Pleural Mesothelioma
Lining of the lungs (pleura) — Approximately 75% of all mesothelioma cases
Overview
Pleural mesothelioma is the most common form of this aggressive cancer, developing in the thin membrane (pleura) that surrounds the lungs. It is almost exclusively caused by inhaling asbestos fibers, which become lodged in the pleural tissue and cause cellular damage over decades.
When asbestos fibers are inhaled, they can travel deep into the lungs and embed themselves in the pleural lining. Over time — typically 20 to 50 years — these fibers cause chronic inflammation, DNA damage, and ultimately malignant cell growth. The pleura consists of two layers: the visceral pleura (attached to the lungs) and the parietal pleura (lining the chest wall). Mesothelioma typically begins in one layer and can spread to the other, eventually encasing the lung and restricting breathing.
The disease is staged from I to IV, with earlier stages offering more treatment options and better prognoses. Stage I disease is confined to one side of the pleura, while Stage IV indicates the cancer has spread to distant organs. Unfortunately, because early symptoms mimic common respiratory conditions, most patients are diagnosed at Stage III or IV.
Symptoms
- • Persistent dry cough or wheezing
- • Shortness of breath, even during rest
- • Chest pain or tightness, often under the rib cage
- • Unexplained weight loss and fatigue
- • Lumps of tissue under the skin on the chest
- • Difficulty swallowing (dysphagia)
- • Pleural effusions (fluid buildup around the lungs)
- • Night sweats and fever
Diagnosis
- • Chest X-ray and CT scan to identify pleural thickening or fluid
- • PET scan to determine if cancer has spread
- • Thoracoscopy (camera-guided examination of the chest cavity)
- • Pleural biopsy — the definitive diagnostic procedure
- • Blood tests for biomarkers like mesothelin (SMRP)
- • Pulmonary function tests to assess breathing capacity
- • MRI for detailed soft tissue imaging
Prognosis
Median survival is 12–21 months after diagnosis, though some patients with early-stage disease who receive aggressive treatment have survived 5 years or more. Prognosis depends on the cell type (epithelioid has the best prognosis), stage at diagnosis, patient age and overall health, and treatment approach.
Treatment Options
- • Extrapleural pneumonectomy (EPP) — removal of the affected lung, pleura, diaphragm, and pericardium
- • Pleurectomy/decortication (P/D) — lung-sparing surgery that removes the pleura and visible tumors
- • Chemotherapy, typically with pemetrexed (Alimta) and cisplatin combination
- • Radiation therapy, often used after surgery to kill remaining cancer cells
- • Immunotherapy with checkpoint inhibitors (nivolumab/ipilimumab), FDA-approved for unresectable mesothelioma
- • Tumor Treating Fields (TTFields) — a newer treatment using electrical fields
- • Clinical trials for emerging treatments
- • Palliative care for symptom management and quality of life
Legal Considerations
Pleural mesothelioma cases often involve strong evidence of asbestos inhalation exposure. The long latency period (20–50 years) means exposure often occurred decades ago in workplaces, military service, or through secondary exposure. Documentation of work history and asbestos exposure sites is critical for building a case.
Average Settlement Range
$1 million – $2.4 million
Your Legal Rights with Pleural Mesothelioma
A pleural mesothelioma diagnosis establishes a strong basis for legal action against the companies responsible for your asbestos exposure. The medical literature clearly links this cancer to asbestos, and courts across the country have consistently awarded significant compensation to patients and their families.
You may be entitled to compensation through personal injury lawsuits, asbestos trust fund claims, and — if you are a veteran — VA disability benefits. These claims can be pursued simultaneously. Over 95% of mesothelioma cases settle before trial, with average settlements in the range of $1 million – $2.4 million.
Mesothelioma attorneys work on contingency, meaning you pay nothing unless they secure compensation for you. Do not delay — every state has a statute of limitations that sets a firm deadline for filing your claim.
Understanding Treatment for Pleural Mesothelioma
Treatment for pleural mesothelioma depends on the stage of the disease, the cell type identified in your biopsy, your overall health, and your treatment goals. Seeking a second opinion from a mesothelioma specialist at a major cancer center is strongly recommended, as these physicians have the most experience with this rare cancer and access to the latest treatment protocols and clinical trials.
A multimodal approach — combining two or more treatment types such as surgery, chemotherapy, radiation, or immunotherapy — generally produces the best outcomes. Your oncologist will develop an individualized treatment plan and can discuss the benefits and risks of each option. Palliative care to manage symptoms and improve quality of life is an important component of treatment at any stage.
Frequently Asked Questions: Pleural Mesothelioma
What is the survival rate for pleural mesothelioma?+
Median survival for pleural mesothelioma is 12-21 months after diagnosis, though outcomes vary significantly based on stage, cell type, and treatment. Patients with epithelioid cell type diagnosed at an early stage who receive aggressive multimodal treatment (surgery, chemotherapy, and radiation) have achieved 5-year survival rates of up to 20%. Clinical trials and immunotherapy are improving outcomes for some patients.
What is the difference between EPP and P/D surgery for pleural mesothelioma?+
Extrapleural pneumonectomy (EPP) removes the affected lung, pleura, diaphragm, and pericardium — it is a more extensive surgery suited for patients healthy enough to lose a lung. Pleurectomy/decortication (P/D) is a lung-sparing approach that removes the pleura and visible tumors while preserving the lung. P/D has become more common as studies show comparable survival with fewer complications and better quality of life.
Is immunotherapy effective for pleural mesothelioma?+
Yes. In 2020, the FDA approved the combination of nivolumab and ipilimumab (checkpoint inhibitors) for unresectable pleural mesothelioma, marking the first new systemic treatment approval in 16 years. Clinical trials showed improved overall survival compared to chemotherapy alone, particularly for patients with non-epithelioid (sarcomatoid or biphasic) cell types. Immunotherapy research for mesothelioma continues to expand.