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The Ins and Outs of Pleural Mesothelioma

Pleural mesothelioma is the most common type of mesothelioma. It accounts for nearly 75% of all cases diagnosed. Cancer can start in any part of the body. However, malignant pleural mesothelioma is a cancer that starts in the chest and attacks the protective lining of the lungs. 

This type of mesothelioma is caused by the inhalation of asbestos fibers that stick to the pleura (lining of the lung). Asbestos can be found in residential or commercial buildings constructed before the 1980s. The most common type of asbestos exposure is occupational. Occupations such as construction, mechanical work, and mining are a few occupations where the risk of exposure to asbestos is higher than others. Military veterans make up over 30% of those diagnosed with mesothelioma. 

Pleural mesothelioma does not typically manifest for 20-50 years after an individual’s initial exposure to asbestos. Pleural mesothelioma also spreads quickly because of its proximity to other vital organs. The prognosis is grim. The life expectancy for an individual diagnosed with pleural mesothelioma is anywhere from 12 to 21 months. 

Signs and Symptoms of Pleural Mesothelioma (Mesothelioma of the Chest)

The signs and symptoms of pleural mesothelioma can be similar to other conditions. One of the main symptoms is shortness of breath and fever. Those two symptoms are commonly associated with other respiratory ailments. Even though the symptoms of pleural mesothelioma may be the same as other conditions, if you have been exposed to asbestos, it is necessary that you consult your physician. Being aware of the symptoms can improve your chances of early detection, diagnosis, and treatment. 

Many patients often mistake their symptoms with other minor respiratory illnesses. Given that mesothelioma is such a rare form of cancer, it is important to express to your past asbestos exposure so your healthcare provider can make a proper diagnosis. The American Cancer Society identifies the following symptoms of pleural mesothelioma:

  • Pain in the side of the chest or lower back
  • Dyspnea (shortness of breath)
  • Cough (dry or painful) or hemoptysis (coughing up blood)
  • Trouble swallowing (feeling like food gets stuck)
  • Hoarseness
  • Swelling of the face and arms
  • Unexplained weight loss
  • Fever 
  • Pleural effusion (fluid buildup) 
  • Mass of tissue under the skin or chest
  • Lethargy 
  • Insomnia 

If you have been exposed to asbestos in the past, and you are experiencing the above-referenced symptoms, a trip to the doctor is warranted. Even minimal exposure to asbestos can lead to the development of mesothelioma. 

Tests and Diagnosis of Pleural Mesothelioma

Pleural mesothelioma attacks the lungs. The first few steps in the diagnostic process may seem basic, but they can provide doctors with certain clues to make an accurate diagnosis. The first round of tests will consist of imagining techniques, such as X-rays, ultrasounds, or CT scans. The imaging tests can show where the tumors are located. The doctor will review the films, and if they think there is a chance of a cancerous tumor, they will proceed to perform a biopsy of the suspect lung. 

There are three different types of biopsies that could be performed, depending on certain individual circumstances:

  • Thoracentesis – biopsy that removes a fluid sample from the pleural cavity
  • Pleural biopsy – biopsy that removes one for more samples of the pleura (lining of the lung)
  • Thoracoscopic biopsy (VATS) – biopsy that is also called a video-assisted thoracoscopic surgery biopsy, is used to obtain a tissue biopsy while being guided by a small camera. 

The doctor will then review the sample(s) under a microscope to see if any cancer cells are present. The most reliable biopsy is a tissue biopsy. It is almost always a necessary procedure to confirm a pleural mesothelioma diagnosis. It is referred to as the “gold standard” for diagnosing malignant pleural mesothelioma.

The 4 Stages of Pleural Mesothelioma 

The four stages of pleural mesothelioma are listed as Stage I-IV. Stage I being the earliest form, and Stage IV being the last, and most terminal stage.

  • Stage I – cancer is located in the pleural lining of the lungs, and it has not grown beyond where it started
  • Stage II – cancer has spread into parts of the lung, diaphragm, or both
  • Stage III – cancer has metastasized and has spread to nearby lymph nodes
  • Stage IV – cancer has spread to other organs and reached all lymph nodes 

The course of recommended treatment depends on the location and stage of the cancer. The rating explains how far the cancer has spread, and it is used to form a treatment plan. Treatment is also based on the cell subtype (epithelioid, sarcomatoid, or biphasic).

Treatment Options for Pleural Mesothelioma 

The treatment of pleural mesothelioma is challenging. It does not respond well to chemotherapy and radiation therapy (RT). Surgery is also rarely effective. To determine the best course of treatment, a team of medical experts will work together to craft a treatment plan. The medical treatment team could include a radiation or medical oncologist, a radiologist, a surgeon, or a pulmonologist. Other experts may be necessary to form the most effective treatment plan possible.

Chemotherapy is the most common treatment type for pleural mesothelioma. Patients often use a combination of treatments, known as multimodal therapy. This type of therapy is most effective if the cancer is diagnosed early. Chemotherapy or a combination thereof can help alleviate symptoms such as trouble breathing and chest pain. They can also improve one’s quality of life and survival.

Surgery is another option, but it is most effective in patients who are in the early stages of cancer. The goal is to successfully remove the cancer and prevent it from resurfacing for as long as possible. There are two types of surgery used as a treatment option for pleural mesothelioma:

  • Extrapleural Pneumonectomy – an aggressive surgical option that removes the cancerous lung along with the pleura, diaphragm, and pericardium (heart sac). 
  • Pleurectomy and Decortication (radical pleurectomy) – removes the cancerous tumors and any affected pleura. 

There are also new treatments emerging. Some other treatment options used to treat mesothelioma include gene therapy, photodynamic therapy, and immunotherapy. These treatments aim to not only fight cancer but cause fewer side effects. Some newer treatments are considered experimental and may only be available through a mesothelioma clinical trial. 

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