Pleural mesothelioma infographic showing Parietal Pleural (Outside Layer), Visceral Pleural (Covers Lungs), Pleura Space (Between Visceral and Parietal Pleura), Asbestos Fibers, Organ Lining of Tissue and Plaque Forms in Pleura

What Causes Pleural Mesothelioma?

Pleural mesothelioma is caused by exposure to cancer-causing asbestos, which was used extensively in the past in several commercial, residential, and military applications. This rare cancer occurs when tiny asbestos fibers are inhaled and lodged in the lungs and chest lining. Over time, these fibers cause inflammation and scarring within the pleural lining. Eventually, the cells of the mesothelium can mutate and form malignant tumors.

Although rare, pleural mesothelioma is the most common type of mesothelioma, accounting for between 70 and 90 percent of mesothelioma cases annually. Understanding the cause of this disease is crucial, especially if you or a loved one has been diagnosed. Keep reading to learn about the symptoms of pleural mesothelioma, how it is diagnosed, the procedures involved, and the staging of the disease. This information can help you better understand the journey ahead and empower you to make informed decisions about your health or the health of someone you care about.

What Are the Symptoms of Mesothelioma?

The most common symptoms of pleural mesothelioma are chest pain and shortness of breath. These symptoms are often accompanied by pleural effusion, a buildup of fluid around the lungs that increases discomfort and makes breathing difficult. Other indicators include anemia, difficulty swallowing, fatigue, fever, a persistent dry cough, and weight loss. If you experience any of these symptoms, especially if they persist or worsen, it is crucial to consult a healthcare professional.

  • Anemia
  • Difficulty swallowing
  • Fatigue
  • Fever
  • Persistent dry cough
  • Weight loss

Unlike other mesothelioma types, pleural mesothelioma symptoms often mimic those of common respiratory conditions, making diagnosis challenging. As a result, it’s frequently mistaken for asthma, COPD, emphysema, influenza, laryngitis, lung cancer, pneumonia, pulmonary fibrosis, synovial sarcomatoid carcinoma, or tuberculosis. If you are experiencing any of the symptoms above, talk to your doctor right away, especially if you know or suspect that you’ve been exposed to asbestos.

How Is Pleural Mesothelioma Diagnosed?

Pleural mesothelioma usually takes decades to manifest [1]; the average age at the time of diagnosis is 69. The period between the original asbestos exposure and when symptoms begin to appear is called the latency period. Unfortunately, the tumors have likely begun to spread by this time, so you must visit your doctor as soon as symptoms appear. Be sure to share any history of asbestos exposure with them. This can assist in the diagnostic process, especially since mesothelioma is rare and the symptoms often mirror other illnesses’ symptoms.

Blue drawing of an x-ray machine with ribs on the screen

Imaging tests

The diagnostic process for mesothelioma generally starts with a series of imaging tests, including chest X-rays, CAT scans, PET scans, and MRIs. Pleural thickening, fluid buildup/pleural effusions, tumors, and irregularities in lung size are usually visible with these imaging tests, which can also illustrate the size of the tumors and the extent to which they have spread.

Cartoon drawing of a blue test tube with a heart next to it

Blood tests

Blood tests such as MesoMark® are used to test for the presence of mesothelin-related proteins, which can indicate mesothelioma. Your doctor may also test for cancer antigen 125, a protein biomarker found in large concentrations of cancer cells, and fibulin-3, another biomarker. The fibulin-3 blood test can help distinguish between mesothelioma and other lung diseases.

Simple blue drawing of a scalpel and surgical scissors


If fluids are present in the chest cavity, your doctor may take samples for cytology or fluid analysis. A tissue biopsy is often the last step in the process and is the only definitive way to diagnose pleural mesothelioma. Biopsies are helpful for understanding what cell type is present in the tumor: epithelioid, sarcomatoid, or biphasic — a combination of the two. This information is essential for establishing a treatment plan.

Procedures for Diagnosing Pleural Mesothelioma

Diagnosing pleural mesothelioma can be challenging because its symptoms often resemble those of other conditions. A multifaceted diagnostic approach is necessary to accurately identify this rare cancer. This area will walk you through the essential procedures used to uncover pleural mesothelioma, clarifying each step of the diagnostic process. Understanding these methods can help you or your loved one navigate the path to a definitive diagnosis and ensure you receive the most appropriate care.

Cartoon drawing of the lungs with one lobe gone and outlined by dashes

Pleural Biopsy

Pleural biopsy is the gold standard method for establishing the diagnosis of mesothelioma. This biopsy is performed on patients experiencing fluid buildup — pleural effusion — between their lungs and chest. A needle is inserted into the chest cavity to collect a sample of the pleural fluid and tissue to check for the presence and extent of mesothelioma.

Easy drawing of procedure using a needle to remove fluid from the lungs


Thoracentesis is a procedure used to remove excess fluid from the pleural space between the lung and chest wall, which can cause breathing difficulties and chest pain. A needle is inserted into the chest cavity to collect a fluid sample for analysis, helping to identify the cause of the effusion, such as infection or cancer, including mesothelioma. Additionally, thoracentesis can provide immediate relief from shortness of breath and discomfort, enhancing the patient’s quality of life.

This is an image of a camera biopsy tool.


Thoracoscopy is a procedure where a camera-equipped, thin tube is inserted into the chest cavity to provide a clear view of the internal area. This allows doctors to accurately take diagnostic samples and remove excess fluid, aiding in both the diagnosis and treatment of various chest conditions.

Drawing of an xray machine with ribs on the screen


This camera-assisted biopsy procedure allows doctors to examine the mediastinum (the space behind the breastbone) to see if the mesothelioma has spread to the lymph nodes there. By obtaining tissue samples from this region, the procedure helps in assessing the extent of cancer spread, which is crucial for staging and planning treatment. This approach provides valuable information for developing an effective treatment strategy and managing the disease more accurately.

Cartoon drawing of crossed surgical scissors and a scalpel.


Thoracotomy is a highly invasive surgical procedure used to obtain a sample of a tumor from the chest cavity for diagnostic analysis. Additionally, it serves as a treatment option, allowing surgeons to remove as much of the tumor as possible to help manage the disease. This approach provides a comprehensive view of the tumor and surrounding tissues, which is critical for accurate diagnosis and effective treatment planning.

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Staging Pleural Mesothelioma

Like most cancers, pleural mesothelioma is staged from 1 to 4. Since the other types of mesothelioma (peritoneal and pericardial) are so rare, this is the only type with a formal staging system. In fact, there are three recognized staging systems for pleural mesothelioma: the TNM staging system (which stands for Tumor, Node, and Metastasis), the Butchart staging system, and the Brigham staging system.

Most doctors stage pleural mesothelioma using the TNM system, which was developed by the American Joint Committee on Cancer. The TNM system stages the cancer based on the size and extent of the tumor (T-tumor), whether the cancer has reached the lymph nodes (N-node), and the presence and extent of metastasis to other parts of the body (M-metastasis).

TNM Staging System for Pleural Mesothelioma

The Butchart and Brigham staging systems are older than the TNM system but are both still used for staging pleural mesothelioma in some cases. The Butchart System is based mainly on the location of the primary tumor, while the Brigham system stages cancer based on whether it has spread to the lymph nodes and whether the tumor can be removed via surgery. In Stage 1, the tumor is confined to its original location with no involvement of the lymph nodes or metastasis to other parts of the body. Stage 2 sees the tumor remain on one side of the body but extend into the pleura, diaphragm, and/or lung, with possible involvement of nearby lymph nodes but no observed metastasis.

Stage 3 involves further tumor extension into the pleura, diaphragm, lung, chest wall, thoracic fascia, heart sac, and/or mediastinal fat, with affected lymph nodes and potential spread to nearby organs. In Stage 4, the tumor has spread beyond its original site and is no longer operable, with possible metastasis to distant lymph nodes and other organs throughout the body.

Pleural Mesothelioma Prognosis

The prognosis for pleural mesothelioma depends on a number of factors, such as stage and cell type, as well as the patient’s age and overall health. Patients with early-stage pleural mesothelioma may undergo surgery, chemotherapy, radiation, and other treatment procedures in an effort to eradicate the cancer and significantly extend life expectancy. However, because this type of mesothelioma is usually diagnosed at a later stage, these curative treatments may not be an option for every patient. In these cases, palliative care is deployed to maintain the patient’s quality of life. The average life expectancy for pleural mesothelioma patients is between 8 and 21 months.

Treating Pleural Mesothelioma

Treating pleural mesothelioma typically requires a comprehensive approach, known as a multimodal treatment plan, which combines several therapeutic strategies to address the disease effectively. This plan often includes surgery to remove as much of the tumor as possible, chemotherapy to target and kill cancer cells throughout the body, and radiation therapy to shrink tumors and alleviate symptoms. Additionally, immunotherapy may be employed to enhance the body’s immune response against cancer cells, while clinical trials offer access to cutting-edge treatments and innovative therapies that are not yet widely available. By integrating these diverse methods, the goal is to maximize treatment effectiveness, manage symptoms, and improve overall patient outcomes.

Surgery for Pleural Mesothelioma

There are two main surgical options for early-stage pleural mesothelioma patients: pleurectomy with decortication, in which the linings of the lung and chest are removed, along with any visible tumors, and extrapleural pneumonectomy, in which the entire affected lung, the pleural linings of the lung and heart, and portions of the diaphragm are removed.

If these curative surgical treatments are not available, palliative surgical procedures may be used to remove fluid that has built up around the lungs to make breathing easier and less painful. These include thoracentesis (also called a pleural tap), in which a doctor uses a needle to remove excess fluid from around the lungs, and pleurodesis, a procedure that closes the space between the outer lining of the lung and the chest wall to prevent fluid buildup around the lungs in the future.

Chemotherapy for Pleural Mesothelioma

Pleural mesothelioma patients often undergo chemotherapy either before surgery to shrink the tumors or afterward to destroy any remaining cancer cells. The most common chemotherapy treatment for this type of mesothelioma is a combination of ALIMTA® and cisplatin. Chemotherapy may also be used instead of surgery as an aggressive curative treatment or as a palliative treatment to improve the quality of life for late-stage patients by slowing the growth and spread of the tumors. If for palliation, a third agent called Avastin is usually added to the combination of cisplatin and ALIMTA.

Advanced Treatment Options: Radiation and Immunotherapy

Radiation for pleural mesothelioma can be administered before or after surgery to shrink tumors and minimize cancer spread. It also serves as a palliative treatment, helping to alleviate symptoms such as chest pain and breathing difficulties. Additionally, immunotherapy is increasingly becoming a standard part of treatment for pleural mesothelioma, as it boosts the body’s immune system to target and attack malignant cancer cells.

Get Connected to Essential Pleural Mesothelioma Resources

If you or a loved one is dealing with pleural mesothelioma, accessing the right treatment and legal support is crucial. Please fill out the form below to connect with dedicated professionals who can provide personalized assistance and guidance. Our network of experts is here to help you navigate your treatment options and explore legal resources tailored to your needs. Don’t face this journey alone—reach out today to get the support you deserve.

If you or a loved one is dealing with pleural mesothelioma, accessing the right treatment and legal support is crucial. Please fill out the form below to connect with dedicated professionals who can provide personalized assistance and guidance. Our network of experts is here to help you navigate your treatment options and explore legal resources tailored to your needs. Don’t face this journey alone—reach out today to get the support you deserve.


Video Transcript


“My theory behind it is, you inhale these asbestos fibers, and they stick out of the lung. Every time you take a breath, those asbestos fibers are scraping on the parietal pleura. And whenever you have scarring, inflammation, that tends to be a precursor for cancer. So the way I look at mesothelioma is, it’s like a “scar gone wild.” You have these asbestos fibers that continue to rub on the inner surface of your chest wall, and it causes scarring, which precipitates inflammation, and little by little, you get these mutations in the genes that will lead to the development of this malignancy.” – Dr. Raja Flores

Mesothelioma Support Team

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