Mesothelioma

Pleural Mesothelioma

What is pleural mesothelioma?

Pleural mesothelioma cancer is the most common form of malignant mesothelioma, accounting for three-fourths of mesothelioma cases. The tumor starts in the lining of the lungs but can spread to other parts of the chest or abdomen, leading to advanced stages of the disease. 1,2

Causes of mesothelioma

Pleural mesothelioma cancer is caused by exposure to asbestos.3 The material was used in many industries before its link with cancer was identified. Inhaling the small fibers causes them to become trapped in the respiratory tissues, including the mesothelium. Over the course of several years plaque forms in the pleura, which leads to mesothelioma cancer.

Pleural mesothelioma symptoms

The most common symptom of pleural mesothelioma1 is chest pain, but other symptoms can include:

  • Difficulty breathing
  • Persistent cough
  • Fever
  • Weight loss

Pleural mesothelioma stages

Staging of pleural mesothelioma4,5 is performed using CT scan images.

  • Stage I — The tumor has not spread beyond the pleura
  • Stage II — The tumor has spread into surrounding tissue, such as the lung or diaphragm
  • Stage III — The tumor has invaded the surrounding tissue, including the chest wall, or metastasized to the lymph nodes
  • Stage IV — Metastasis and infiltration to other organs

Diagnosis of pleural mesothelioma

Pleural mesothelioma cancer is diagnosed5 using:

  • Imaging — chest X-ray and CT scan
  • Biopsy — pleural biopsy of the lining of the lungs or thoracentesis (testing the fluid in the chest cavity)
  • Blood test — looking for the proteins released when the mesothelium is damaged

Pleural mesothelioma treatment

The standard treatments for pleural mesothelioma6 are surgery, radiation, and chemotherapy. The surgical options are:

  • Wide local excision — Removal of the tumor and some of the healthy tissue surrounding it
  • Pleurectomy — Removal of the tumor from the lung, chest lining and/or diaphragm without damaging the structures
  • Decortication — Removal of a portion of the lung (done with pleurectomy)
  • Extrapleural pneumonectomy — Removal of the lung or other tissue where the cancer has spread

Treatment of stage I pleural mesothelioma usually involves surgery with adjuvant chemo or radiotherapy — therapy is performed prior to surgery to shrink the tumor, or after surgery to prevent recurrence.5,7 The recurrence rate after surgery can be as high as 50 percent.8

Prognosis of pleural mesothelioma

Mesothelioma prognosis8 depends on age, overall health and the mesothelioma cell type, called histology. Without treatment a patient can expect to survive four to eight months. With standard treatment, the median survival after diagnosis is 16 to 19 months, though some mesothelioma patients can live several years after diagnosis.

Lung cancer versus pleural mesothelioma

Though the symptoms and treatments of pleural mesothelioma are similar to those of lung cancer, the two diseases are very different from a medical standpoint.

First, pleural mesothelioma starts in the lining of the lungs, compared to lung cancer which begins in the lung itself.9 Lung cancer is characterized by the type of cell the tumor starts from,10 whereas mesothelioma can start in other parts of the mesothelium, not just the pleura.

Second, the known cause of pleural mesothelioma is asbestos exposure in the workplace, whereas the accepted environmental cause of lung cancer is smoking. In contrast, smoking has not been shown to cause mesothelioma, though it can aggravate the disease.9

Regardless of the type of cancer, early detection is important for a more favorable prognosis.

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