Pleural mesothelioma is a malignant cancer that develops in the lining of the lungs called the pleura. It is the most common type of mesothelioma. 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. Although the prognosis is typically poor, finding a pleural cancer specialist can diversify your treatment options and help improve your prognosis. 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.
Symptoms of Pleural Mesothelioma
Symptoms of pleural mesothelioma include persistent dry or raspy cough, coughing up blood, shortness of breath, and difficulty swallowing. 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. 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.
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Two layers of tissue make up the lining around the lungs, known as the pleura. These tissues protect and support the lungs and other important structures of the chest. They also produce lubricating fluid between the two 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 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. 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.
Reliable Ways to Diagnose
While imaging, like the PET or CT scan, plays an important role in staging mesothelioma and guiding treatment, it cannot be used to diagnose the cancer on its own. More reliable ways to diagnose the disease include thoracoscopy, which allows doctors to view the patient’s chest through a small camera and collect a tissue biopsy, which doctors use to test tissue and fluid samples for cancerous cells.
Difficult to Confirm a Diagnosis
It is challenging for doctors to tell the difference between pleural mesothelioma and lung cancer. While doctors may suspect mesothelioma based on a patient’s symptoms, history of asbestos exposure and irregular imaging scan results, these signs are not enough to confirm a diagnosis.
Cytology and Biopsy
In order to diagnose mesothelioma with a high level of confidence, other tests are needed. One such test is thoracentesis, in which doctors insert a hollow needle into the lungs to collect pleural fluid. Cell samples from the fluid are examined under a microscope to look for substances that indicate the presence of cancer. Sometimes, however, there may be no pleural fluid to study, and additional testing is needed. In these cases, doctors perform biopsies to collect pleural tissue samples 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. 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.
Unfortunately, there is currently no cure for pleural mesothelioma. Researchers are persistently working toward the discovery of a cure. There are pleural mesothelioma treatment options, however, that can greatly improve a person’s quality and length of life without fully curing the mesothelioma.
Pleural Mesothelioma Treatment Options
Forming in the protective lining surrounding the lungs, pleura mesothelioma is often not diagnosed until it has progressed. The treatment options for pleural mesothelioma include:
- Surgery – Pleura mesothelioma is formed in the lining around the lungs and is therefore shielded by the rib cage, meaning that reaching it through surgery can require invasively cutting through bone. Two of the more common ways of treating pleural mesothelioma through surgery include ‘extra pleural pneumonectomy’(EPP) and ‘pleurectomy.’ This surgery is not a cure for pleural mesothelioma.
- Chemotherapy Treatment – Chemotherapy used in the treatment of pleural mesothelioma is not a cure, yet it can still provide some benefit to a mesothelioma patient. Studies suggest that chemotherapy treatments can result in the reduction of tumors and extend life. Chemotherapy has also been shown to palliate symptoms, including reducing shortness of breath, reduction of effusions, reduction of pain and improvement has been noted in quality of life studies.
- Radiation Treatments – Radiation in the treatment of pleural mesothelioma has proved to be useful in conjunction with EPP. It should be noted that the types of radiation that should be used are currently under investigation. Some centers are testing IMRT (intensity-modulated radiation therapy), photodynamic therapy, and adjuvant hem thoracic radiotherapy.
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