Pleural Mesothelioma: Symptoms, Causes, Treatment

What are the symptoms of pleural mesothelioma?

Pleural mesothelioma is a rare and aggressive cancer that affects the pleura, the thin membrane lining the lungs and chest wall. It is primarily caused by exposure to asbestos. The symptoms of pleural mesothelioma often develop gradually and may be mistaken for less serious conditions, especially in the early stages. Here’s a list of common symptoms:

1. Chest Pain

Sharp or dull pain in the chest, typically near the rib cage, is one of the most common early symptoms.
The pain may be localized or spread to the shoulder or upper abdomen.

2. Shortness of Breath (Dyspnea)

Difficulty breathing or a sensation of breathlessness is common, especially as the tumor grows and presses on the lungs.
This can be caused by the buildup of fluid in the pleural space (pleural effusion) or by tumor growth restricting lung expansion.

3. Chronic Cough

A persistent, dry cough that doesn’t go away is a frequent symptom.
Coughing may be accompanied by chest discomfort or tightness.

4. Unexplained Weight Loss

Unintentional weight loss, even without changes in diet or exercise, is a common symptom as the disease progresses.

5. Fatigue

Persistent tiredness or fatigue can occur due to the body fighting the cancer or the strain on the respiratory system.

6. Fever and Night Sweats

Some individuals may experience low-grade fever or excessive sweating at night.

7. Pleural Effusion

Fluid buildup between the layers of the pleura can lead to pressure on the lungs, causing breathing difficulties, chest pain, and discomfort.
This can also lead to a feeling of heaviness or fullness in the chest.

8. Difficulty Swallowing (Dysphagia)

In some cases, the tumor can press on the esophagus, making it hard to swallow.

9. Lumps under the Skin

In advanced stages, small lumps or masses may develop under the skin of the chest, indicating the spread of the disease.

10. Hoarseness or Voice Changes

If the cancer affects the nerves that control the voice box, it may lead to hoarseness or changes in the voice.

11. Reduced Lung Function

Over time, the affected lung may lose its ability to fully expand, leading to breathing difficulties and reduced physical capacity.

12. Recurrent Respiratory Infections

Individuals with pleural mesothelioma may experience frequent respiratory infections, such as bronchitis or pneumonia, due to compromised lung function.

Advanced Symptoms:

As the disease progresses, more severe symptoms can develop, including:

Severe chest pain that becomes constant and harder to manage.
Increased difficulty breathing, even at rest.
Signs of metastasis, such as pain in other parts of the body or neurological symptoms if the cancer spreads to other organs.

Summary of Symptoms:

Chest pain (sharp or dull).
Shortness of breath (due to pleural effusion or lung restriction).
Chronic cough.
Unexplained weight loss.
Fatigue and night sweats.
Pleural effusion causing chest pressure and discomfort.
Difficulty swallowing or hoarseness.
Lumps under the skin in the chest area.

Pleural mesothelioma is often difficult to diagnose in its early stages because the symptoms can mimic other conditions like pneumonia or bronchitis. If there is a history of asbestos exposure, early screening and medical attention are crucial for timely diagnosis and treatment.

What are the causes of pleural mesothelioma?

Pleural mesothelioma is primarily caused by exposure to asbestos, a group of minerals that were commonly used in construction and industrial products due to their heat-resistant properties. The primary causes and risk factors for pleural mesothelioma include:

1. Asbestos Exposure

Direct Asbestos Exposure: Working in industries such as construction, shipbuilding, and manufacturing where asbestos was used can lead to inhalation of asbestos fibers.
Occupational Exposure: Professions with high risk include asbestos miners, construction workers, shipyard workers, and those involved in asbestos insulation or removal.

2. Environmental Asbestos Exposure

Secondary Exposure: Individuals who live near asbestos mines or industries may be exposed to asbestos fibers that become airborne.
Household Exposure: Family members of workers who handle asbestos may be exposed to asbestos fibers brought home on clothing or equipment.

3. Asbestos-Containing Products

Building Materials: Asbestos was used in insulation, roofing materials, flooring tiles, and cement products.
Automotive Parts: Asbestos was also used in brake pads and clutches, leading to exposure in auto mechanics and repair workers.

4. Genetic Factors

Genetic Predisposition: While not as well understood, some studies suggest that genetic factors may influence susceptibility to pleural mesothelioma in individuals exposed to asbestos.

5. Other Factors

Radiation Exposure: Previous exposure to radiation therapy, especially in the chest area for treating other cancers, has been associated with a small increased risk of mesothelioma.
Fibrous Silica Exposure: There is some evidence suggesting that exposure to fibrous silica might contribute to mesothelioma risk, although asbestos is the predominant risk factor.

6. Age and Gender

Age: Pleural mesothelioma typically has a long latency period, with symptoms often developing 20-50 years after asbestos exposure.
Gender: Men are more commonly affected than women, likely due to higher rates of occupational asbestos exposure in the past.

Key Points

Latent Period: The disease often develops decades after initial asbestos exposure, making it challenging to link the disease directly to specific exposures.
Preventive Measures: Avoiding asbestos exposure and using appropriate protective equipment can significantly reduce the risk of developing pleural mesothelioma.

If you have a history of asbestos exposure or are experiencing symptoms related to pleural mesothelioma, consulting a healthcare provider for appropriate diagnostic testing and evaluation is crucial.

How is the diagnosis of pleural mesothelioma made?

Diagnosing pleural mesothelioma involves several steps to confirm the presence of cancer and determine its extent. The process typically includes a combination of imaging studies, biopsies, and other diagnostic tests. Here’s an overview of how pleural mesothelioma is diagnosed:

1. Medical History and Physical Examination

Medical History: The doctor will inquire about symptoms, asbestos exposure history, and any relevant occupational or environmental exposures.
Physical Examination: The physician will perform a physical exam, paying particular attention to the chest, lungs, and other areas for signs of pleural effusion or abnormal masses.

2. Imaging Studies

Chest X-Ray:

Initial Imaging: Often the first imaging test used to look for abnormalities in the chest, such as pleural effusion or thickening of the pleura.

Computed Tomography (CT) Scan:

Detailed Imaging: Provides detailed cross-sectional images of the chest, helping to visualize tumors, pleural thickening, and fluid accumulation.

Magnetic Resonance Imaging (MRI):

Further Details: Used to evaluate the extent of the tumor, especially if it has spread to other areas, and to assist in planning surgical procedures.

Positron Emission Tomography (PET) Scan:

Metastasis Detection: Helps to assess the metabolic activity of the tumor and identify areas where the cancer might have spread.

3. Thoracentesis

Pleural Fluid Analysis: A procedure where a needle is inserted into the pleural space to remove and analyze pleural fluid. This can help in diagnosing mesothelioma and determining the cause of pleural effusion.

4. Biopsy Procedures

Needle Biopsy:

CT-Guided or Ultrasound-Guided: A needle is used to obtain a tissue sample from the pleura. This procedure can be performed with the help of imaging techniques to ensure accurate sampling.

Thoracoscopy (Video-Assisted Thoracoscopic Surgery, VATS):

Minimally Invasive: A small incision is made in the chest, and a camera is inserted to visualize the pleura and take tissue samples for biopsy.

Open Biopsy:

Surgical Procedure: In some cases, an open surgical procedure may be required to obtain a larger tissue sample or to perform a more comprehensive evaluation.

5. Histopathological Examination

Microscopic Analysis: The tissue samples obtained from biopsies are examined under a microscope by a pathologist to confirm the presence of mesothelioma cells and differentiate it from other types of cancer or diseases.

6. Immunohistochemistry

Specialized Testing: Additional tests on biopsy samples to identify specific markers that are characteristic of mesothelioma. This helps in confirming the diagnosis and distinguishing mesothelioma from other cancers.

7. Genetic and Molecular Testing

Further Analysis: In some cases, genetic or molecular tests might be performed on the tumor tissue to provide more information about the cancer and guide treatment options.

Diagnosis Summary

A combination of imaging studies, fluid analysis, and tissue biopsy is essential for an accurate diagnosis of pleural mesothelioma. If pleural mesothelioma is suspected, timely and comprehensive diagnostic evaluation is crucial for determining the appropriate treatment plan.

What is the treatment for pleural mesothelioma?

The treatment for pleural mesothelioma aims to manage symptoms, improve quality of life, and extend survival. Treatment plans are often personalized based on the stage of the disease, the patient’s overall health, and other factors. The primary treatment options include:

1. Surgical Treatments

Extrapleural Pneumonectomy (EPP):

Procedure: Removal of the affected lung, the pleura lining the lung and chest wall, and sometimes part of the diaphragm and pericardium.
Indication: Typically considered for early-stage disease in patients who are otherwise healthy enough to tolerate the surgery.

Pleurectomy/Decortication (P/D):

Procedure: Removal of the pleura (both visceral and parietal) without removing the lung. Sometimes includes partial removal of the diaphragm.
Indication: Often used for patients who are not candidates for EPP or to alleviate symptoms and improve quality of life.

Thoracoscopy (Video-Assisted Thoracoscopic Surgery, VATS):

Procedure: Minimally invasive surgery to obtain biopsies, drain pleural fluid, or perform other interventions.
Indication: Used for diagnosis or palliative purposes.

2. Chemotherapy

Drugs: Common regimens include a combination of cisplatin and pemetrexed (Alimta), sometimes with bevacizumab (Avastin).
Purpose: To shrink tumors, control disease progression, and manage symptoms.

3. Radiation Therapy

Types:
External Beam Radiation Therapy (EBRT): Targets specific areas where mesothelioma is present.
Palliative Radiation: Used to relieve symptoms such as pain or difficulty breathing.
Purpose: Can be used to reduce tumor size, manage symptoms, or complement other treatments.

4. Immunotherapy

Drugs: Checkpoint inhibitors like nivolumab (Opdivo) and pembrolizumab (Keytruda) are being explored.
Purpose: To help the immune system recognize and attack cancer cells.

5. Targeted Therapy

Drugs: Targets specific genetic mutations or molecular pathways involved in mesothelioma.
Purpose: To provide a more personalized treatment approach, based on the cancer’s genetic profile.

6. Palliative Care

Pain Management: Medications and therapies to manage pain and improve comfort.
Symptom Control: Measures to alleviate symptoms such as shortness of breath, cough, and fluid buildup.
Supportive Care: Includes counseling, nutritional support, and support for the patient and family.

7. Clinical Trials

Participation: Offers access to new and experimental treatments. Clinical trials are ongoing to test novel therapies and improve treatment outcomes.

8. Multimodal Therapy

Combination Approach: Often, a combination of surgery, chemotherapy, and radiation therapy is used to optimize treatment outcomes and address different aspects of the disease.

Treatment Planning

Multidisciplinary Team: Treatment plans are typically developed by a team of specialists, including oncologists, surgeons, radiologists, and palliative care providers.
Personalized Care: Treatment decisions are based on factors such as the stage of the disease, the patient’s overall health, and their preferences.

Monitoring and Follow-Up

Regular Check-Ups: Ongoing monitoring to assess the effectiveness of treatment, manage side effects, and detect any recurrence of the disease.

The treatment plan for pleural mesothelioma is tailored to each individual, and ongoing research continues to advance treatment options and improve outcomes. If you or someone you know is dealing with pleural mesothelioma, working closely with healthcare providers to explore all available treatment options is essential.

What is the life expectancy for pleural mesothelioma?

The life expectancy for individuals with pleural mesothelioma varies significantly based on several factors, including the stage of the cancer at diagnosis, the patient’s overall health, age, and the treatments received. On average, pleural mesothelioma has a poor prognosis due to its aggressive nature and late diagnosis. Here’s an overview of key factors that affect life expectancy:

1. Average Life Expectancy

For most people, the average life expectancy after diagnosis is 12 to 21 months.
If diagnosed in early stages, life expectancy may extend beyond two years, particularly with aggressive treatment options.
In later stages, the life expectancy is typically 6 to 12 months due to the advanced progression of the disease.

2. Factors Affecting Life Expectancy

Stage of the Disease:
- In stage 1 or 2, when the cancer is localized, patients may live longer, particularly if they undergo surgery and other aggressive treatments. Life expectancy could reach up to 2-3 years in some cases.
- In stage 3 or 4, when the cancer has spread (metastasized), life expectancy is typically shorter, often 6-12 months.
Patient’s Age and Overall Health:
- Younger and healthier patients typically respond better to treatment and may have longer life expectancies. Older patients or those with other health conditions may have shorter life spans.
Type of Treatment:
- Aggressive treatments like surgery (extrapleural pneumonectomy or pleurectomy) combined with chemotherapy and radiation can extend life expectancy in some patients, especially in the early stages.
- Newer treatments like immunotherapy and targeted therapies are improving outcomes for some individuals.
Cell Type (Histology):
- Epithelioid mesothelioma, the most common cell type, tends to have a better prognosis, with an average life expectancy of 12 to 24 months.
- Sarcomatoid and biphasic mesothelioma are more aggressive and have shorter life expectancies, often less than 12 months.
Response to Treatment:
- Some patients respond well to treatment and may experience periods of remission, while others may not see significant improvement.

3. New Advances in Treatment

Immunotherapy: Treatments like Keytruda (pembrolizumab) and Opdivo (nivolumab) are offering hope for some patients, extending life expectancy beyond traditional chemotherapy in certain cases.
Clinical trials: Participation in clinical trials for new treatments, such as gene therapy and targeted therapy, can improve outcomes for some individuals.

4. Survival Rates

5-year survival rate: Only about 10% of pleural mesothelioma patients live five years or more after diagnosis, but this varies based on factors like early detection and treatment.

Summary:

Average life expectancy: 12-21 months.
Early-stage (1 or 2) diagnosis may extend life expectancy up to 2-3 years.
Advanced-stage (3 or 4) diagnosis typically results in 6-12 months of life expectancy.
Factors like stage, treatment, cell type, and patient health significantly impact life expectancy.

Though the prognosis for pleural mesothelioma is generally poor, early detection and advances in treatments like immunotherapy and surgery can improve survival outcomes for some patients.