reduce their impact on lung function.
These interventions aim to improve breathing and enhance the patient's quality of life. Always consult a healthcare provider for personalized treatment options.

Can pleural mesothelioma be misdiagnosed as another condition?

Yes, pleural mesothelioma can indeed be misdiagnosed as other conditions due to the overlap of its symptoms with those of more common respiratory diseases. Here are the key points:

1. Common Misdiagnoses
Pneumonia or Bronchitis: Early symptoms like chest pain, shortness of breath, and cough are often mistaken for these common respiratory infections.
Lung Cancer: Since both lung cancer and pleural mesothelioma can present with similar radiological findings and symptoms, they are sometimes confused.
Other Pleural Conditions: Conditions such as pleural effusion (fluid buildup) or pleurisy (inflammation of the pleura) may also mimic mesothelioma symptoms.
2. Challenges in Diagnosis
Non-Specific Symptoms: Symptoms like shortness of breath and chest pain are not unique to mesothelioma, making it harder to distinguish from other diseases.
Radiological Similarities: Imaging studies may show pleural thickening or effusion, which are not exclusive to mesothelioma.
Rarity of the Disease: Mesothelioma is rare, so it may not be the first condition considered by healthcare providers.
3. Importance of Biopsy
A biopsy is crucial for an accurate diagnosis. This involves taking a tissue sample from the affected area and examining it under a microscope to confirm the presence of mesothelioma cells.
4. Role of Asbestos Exposure History
A history of asbestos exposure is a significant clue. Patients with such a history should inform their healthcare provider, as it raises the suspicion of mesothelioma and prompts further investigation.
While pleural mesothelioma can be misdiagnosed due to its non-specific symptoms and rarity, a combination of detailed medical history, imaging studies, and biopsy can help ensure an accurate diagnosis. Always consult a healthcare professional for proper evaluation and diagnosis.

Can talcum powder use cause mesothelioma?

"Yes, there is a potential link between talcum powder use and mesothelioma. Talc in its natural form can contain asbestos, a known cause of mesothelioma. If talcum powder is contaminated with asbestos and inhaled or ingested, it may lead to the development of mesothelioma. However, not all talcum powder contains asbestos, and many modern products are asbestos-free.
Numerous court cases have been filed claiming that asbestos-contaminated talcum powder products caused mesothelioma. However, talcum powder itself does not cause mesothelioma.
It's always important to remember that individual health situations are unique and complex; if you're concerned about potential asbestos exposure from talcum powder, consult with your doctor or a mesothelioma specialist.

Is pleural mesothelioma curable?

Pleural mesothelioma, a cancer affecting the lining of the lungs, is currently not curable. However, advancements in treatment options can help improve quality of life and, in some cases, extend survival. Below is a detailed explanation:

1. Current Treatment Options
Surgery: Surgical procedures, such as pleurectomy/decortication (removal of the pleura) or extrapleural pneumonectomy (removal of the lung and surrounding tissue), may be performed to reduce tumor burden and alleviate symptoms. However, these are not curative and are typically used in combination with other treatments.
Chemotherapy: Chemotherapy, often with drugs like pemetrexed and cisplatin, is a standard treatment to slow disease progression and manage symptoms.
Radiation Therapy: Radiation can be used to target specific areas, reducing pain and controlling tumor growth.
Multimodal Therapy: A combination of surgery, chemotherapy, and radiation is often employed to maximize treatment effectiveness.
2. Emerging and Experimental Therapies
Immunotherapy: This approach uses the body's immune system to fight cancer. Drugs like immune checkpoint inhibitors have shown promise in some mesothelioma patients.
Targeted Therapy: These therapies focus on specific genetic mutations or proteins in cancer cells, offering a more personalized treatment approach.
Gene Therapy and Clinical Trials: Ongoing research is exploring innovative treatments, including gene therapy and other experimental approaches, which may offer hope for future advancements.
3. Prognosis and Individual Factors
Prognosis: Pleural mesothelioma is considered a terminal illness, with survival rates varying based on factors such as the stage of the disease, the patient’s overall health, and response to treatment.
Individualized Care: Each patient’s situation is unique, and treatment plans are tailored to their specific needs and preferences. Early diagnosis and a multidisciplinary approach can improve outcomes.
4. Palliative Care
For patients with advanced disease, palliative care focuses on symptom management, such as relieving pain and breathlessness, to enhance quality of life.
While pleural mesothelioma is not curable, advancements in treatment and supportive care offer hope for improved quality of life and extended survival. Patients are encouraged to discuss their options with a specialized healthcare team to determine the best course of action for their individual circumstances.

For the latest information, visit our page on pleural mesothelioma treatments and prognosis.