Pleural mesothelioma, which develops in the lining on the outside of the lung (pleura), is caused by exposure to asbestos. The average life expectancy for someone who has been diagnosed with pleural mesothelioma is 18 to 24 months.
If you’ve been exposed to asbestos at any point in your life, it’s important to make an appointment with a mesothelioma specialist to catch possible mesothelioma as early as possible. Cancers caught in early stages have more available treatment options and better prognoses.
What is Pleural Mesothelioma?
Pleural mesothelioma is a type of cancer caused by inhaling asbestos fibers. These fibers can get lodged into the protective lining of the lungs, causing genetic mutations in the surrounding cells, and in some cases, leads to pleural mesothelioma.
About 75 percent of all mesothelioma cases diagnosed each year are pleural mesothelioma—and since it’s one of the most common types of mesothelioma specialists have more opportunities for clinical trials that often lead to the development of new treatments.
Both those who worked in a job that exposed them to asbestos, and those who have been around other people who’ve been exposed, are at risk. Patients are generally diagnosed after a biopsy, and accurate diagnosis is important since pleural mesothelioma can vary by stage and cell type, which impacts treatment options. Healthcare treatment for pleural mesothelioma can include surgery (if caught in early stages), immunotherapy, chemotherapy and radiation.
The Prognosis of Pleural Mesothelioma
Prognosis refers to how the disease is expected to progress as well as the individual’s possible long-term survival. Your prognosis depends on several factors, including:
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- Age
- Cancer stage
- Cell type
- Overall health (heart, kidneys, etc.)
The cell type and cancer stage of the pleural mesothelioma play the biggest roles in your prognosis.
There are three commonly discussed types of mesothelioma cells or subtypes: epithelioid, sarcomatoid and biphasic.
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- Epithelioid mesotheliomas are the most common (approximately 60-70%)—but least aggressive. They also respond well to treatment. Patients with epithelioid mesothelioma often live 24 months after diagnosis.
- Sarcomatoid mesotheliomas make up about 10-20% of mesothelioma subtypes. Sarcomatiod mesotheliomas don’t respond as well to treatment as these cells tend to be more aggressive and spread quickly. They also tend to have a worse prognosis and lower life expectancy than epithelioid cell types.
- Biphasic tumors, which make up roughly 20-35% of mesothelioma tumors, contain both epithelioid and sarcomatoid cells. Prognosis depends on a number of factors including the ratio of sarcomatoid and epithelioid cells in the tumor.
- Epithelioid mesotheliomas are the most common (approximately 60-70%)—but least aggressive. They also respond well to treatment. Patients with epithelioid mesothelioma often live 24 months after diagnosis.
Prognosis for Early-Stage Pleural Mesothelioma
If you’ve been diagnosed with Stage 1 or stage 2 pleural mesothelioma, you generally have more treatment options available since the mesothelioma cancer hasn’t spread far from the lining of the lung and is easier for doctors to surgically remove. If you’re Stage 1 or 2, you should ask your doctor if you’re a surgical candidate. Many patients who are Stage 1 or 2 have an average life expectancy exceeding two years.
Prognosis for Advanced Stage Pleural Mesothelioma
Both stage 3 and stage 4 are considered advanced forms of pleural mesothelioma.
Stage 3
Stage 3 pleural mesothelioma means the cancer has metastasized or spread to the nearby tissue, organs or lymph nodes. Sometimes doctors get even more specific, referring to stage 3 pleural mesothelioma as being:
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- Stage 3A, indicating the pleural mesothelioma cancer cells are located in the lung lining on one side of the chest, and may have spread to the nearby lymph nodes, chest wall or lining of the heart.
- Stage 3B, indicating the pleural mesothelioma cancer cells are located in one or more distant lymph nodes.
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A stage 3 patient is less likely to have surgery as a treatment option. Depending on cell type, age and the overall health of the patient, a person suffering with stage 3 pleural mesothelioma may have a life expectancy of 12 to 24 months.
Stage 4
Stage 4 refers to pleural mesothelioma that has metastasized or spread to organs, tissues or lymph nodes that are not adjacent to the original cancer site. Late or advanced-stage mesothelioma prognosis tends to be poor, and life expectancy may be less than one year. Treatment for late-stage mesothelioma often involves palliative treatments to improve quality of life.
Life Expectancy with Pleural Mesothelioma
The average life expectancy for an individual with pleural mesothelioma is often 18 to 24 months. However, as stated, this life expectancy will vary greatly by the stage of the disease, the cell type of the mesothelioma, the patient’s age, and overall health.
In general, younger people diagnosed with mesothelioma live longer than older people. While mesothelioma can develop many decades after asbestos exposure and patients are generally older when diagnosed, patients diagnosed before the age of 45 can live up to six times longer than patients diagnosed after 75.
Similarly, gender plays an important role in prognosis as women diagnosed with mesothelioma tend to live longer than men. One NCI study on peritoneal mesothelioma found women have a five-year survival rate three times that of men.
Other conditions can also be risk factors that impact prognosis. Patients with some conditions may not be able to manage the side effects of aggressive treatment.
Pleural Mesothelioma Survival Rates
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One-year survival rate |
73% |
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Two-year survival rate |
23% |
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Three-year survival rate |
16% |
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Five-year survival rate |
12% |
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10-year survival rate |
4.7% |
How Pleural Mesothelioma Develops
When you’re exposed to asbestos fibers, they can become lodged in the pleura, causing scarring or inflammation. Over a period—often a minimum of 20 years—that scarring and inflammation can lead to genetic mutations in the nearby cells and cancerous tumors can form in the pleura.
The more exposure an individual has to asbestos, the more likely they may be to develop mesothelioma. However, it’s still possible to get mesothelioma from very small amounts of asbestos exposure.
Surprisingly, individuals can develop mesothelioma from second-hand asbestos exposure. Asbestos can also be ingested through the mouth, enter into your bloodstream and spread through your body.
Symptoms of Pleural Mesothelioma
Symptoms caused by pleural mesothelioma primarily affect the respiratory system, which includes the airways, lungs, and breathing muscles. The first signs a patient may feel are a persistent cough and shortness of breath. These symptoms are caused by excess fluids (pleural effusion) in the lining of the lungs.
Common symptoms associated with pleural mesothelioma
Pleural mesothelioma symptoms often include:
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- Dry cough
- Chest pains
- Coughing up blood
- Fluid in the lungs or pleural cavity
- Night sweats
- Shortness of breath
- Swelling of face or arms
- Weight loss
How Pleural Mesothelioma is Diagnosed
Pleural mesothelioma is difficult to diagnose because its symptoms are nonspecific. A nonspecific symptom is one that is the same for many other conditions. Pleural mesothelioma has the same symptoms as more common respiratory conditions, like pneumonia or chronic obstructive pulmonary disease (COPD).
Under a microscope, it’s also hard for doctors to distinguish between pleural mesothelioma and other cancers. For these reasons, your doctor runs tests to confirm the location, cancer stage, and cell type of the mesothelioma.
Your diagnosis can affect the type of treatment you receive. Doctors often won't perform a surgical operation on a later stage patient, for instance. Getting a second opinion from another specialist may yield a different diagnosis and open up your treatment options.
Diagnostic Imaging Tests
Doctors examine the chest area with a diagnostic imaging test, like an X-ray or CT scan, to find abnormal-looking masses or growths that may be tumors. The imaging scans can show the location and stage of the tumor. Imaging tests are painless, but some require you to be still for long periods of time.
Common imaging tests doctors use to start a diagnosis include:
- Chest X-ray
- Computerized tomography (CT) scan
- Magnetic resonance imaging (MRI).
- Positron emission tomography (PET) scan.
Biopsies
Depending on the imaging test results, the doctors may request a biopsy. This requires a small fluid or tissue sample. It also provides important information (like the cell type of the mesothelioma) that doctors use to create the most effective treatment plan possible.
How Often Is Pleural Mesothelioma Misdiagnosed?
While pleural mesothelioma is often misdiagnosed as another condition, most diagnoses of pleural mesothelioma are accurate. Still, you might consider asking your doctor to send your biopsied tissue to a second laboratory to confirm your diagnosis. Since the disease is so rare, some doctors haven’t seen a case of mesothelioma, making a second opinion helpful.
Sometimes, rather than a biopsy, your oncologist may recommend a cytology to drain fluid from the lung or pleural cavity that can be tested for cancerous cells.
Staging System for Pleural Mesothelioma
As part of the diagnostic process, your doctor will also determine the stage of the mesothelioma, which describes how far it’s spread from where it first appeared in the lining of the lung. This helps doctors determine which treatment options are available to you: patients with stage 1 or stage 2 pleural mesothelioma have more standard treatment options than patients with stage 3 or stage 4.
The stages of pleural mesothelioma
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- Stage 1. The cancer is localized to the lining of the lung.
- Stage 2. The cancer has spread to the lung itself, part of the diaphragm, and nearby lymph nodes.
- Stage 3. The cancer spread throughout one side of the chest, into the chest wall, esophagus and more lymph nodes.
- Stage 4. The cancer has spread into both sides of the chest, affecting other organs, the blood, and bone cells.
Treatments Options for Pleural Mesothelioma
Standard treatment options for mesothelioma include surgery, chemotherapy, immunotherapy and radiation therapy. Doctors often combine two or more of these treatments into a multimodal therapy, which has significantly improved the life expectancy in patients with pleural mesothelioma.
Extrapleural Pneumonectomy (EPP)
Extrapleural pneumonectomy (EPP), which was developed by world-renowned mesothelioma surgeon Dr. David Sugarbaker, is one of the most effective surgeries available to patients with pleural mesothelioma.
During an EPP, a surgeon removes:
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- The entire lung affected by mesothelioma
- Parts of the protective lining of the chest, lung and heart
- Nearby lymph nodes
- Part or all of the diaphragm
EPP isn’t used as frequently as pleurectomy with decortication due to its side effects, though in some cases, it can offer the best chance at removing mesothelioma cancer from the body. Since EPP is a major and invasive procedure, your doctor will only suggest it if you’re in good overall health and can recover from it.
Despite its risks, researchers in several studies have demonstrated the effectiveness of the EPP. In fact, one study reported the median survival rate for patients who received the EPP was as high as 27 months, almost twice the average mesothelioma survival rate.
Pleurectomy with Decortication (P/D)
Pleurectomy/decortication (P/D) is a less invasive, lung-sparing alternative to the EPP. Mesothelioma specialist Dr. Robert Cameron is often credited for developing the procedure, believing the EPP was unnecessarily radical. The P/D has been accepted by most surgeons and specialists to be the surgical procedure of choice to remove most or all of the mesothelioma.
The P/D consists of two surgical techniques:
- Pleurectomy. Surgeons remove the protective lining of the lung on which the tumor is growing.
- Decortication. Surgeons remove visible tumors around and on the diseased lung.
Researchers have shown that the P/D can produce survival rates equal to, and often better than, those of the EPP.
Pleurodesis as Palliative Care
Pleurodesis is a palliative surgery doctors use to ease the pain and pressure caused by fluid buildup (pleural effusion) in the chest between the inner and outer pleural linings. Surgeons perform a pleurodesis by inserting a hollow tube into the chest wall to drain the excess fluid. In some cases, talc may also be injected into the pleural cavity in an attempt to avoid future fluid buildup.
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Chemotherapy for Pleural Mesothelioma
As a treatment for pleural mesothelioma, doctors may use a chemotherapy drug by itself or combined with other chemotherapy drugs. The first notably successful combination of chemotherapy drugs for mesothelioma is Alimta and cisplatin. Together, the drugs increased the survival time of patients by an average of 3 months.
Doctors also combine chemotherapy with surgery. Prescribing chemotherapy before (neoadjuvant), during (intraoperative) or after (adjuvant) the procedure has shown to bump up survival times.
A recent medical study showed that patients who had a combination of surgery and heated chemotherapy survived for 35 months while those who had only surgery survived for 22.
Radiation Therapy for Pleural Mesothelioma
Doctors use radiation therapy to shrink pleural mesothelioma tumors. Radiation is used as a palliative treatment or in combination with chemotherapy and surgery.
A recent study on the effect of radiation therapy with surgery and chemotherapy showed that the combination produced an average survival time of 33 months — up to 3 times the life expectancy of many patients with pleural mesothelioma.
Emerging Treatments for Pleural Mesothelioma
Gene Therapy
Gene therapy is an attempt to use modified genes to kill or slow the growth of the cancer. One type of gene therapy, called gene transfer, is an introduction of genes to the cancer cells to slow the growth or kill the cancer. Gene transfers of “suicide genes” cause cancer cells to produce an enzyme that enables the death of cancer cells while leaving other cells unharmed.
CAR-T cell therapy is the first type of gene transfer to receive FDA approval for the treatment of some cancers. CAR-T cell gene therapy uses the body’s own immune system, much like immunotherapy, to attack the cancerous cells.
Currently, gene therapy has only been used in clinical trials and side effects can vary. A patient beginning a clinical trial should ask questions about available alternative treatments and the risks and side effects.
Photodynamic Therapy
Photodynamic therapy is a treatment that combines a photosensitizer, oxygen and specific light wavelengths to kill cancer cells—and is often used in conjunction with surgery for mesothelioma patients that are in an earlier stage.
The side effects from photodynamic therapy are believed to be less than most other types of treatment for pleural mesothelioma. In addition, the combination of surgery with photodynamic therapy has shown overall average survival rates of more than 30 months.
Pleural Mesothelioma FAQs
What causes pleural mesothelioma?
Pleural mesothelioma is a rare cancer of the lining of the lungs (pleura) caused by asbestos exposure. Asbestos fibers lodge in the pleura, causing chronic inflammation and pleural thickening. Over time, inflammation can lead to genetic mutations in the nearby cells and cancerous tumors.
How quickly does pleural mesothelioma spread?
Mesothelioma can have a 20–50-year or more latency period before a patient notices symptoms. Late-stage (3-4) disease tends to metastasize more quickly than early-stage disease. Certain types of cancer cells, like sarcomatoid and biphasic mesotheliomas, are very aggressive and metastasize to other areas of the body quickly. Other cell types like epithelioid mesothelioma are less aggressive.
Is pleural mesothelioma curable?
There is no cure for mesothelioma, though some patients have been able to go into short-term remission. Treatment of malignant pleural mesothelioma can lead to a better prognosis. Additionally, maintaining good overall health can improve your prognosis.
How long can you live with pleural mesothelioma?
Average life expectancy for patients with pleural mesothelioma is around 18 to 24 months. However, life expectancy may vary by the stage of the disease, cell type of the tumor, patient age and overall health. Cancer treatments, including surgery, chemotherapy and radiotherapy, can extend life. Additionally, cancer research into emerging fields, like immunotherapy, shows promise in increasing life expectancy.
Where does pleural mesothelioma spread to?
Pleural mesothelioma begins in the lining of the lung (pleura). Cancer cells then spread to the lung itself, diaphragm and nearby lymph nodes. Metastatic cancer then spreads throughout one side of the chest, into the chest wall, esophagus and more lymph nodes. Finally, mesothelioma spreads to both sides of the chest, other organs, blood and bones.
How does pleural mesothelioma compare to other types of mesothelioma?
Pleural mesothelioma is the most common type of mesothelioma. Because of its location, it can often be misdiagnosed as lung cancer. Peritoneal and testicular mesotheliomas have slightly better prognoses than pleural mesothelioma. However, because pleural mesothelioma is so much more common, there are more clinical trials and emerging research available.
How can I help my loved one with mesothelioma?
You can support loved ones by helping with regular chores like laundry or grocery shopping, assisting with organizing personal affairs, and providing emotional support during a difficult diagnosis. You can also advocate for cancer research and encourage your loved one to take part in any clinical trials that can improve quality of life.
Sources:
- Mccaughan, B. C. “A Systematic Review of Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma.” Journal of Thoracic Oncology, 1692-1703. Retrieved July 9, 2014, from http://www.ncbi.nlm.nih.gov/pubmed/20802345.
- “Radical pleurectomy/decortication followed by high dose of radiation therapy for malignant pleural mesothelioma. Final results with long-term follow-up.” Retrieved on October 16, 2014 from http://www.sciencedirect.com/science/article/pii/S016950021300457.
