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    Understanding Pleural Mesothelioma

    If you’ve been diagnosed with pleural mesothelioma, you want to know where you can find the best treatment options and ways to improve life expectancy. Our Pleural Mesothelioma Guide is a complete and trusted resource providing valuable information, answers, and more — for free.

    Learn about the top treatment options for your diagnosis and how others have improved life expectancy.

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    Pleural Mesothelioma

    Pleural mesothelioma is caused by inhaling asbestos fibers that get lodged into the protective lining of the lungs (the pleura) which cause genetic mutations in the surrounding cells. Pleural mesothelioma makes up approximately 75 percent of all mesothelioma cases, meaning specialists have more opportunities to develop new treatments each year. As a result, pleural mesothelioma patients commonly have the most available treatment options.

    Why does your diagnosis matter?

    An accurate diagnosis is important because pleural mesothelioma can vary by stage and cell type, both of which affect treatment options.

    What treatments are available?

    Most pleural mesothelioma patients are prescribed chemotherapy and/or radiation to help slow down the spread of aggressive mesothelioma cells. But surgical options such as a pleurectomy often offer the best chance for a longer survival time.

    What is the prognosis for this disease?

    Depending mostly on factors like the stage the disease was diagnosed and the patient’s overall health, the prognosis for pleural mesothelioma is typically just over a year. However, patients using novel treatments have lived for years with the disease.

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    Diagnosing Pleural Mesothelioma

    Because its symptoms are nonspecific, meaning the symptoms also appear in many other conditions, pleural mesothelioma can be difficult to diagnose. 

    Pleural mesothelioma has similar symptoms as more common respiratory conditions such as pneumonia or chronic obstructive pulmonary disease (COPD). Even under a microscope, doctors can have a hard time distinguishing between pleural mesothelioma and other cancers. That’s why tests are run to confirm the location, cancer stage, and cell type of the mesothelioma.

    Doctors rely on your diagnosis to determine the type of treatment you receive, which is why they often won’t perform a surgical operation on a later stage patient. It’s always a good idea to get a second opinion from another mesothelioma specialist in order to confirm a diagnosis and expand your treatment options.


    A biopsy is one of the more accurate ways to diagnose mesothelioma. The procedure involves taking a small fluid or tissue sample that provides important information like the cell type of the mesothelioma. Using that information, doctors then create the most effective treatment plan for your diagnosis.

    Diagnostic Imaging Tests

    X-ray and CT scans are diagnostic imaging tests which examine the chest area to locate and stage abnormal-looking masses or growths that may be tumors.
    Common imaging tests doctors use to start a diagnosis include:
    • X-ray
    • Magnetic resonance imaging (MRI)
    • Computerized tomography (CT) scan
    • Positron emission tomography (PET) scan

    Symptoms of Pleural Mesothelioma

    Primarily affecting the respiratory system, pleural mesothelioma symptoms impact the airways, lungs, and breathing muscles. Caused by excess fluids (pleural effusion) in the lining of the lungs, some of the first signs a patient may feel are a persistent cough and shortness of breath.

    Other symptoms felt by patients with pleural mesothelioma include:

    • Shortness of breath
    • Chest pains
    • Dry cough
    • Weight loss

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    Treating Pleural Mesothelioma

    Standard treatment options for pleural mesothelioma include surgery, chemotherapy, and radiation therapy. Multimodal therapy, a combination of two or more of these treatments, has been shown to significantly improve the life expectancy of pleural mesothelioma patients.

    Surgical Treatments for Pleural Mesothelioma

    Extrapleural Pneumonectomy (EPP)

    The extrapleural pneumonectomy (EPP) is one of the most effective surgeries available to patients with pleural mesothelioma because it removes:

    • 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

    The EPP is believed to be the best chance of removing mesothelioma from the body. But because it’s a major invasive procedure, you must be in good overall health and be able to recover from it before your doctor will recommend it. Despite the risk, researchers in several studies have shown the EPP provides significant reward. One study published in the Journal of Thoracic Oncology reported the median survival rate for patients who received the EPP was more than double the average mesothelioma survival rate.

    Pleurectomy with Decortication (P/D)

    The pleurectomy/decortication (P/D) is a less invasive, lung-sparing alternative to the EPP that consists of two surgical techniques:

    • Pleurectomy – where surgeons remove the protective lining of the lung on which the tumor is growing
    • Decortication – where surgeons remove visible tumors on and around the diseased lung

    The P/D has produced survival rates equal to and sometimes better than those of the EPP.


    Pleurodesis is a palliative surgery which eases the pain and pressure caused by a pleural effusion, a fluid buildup in the chest. Pleural effusions build up between the inner and outer pleural linings and inhibit lung and chest expansion. This procedure involves inserting a hollow tube into the chest wall, draining the excess fluid through the tube, and relieving pressure in the lungs and chest. It’s been proven effective in helping patients breathe easier and reducing overall chest pain.

    Chemotherapy for Pleural Mesothelioma

    A chemotherapy drug may be used by itself or combined with other chemotherapy drugs to enhance their effects. The first notably successful combination of chemotherapy drugs for mesothelioma, Alimta and Cisplatin, increased the survival time of patients by an average of 3 months. Chemotherapy is also combined with surgery, either before (neoadjuvant), during (intraoperative) or after (adjuvant), to improve survival rates. Using a combination of surgery and heated chemotherapy has been proven to help patients survive for 35 months.


    Radiation Therapy for Pleural Mesothelioma

    Radiation is used as a palliative treatment, or in combination with chemotherapy and surgery, to shrink pleural mesothelioma tumors. This combination produced an average life expectancy of 33 months — almost 3 times the average of most patients with pleural mesothelioma.

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    The 4 Stages of Pleural Mesothelioma

    Determining the stage of the mesothelioma, which describes how far it’s spread from where it first appeared in the lining of the lung, helps doctors decide which treatment options are available to you. Those with stage 1 or stage 2 pleural mesothelioma will have more available treatment options.


    The Stages of Pleural Mesothelioma
    • 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.

    Improving Your Prognosis

    Pleural mesothelioma patients tend to have more available treatment options than patients diagnosed with peritoneal or pericardial mesothelioma. Because it’s the most common form of the disease, more doctors have seen and treated it compared to other forms of mesothelioma.

    Your prognosis depends on a number of factors including:

    • Cancer stage
    • Cell Type
    • Age
    • Overall health (heart, kidneys, etc.)

     The two biggest factors in your prognosis are the cell type and cancer stage of the mesothelioma. 

    If your diagnosis reveals the epithelioid cell type, you’ll likely have a better prognosis as they typically don’t spread as quickly as other cell types and often respond better to treatment. Also, stage 1 or stage 2 pleural mesothelioma patients have more treatment options available because early-stage pleural mesothelioma hasn’t spread far from the lining of the lung and is easier for doctors to surgically remove.