Pleural Mesothelioma

Is an asbestos-related cancer that attacks the two linings which surround the lungs and the chest cavity. These linings are known as the pleura, which cushions and protects the lungs while you breathe in and out. Pleural Mesothelioma is the most common type of mesothelioma as it accounts for 3 out of 4 (75%) of all mesothelioma diagnoses.

Dr. Meso Explaining Pleural Mesothelioma CT Scan

The reason for this is because the tiny asbestos fibers are more easily inhaled in comparison to being ingested (which tends to lead to other forms of mesothelioma). Once inhaled, the small asbestos fibers become lodged into the pleura and with these fibers now present, they begin to disrupt natural cell growth within the pleura. Learn more about the histology of mesothelioma.

Pleural mesothelioma is often difficult to detect and currently a CT scan of the chest is the best way for assessing how far the disease has progressed. Many cancers are diagnosed by serum markers, however, mesothelioma cannot be diagnosed this way as currently no serum markers exist.

Causes of Pleural Mesothelioma

Almost every patient that is diagnosed with pleural mesothelioma has come into contact with asbestos at some point. Asbestos is a mineral that occurs naturally in other minerals and rocks. Originally, it was admired by contractors for to its fire retardant and unique insulating capabilities.

In most cases, asbestos exposure occurs when the asbestos containing material is loosened or disturbed. This leads to the release of asbestos fibers by the material into the air.

Asbestos causes pleural mesothelioma when:

  • A person inhales asbestos fibers and ingest them.
  • The body tries to remove the microscopic fibers but they get stuck within the protective lungs’ lining.
  • The trapped asbestos fibers cause irritation to the mesothelioma cells leading to genetic mutations and eventual development of tumors.

Basically, cell division is affected by the genetic mutations that are caused by asbestos fibers. This leads to the development of mesothelioma tumors.

Risk Factors

Development of pleural mesothelioma is attributed to numerous risk factors. These are factors that increase the risk of developing pleural mesothelioma.

They include:

  • Occupation
  • Asbestos type
  • Working conditions
  • Exposure frequency or duration
  • Breathing rate during the exposure
  • Weather
  • Past illness of the lungs
  • Exposure concentration

Work history is among the major factors that are involved in most cases of asbestos exposure. Nevertheless, occupational exposure poses a lesser threat now compared to past years. This is due to the permissible exposure limits standards and regulations that have been adopted in most countries. However, asbestos exposure risk remains high in working conditions that do not meet these standards.

How People Are Commonly Exposed

  • Occupationally

This was the most common form of asbestos exposure. Individuals in industrial occupations worked with construction materials that had asbestos before the material was banned. Shipyard workers and electricians were among the individuals who suffered occupational asbestos exposure most.

  • Naturally

Since this mineral occurs naturally, individuals who lived close to asbestos deposits were exposed to it through mining projects and water run-off. Nevertheless, this was a rare form of asbestos exposure.

  • Secondhand exposure

Secondhand asbestos exposure occurred when individuals who worked on occupations using materials that had asbestos inadvertently exposed the occupants of those occupations or buildings. Asbestos fibers on clothes and hair would also be transferred to individuals who were not working on asbestos materials directly. Such individuals included family members of the workers.

 

Pleural Mesothelioma Symptoms

Mesothelioma in general is difficult to diagnose because there are no real symptoms in the early stages. Furthermore, once symptoms do start to develop, they are often mistaken for common illnesses.  Early symptoms include coughing, muscle weakness, night sweats, fever, and fatigue. Unfortunately, early symptoms go undiagnosed or misdiagnosed until further warning signs become apparent from more serious symptoms. It is important to see your doctor if you have or develop any of these symptoms listed above, especially if you have also been exposed to asbestos in the past.

Symptoms of pleural mesothelioma

  • Shortness of breath
  • Fatigue
  • Chest pain
  • Unexplained weight loss
  • Persistent cough
  • Sweating
  • Hoarse voice
  • Difficulty swallowing
  • Changes in shape of fingers/nails

Advanced Stages Of Mesothelioma Symptoms

  • Nerve problems in arm
  • Bone pain
  • Horner’s syndrome
  • Hypoglycemia

Mesothelioma symptoms often don’t emerge until about 20 to 50 years after initial exposure, and the symptoms do not appear until the disease has progressed into advanced stages. Pleural mesothelioma is the only type of this cancer that is classified into stages.

Pleural Mesothelioma Stages

The staging for pleural mesothelioma is different from peritoneal (abdominal) mesothelioma. Doctors use four stages to describe how mesothelioma grows. Patients in stage 1 or 2 have the most treatment options. Patients with stage 3 or 4 can use palliative treatments or alternative therapies to improve their quality of life.

Stage 1 Pleural Mesothelioma

The least serious stage is stage l.  No lymph node involvement, and the patient usually qualifies for extrapleural pneumonectomy.  This surgery attempts to remove the tumor and as much of its growth as possible. Highest rate of survival.

Stage 2 Pleural Mesothelioma

In stage ll, the tumor has become larger and it has invaded the diaphragm or the lung. Lymph nodes may now be involved. Doctors may mistake the signs of this stage of mesothelioma for other illnesses, such as the flu.  Patients at this stage have likely lost weight but still feel bloated. Surgical resection may still be possible

Stage 3 Pleural Mesothelioma

In Stage lll, the mesothelioma has now invaded an area of the chest wall or other region such as the esophagus, chest wall or the lymph nodes. At this time surgery is usually ruled out as a beneficial treatment.  Patient usually will be suffering from sever chest pains along with discomfort throughout the body.

Stage 4 Pleural Mesothelioma

Stage lV mesothelioma has now invaded multiple areas of the body including the diaphragm, pericardium, lymph nodes and other organs. The cancer may also be present in the bloodstream, liver, or bones as well. Surgical option is no longer feasible. Chemotherapy & radiation treatments are now used to extend the life of the patient and provide symptom relief.

Pleural mesothelioma, pericardial, peritoneal and testicular mesotheliomas do not share a universal staging system. These diagnoses are rare and there are not enough cases to accurately describe them using stages.

Patients diagnosed with peritoneal or pericardial mesothelioma are usually categorized as having localized or advanced mesothelioma. A mesothelioma doctor with experience treating mesothelioma can determine how far the cancer has spread and what treatment options will work best.

Learn more about the Stages Of Mesothelioma.

Top 10 Best Mesothelioma Cancer Centers

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Traditional Pleural Mesothelioma Treatments

Surgery Options For Pleural Mesothelioma

Surgery to remove the mesothelial lining of the lung and chest cavity.

A procedure that uses drugs or chemicals in order to make a scar between the layers of the pleura. Fluid is drained from the space first with a chest tube, then the chemical is put into that space. The subsequent scarring will stop the buildup of fluid inside the pleural cavity.

Surgery that removes a whole lung and some of the lining of the diaphragm, chest and the sac that is around the heart.

Surgery to remove all or part of a lung.

Also known as pleuroscopy, this is a procedure where a thoracoscope is introduced through a tiny incision in the chest. Through other small incision, an endoscope is inserted to obtain internal images and videos. When surgeons perform thoracoscopy to aid another surgery, it is termed as video-assisted thoracoscopic surgery or VATS.

This is an extensive surgical procedure that exposes the patients’ lungs, heart, diaphragm, and trachea to the doctor. It is a 4 to 10-inch long incision made on any side of the chest. It helps the doctor to perform wedge resection, lobectomy, pneumonectomy, segmentectomy, extrapleural pneumonectomy and pleurectomy/decortication like major surgical treatments to manage the lung cancer.

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Top Pleural Mesothelioma Specialists

Dr. Bueno

Brigham and Women’s Hospital

75 Francis Street

Boston, MA 02115

(617)732-8148

Dr. Joseph S. Friedberg

Penn Presbyterian Medical Center

Wright-Saunders Building, Suite 266

51 North 39th Street

Philadelphia, PA 19104

(215) 662-9195

Dr. David Harpole, Jr.

Duke Cancer Institute

2424 Erwin Road, Suite 403

Durham, NC 27705

(919) 668-8413

Dr. Raffit Hassan

Center for Cancer Research/National Cancer Institute

Building 37, Room 5116

Bethesda, MD 20892

(301) 451-8742

Dr. Raja M. Flores

Mount Sinai Medical Center

One Gustave L. Levy Place

New York, NY 10029

(212) 241-9466

Robert B. Cameron, M.D.

Cardiothoracic Surgery and Surgical Oncology

Medical Treatment Center:

UCLA Jonsson Comprehensive Cancer Center

757 Westwood Plaza, Los Angeles, CA 90095

310-267-4612

 

Abraham Lebenthal, M.D.

Pleural Mesothelioma

Brigham and Women’s Hospital, Boston

VA Boston Healthcare System

75 Francis Street
Boston, MA

Last Modified:Apr 14, 2017 @ 12:05 am

Sources:

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  • Robinson, Benjamin M. “Malignant pleural mesothelioma: an epidemiological perspective.” Annals of Cardiothoracic Surgery. 2012 Nov; 1(4): 491–496. Doi: 10.3978/j.issn.2225-319X.2012.11.04. PMCID: PMC3741803
  • National Comprehensive Cancer Network. (2014). Malignant Pleural Mesothelioma NCCN Guideline for Patients. Retrieved from http://www.nccn.org/patients/guidelines/mpm/#38
  • Cafarotti, S., Porziella, V., Margaritora, S., Granone, P. What is the best way to diagnose and stage malignant pleural mesothelioma? (2011). Interact CadioVasc Thorac Surg. 2011; 12(5): 811. doi: 10.1510/icvts.2010.255901A
  • Zauderer, M., Krug, L. The evolution of multimodality therapy for malignant pleural mesothelioma. Curr Treat Options Oncol. 2011; 12(2): 163-172. doi: 10.1007/s11864-011-0146-4
  • Kaufman, A., Flores, R. Surgical treatment of malignant pleural mesothelioma. Curr Treat Options Oncol. 2011; 12(2): 201-216. doi: 10.1007/s11864-011-0154-4
  • Dodson, R., Hammar, S. Asbestos: Risk Assessment, Epidemiology, and Health Effects. Taylor & Francis: Boca Raton; 2011.
  • Pass, I., Vogelzang, N., Carbone, M. Malignant Mesothelioma: Advances in Pathogenesis, Diagnosis, and Transitional Therapies. Springer: New York; 2005.
  • Robinson, B., Lake, R. Advances in Malignant Mesothelioma. N Engl J Med. 2005; 353: 1591-1603. Retrieved from http://www.accg.org.br/uploads/arquivos/60a8f968b51a724580704995fcfd39c7.pdf
  • Miles, Susan E. “Clinical consequences of asbestos-related diffuse pleural thickening: A review.” Journal of Occupational Medicine and Toxicology. 2008; 3:20. DOI:
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