Pleural Mesothelioma 👉 How It Develops and Top Medication

Pleural mesothelioma is a cancer in the protective lining of the lungs, known as pleura. This is caused by breathing in asbestos fibers into the lungs. This is the most common form of mesothelioma.

What is Pleural Mesuralelioma?

Pleural mesothelioma is a cancer of the pleural cavity, which is a thin membrane between the chest wall and the lung cavity. This specific disease is around 80% of all mesothelioma cases.

When the disease is called "malignant pleural mesothelioma," this means cancer and will spread. The average life expectancy of malignant pleural mesothelioma patients is between 11 and 20 months, with differences depending on how advanced the disease is and the treatments available.

Some patients have lived for some years because of the surgical techniques that have developed to eliminate malignant pleural mesothelioma from the body.

Causes of Pleural Mesothelioma

The only known cause of pleural mesothelioma is exposure to asbestos fibers. Asbestos products are commonly found in homes and businesses that were built before the 1980s. Occupational asbestos exposure is the most common cause of mesothelioma even though secondhand exposure can also occur.

When asbestos fibers are inhaled, they often travel to the lungs. But instead of going through the lungs, these fibers sometimes approach the pleural space, where cell mutation and cancer occur. Asbestos fibers are more likely towards the pleural space than other fibers that have mesothelial cells.

Pleura has two walls: parietal and visceral. Parietal lining lining the chest wall. Visceral layer lining the cavity of the lungs. Asbestos fibers, which are sharp, approach the narrow passageway and enter the parietal or visceral layer, each of which includes mesothelial cells.

While these cells often absorb unexpected particles, they struggle to remove asbestos fibers. An irritable substance can cause mesothelial cells in the pleura to mutate.

How Is Pleural Mesothelioma Treated?


There are two main surgical options for malignant pleural mesothelioma patients: extrapleural pneumonectomy and pleurectomy with decortication. The former removes the affected lung while the latter maintains this organ.


In 2019, chemotherapy drugs approved by the US Food and Drug Administration (FDA) for malignant pleural mesothelioma namely pemetrexed and cisplatin. Chemotherapy is often applied in combination with other treatment options.


Scientists are optimizing radiation techniques to specifically target tumors, leaving healthy lung tissue without injury. Radiation is the most non-invasive treatment option for this cancer and is also applied for palliative purposes.

Symptoms of Mesothelioma pleura

Pleural mesothelioma patients may experience symptoms such as fever, shortness of breath and persistent cough. While these symptoms are common to some diseases, people who interact with asbestos during their lives should consult a doctor.

Other symptoms of pleural mesothelioma include:

Pain in the lower back or chest components

Out of breath

Weight loss that cannot be described

Swelling of the face or arms

Fluid buildup in the pleural space



Trouble swallowing

Because mesothelioma is a rare cancer, ordinary doctors may not consider this disease as a possible diagnosis. Fortunately, researchers are studying more targeted methods for detecting and diagnosing mesothelioma.

Pleural Mesothelioma Diagnosis

The first step in diagnosing mesothelioma is an imaging experiment, such as an X-ray or computed tomography (CT) scan. If the results of the experiment determine the possibility of a cancerous tumor, the doctor will likely undergo a biopsy.

Biopsy involves taking small tissue samples to decide whether there are cancer cells. Biopsy also helps doctors determine the variety of cancers, cell histology, and possible stages of the disease (if the biopsy is a clear lymph node).

Doctors can also extract fluid samples to look for cancer cells. However, this method is less reliable compared to tissue biopsy.

Experiments also help determine whether a malignant disease or cancer is less dangerous.

Stage 1 - Tumors only exist in the pleural cavity, which is the origin of the disease. Cancer may have just developed and not have enough time to spread to other tissues. Detection at this stage is interesting but also difficult.

Stage 2 - Cancer is largely confined to the origin spot, but partly the involvement of the local clear lymph node begins. Malignant pleural mesothelioma can also begin to spread to the lung cavity and approach the nearby lungs.

Stage 3 - The disease is no longer localized, metastasizes to nearby lungs, diaphragm and more clear lymph nodes. Many patients first recognize their mesothelioma when they have already taken this stage.

Stage 4 - The cancer has spread far outside the pleura and has invaded the lung cavity, affecting the nearby lungs, diaphragm and possibly the heart. Many alternative treatments are not available because of how far mesothelioma is in Stage 4.

Surgery for Pleural Mesothelioma

Extrapleural pneumonectomy is the usual surgical treatment for malignant pleural mesothelioma. During EPP, a surgeon removes diseased lungs and pleura. The surgeon also removes the diaphragm and pericardium components, which are a protective layer around the heart.

The purpose of EPP is to eliminate as much as possible, if not all, of cancerous tissue. Mesothelioma tumors are microscopic, which is why removal of all cancers is a challenge for surgeons.

But, patients can undergo chemotherapy after their surgery to concentrate on the remaining tumors that still exist in the body. Applying chemotherapy after surgery is called adjunctive cancer treatment.

Chemotherapy can also be applied as a precautionary measure before surgery to shrink the tumor and make the operation more targeted. Applying chemotherapy before surgery is called neoadjuvant treatment.

David Sugarbaker perfected EPP. Until his death in 2018, he was one of the leading mesothelioma experts in the country.

Pleurectomy With Decortication (P / D)

Pleurectomy with decortication is an option for EPP. This is maximized for malignant pleural mesothelioma after EPP has been widely applied to treat disease.

P / D is most targeted for patients with early pleural mesothelioma because it can save their lungs. Surgery only involves removing the pleura, where a large number of cancers are located.

Some patients may need their pericardium and some of the diaphragm removed during P / D. When these two components are removed, this operation is called "extended pleurectomy with decortication." This extended operation was right on target when the cancer had spread outside the pleural space and covered the diaphragm and pericardium (but not the lungs).

Patients can also undergo chemotherapy before or after P / D to shrink or contain tumors or attack what remains that is not found during surgery.

Chemotherapy for Pleural Mesothelioma

Pemetrexed and cisplatin are two chemotherapy drugs that are FDA-approved for treating malignant pleural mesothelioma. These drugs are often given intravenously, like most chemotherapy treatments.

Patients can undergo hyperthermic intrapleural chemotherapy. This form of treatment involves the heat manifestation of chemotherapy drugs that are sent immediately to the pleural cavity or lung cavity, where instead doctors believe they should target to cleanse the body of tumors.

Radiation for Pleural Mesothelioma

Radiation alone is rarely curative for mesothelioma sufferers. This therapy can be used before or after surgery to reduce the size of the tumor before surgery or reduce the possibility of recurrence thereafter.

Doctors can also apply radiation to patients with severe, end-stage pleural mesothelioma to help relieve the pain caused by fluid buildup or tumor pressure. This therapy can shrink the tumor, which should relieve pressure on the chest and lungs.

Not every patient gets the same type of chemotherapy and radiation. Mesothelioma experts can provide their patients with a special treatment agenda.