Pleural Mesothelioma


What is pleural mesothelioma?

Pleural mesothelioma is a rare cancer that grows around the lungs and chest. Asbestos exposure causes most cases. Malignant (cancerous) pleural mesothelioma forms in the pleura. This thin tissue membrane lines the walls of the chest and covers the lungs.

The condition gets its name from the mesothelium, a lining that protects your internal organs. The mesothelium produces a lubricant that keeps organs from sticking together. Cancer that forms in any part of the mesothelium is called mesothelioma.

How common is pleural mesothelioma?

Approximately 3,000 Americans receive a mesothelioma diagnosis every year. Pleural mesothelioma accounts for 3 out of 4 of these cancers.

What is asbestos?

Asbestos is the name for a group of strong natural mineral fibers that are fire- and chemical-resistant. Builders and manufacturers have used asbestos for years. The fibers are in shingles, floor tiles and ceilings in many homes. Manufacturers use asbestos in automotive brake pads and linings, among many other uses. Asbestos fibers are only harmful when they’re airborne. Undisturbed asbestos products generally aren’t dangerous.

Who is at risk for pleural mesothelioma?

Asbestos naturally occurs in air, water and soil. Almost everyone breathes in small amounts of asbestos throughout their lives. This slight exposure doesn’t increase your risk of cancer.

Most people who develop pleural mesothelioma have had high levels of asbestos exposure over a long time. Typically, these exposures occur while on the job.

Professions most at risk for asbestos exposure include:

  • Automotive, factory and railway workers.
  • Building renovators and demolition crews.
  • Construction workers and builders, including shipbuilding.
  • Firefighters.
  • Insulation manufacturers and installers.
  • Miners.
  • Plumbers.

Symptoms and Causes

What causes pleural mesothelioma?

For eight in 10 people who have pleural mesothelioma, asbestos exposure is the cause. But most people who have been exposed to asbestos never develop mesothelioma. Rarely, high levels of radiation — such as treatment for another cancer — can cause pleural mesothelioma.

Airborne asbestos fibers break down into tiny particles too small to see. When you breathe them in, the particles settle in your lungs. These particles can cause scarring and inflammation. In some cases, they cause cell changes that lead to cancer.

Intact materials containing asbestos are safe. Asbestos only poses a health risk when disturbing the material releases the fibers into the air.

What are the symptoms of pleural mesothelioma?

It can take 30 to 50 years for pleural mesothelioma to develop after asbestos exposure. Early signs of pleural mesothelioma can be bothersome but easy to dismiss. The main indications are ongoing chest pain and shortness of breath.

Other symptoms include:

Diagnosis and Tests

How is pleural mesothelioma diagnosed?

Your healthcare provider will perform a physical exam, review your medical history and assess risk factors. You may get one or more of these tests:

  • Blood tests to check for high levels of substances (fibulin-3 and soluble mesothelin-related peptides) often linked to mesothelioma.
  • Chest X-rays to look for lung changes, such as thickening in the pleura or pleural effusion (fluid between the lungs and chest wall).
  • Imaging tests, such as an MRI, CT scan or positron emission tomography (PET) scan to check for signs of cancer.
  • Pleural fluid cytology and biopsy to check fluid in the chest and tissue for cancer cells.

Management and Treatment

What are the complications of pleural mesothelioma?

Pleural mesothelioma increases the risk of pleural effusion. This condition occurs when fluid builds up between the lungs and chest wall. You may struggle to breathe.

Your healthcare provider may perform a procedure called a thoracentesis to drain the fluid. Your provider inserts a thin needle into the space between the lungs and chest wall to remove fluid. Some people need a catheter (thin hollow tube) to continually drain the fluid.

How is pleural mesothelioma managed or treated?

Pleural mesothelioma is difficult to treat because it isn’t a solid tumor. The disease can spread along nerves, blood vessels and tissues.

Treatments may include:

  • Surgery (pleurectomy): A surgeon removes part or all of the pleura. Sometimes, the surgeon also removes the diseased lung.
  • Chemotherapy: Chemotherapy can shrink the cancer or slow its growth.
  • Immunotherapy: Immunotherapy treatments are now approved and can also shrink cancer or slow its growth.
  • Thoracentesis or catheters: These treatments remove excess fluid from the chest to ease breathing. They can reduce symptoms, but they don’t treat the cancer.
  • Clinical trials: Several therapies show promise in clinical trials. For example, targeted therapy harnesses specific immune-system elements to attack genes and proteins in cancer cells. Talk to your provider to see if you might benefit from a therapy still in development.


How can I prevent pleural mesothelioma?

Since the late 1970s, the Environmental Protection Agency (EPA) has regulated the use of asbestos in building materials. EPA also regulates the cleanup of asbestos-containing materials. Many homes, buildings, cars and products made before 1980 are still likely to have asbestos.

Workers at risk for asbestos exposure should wear protective gear to prevent breathing in asbestos. It’s also important to avoid getting the particles on clothing, hair and shoes.

Before you remodel an older home, have an asbestos abatement expert check your home. Removing asbestos in ceilings or walls is unnecessary if you aren’t disturbing those parts of the home. If you plan to take out a wall or drill into a surface that has asbestos, you need to hire an asbestos abatement company to do the job. You should never try to remove materials containing asbestos yourself. This step is important to protect your family’s health.

Outlook / Prognosis

What is the prognosis (outlook) for people who have pleural mesothelioma?

There isn’t a cure for pleural mesothelioma. Treatments can provide longer life, relieve symptoms and help you stay more comfortable. You can also try therapies that show promise in clinical trials.

Unfortunately, for most people with pleural mesothelioma, life expectancy is one to four years after diagnosis.

Living With

When should I call the doctor?

You should call your healthcare provider if you’re at risk for pleural mesothelioma and experience:

  • Back or chest pain.
  • Chronic cough or hoarseness.
  • Difficulty breathing or swallowing.
  • Facial swelling.
  • Unexplained weight loss.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

  • Has the cancer spread?
  • What is the best treatment for me?
  • How can I manage symptoms or treatment side effects?
  • Should I look out for signs of complications?

A note from Cleveland Clinic

Asbestos exposure is the top cause of pleural mesothelioma. Still, most people who have been exposed to asbestos at work or home don’t develop this cancer. If you have a known asbestos exposure, it’s especially important to be familiar with disease symptoms. Finding out you have pleural mesothelioma can be difficult. The disease has no cure. Your healthcare provider can discuss treatment options with you.

Last reviewed by a Cleveland Clinic medical professional on 12/18/2020.


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