Pleural Mesothelioma

Pleural mesothelioma is a particular type of cancerous tumor, defined as an uncommon “neoplasm,” or abnormal growth, of the “pleura,” which is the membrane covering the lungs. In the general North American population, there are one or two cases of malignant pleural Mesothelioma diagnosed per million people. However, the exact incidence of the disease is difficult to estimate, since it is often simply diagnosed as lung cancer.

It is very well-established that asbestos and mesothelioma are connected. A vast majority of mesothelioma cases involve people who have been exposed to asbestos fibers. Mesothelioma is much less common in women than in men, but of 117 women who did have the condition in a U.K study, 98% had asbestos fiber in the lungs in greater amounts than was found in the rest of the population.

Symptoms of Malignant Pleural Mesothelioma

• Difficulty breathing
• Coughing
• Fever
• Weight loss
• Chest and lower back pain
• Muscle weakness and sensory loss
• Swelling of the face and arms
• Hoarseness
• Coughing up blood

Most often, shortness of breath or chest wall pain will be the first symptoms that bring people to a doctor, along with fever, weight loss and declining physical performance. A physical examination will find decreased breath sounds and a “dull” sound when the chest is tapped. Often, a chest x-ray will reveal a rupture in the pleura, which causes an “effusion,” a release of fluid into the body cavities.

According to most reports, after diagnosis, the median duration of survival is 4 to 18 months. However, patients who are relatively young, have good performance status, have a lack of chest pain and /or a normal platelet count tend to survive longer.

Progression of the Disease

Initially, the shortness of breath and chest pain can be held under control with limited pain medication and thoracenteses, in which the fluid in the pleura is drained. But this is of course a temporary solution; over time, the tumor grows and traps the lung.

The tumor forms large masses of tissue which invade nearby structures such as the chest wall, the interlobar fissure, lung parenchyma, mediastinum, pericardium, diaphragm, esophagus, large vessels of the mediastinum, contralateral pleura, and the peritoneal cavity. When one or more of these vital structures is restricted, death often results. (Please visit our Glossary for definitions of any of these or other terms.)

Detecting Malignant Pleural Mesothelioma

In a chest x-ray, a malignant pleural mesothelioma typically appears as non-concentrated (or “diffuse”) thickening of the pleura. All surfaces of the pleura are involved and the tumor often extends into its fissures. The side of the chest involved seems to have lost volume despite the tumor taking up a large amount of space. Open thoracotomy biopsy, in which tissue is removed and tested, is usually needed to establish a firm diagnosis of pleural mesothelioma.

To determine the stage of the disease, CT scans are more accurate than chest x-rays. CT scans can help define the extent of the tumor, whether it has invaded other sites, and the status of the underlying lung. Diffuse malignant pleural mesothelioma generally spreads into the other side of the chest, to the chest wall, or below the diaphragm. The tumor rarely spreads to other organs, but it can appear in the lungs, bone, liver, brain or lymph nodes.

Surgery To Eradicate the Tumor Is Dangerous

There is no cure for pleural mesothelioma, and there is much discussion about the value of surgery in mesothelioma, apart from a biopsy for diagnosis. Although removing the pleura entirely can reduce the prevent further ruptures and effusions, surgery is not often used to help people manage mesothelioma and many specialists advocate supportive care alone.

Mesothelioma progresses quickly and any surgery intended to eradicate the disease would involve removing some vital organs. Any patient considered for such radical surgery must be able to withstand prolonged anesthesia and the removal of the pleura. Physicians must carefully evaluate the patient’s cardiac (bloodstream-related) and pulmonary (lung-related) functions. Two surgical techniques have been advocated called decortication (pleurectomy), and extrapleural pneumonectomy.

Surgery Can Prevent Future Effusions

One standard approach for treating recurring, painful effusions is to remove the pleural space, in which fluids collect after a rupture. The physician produces an irritation or inflammation of the surfaces of the pleura, which causes them to stick together. With this cavity obliterated, there is no space for future effusions. Techniques to accomplish this have included repeated thoracentesis, chronic tube drainage, and the instillation of various agents, such as talc, radioisotopes, antibiotics, antiparasitics, chemotherapeutic agents, biologic substances and steroids. However, these methods are still being studied.

A last option for the control of recurrent pleural effusions is thoracotomy and pleurectomy, in which an incision is made in the chest and the pleura is stripped from the lungs. This procedure is very effective in preventing further pleural effusions, but it is seldom used because it often results in death for those in an advanced state of the disease. Most recommend this procedure only for the unique patient with an otherwise good prognosis whose effusion cannot be controlled with less aggressive techniques.

Our Attorneys Are Here to Help

Even after reading all the above information, you probably have more questions. To best serve people suffering from Mesothelioma, the lawyers of Harowitz & Tigerman have provided another entire Web site on the topic, filled with California Mesothelioma Information.

And of course, our lawyers are also here to answer your questions. Contact us immediately for a FREE initial consultation with one of our lawyers. We realize that you likely don’t have the money to pay attorney’s fees, so we do not charge you anything until we win you money.

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