Pleural Mesothelioma

Medical experts have been unable to definitively assess the prognosis of pleural mesothelioma partly because there are relatively few cases and it is so difficult to diagnose that patients don't get treatment for a long time after the disease strikes. Studies of pleural mesothelioma patients show that important prognostic factors include stage of cancer, age, and histology. Surgery improves the lifespan of the patient, even though it does not cure the disease. For patients treated with surgery, factors associated with improved long-term survival include epithelial histology, negative lymph nodes, and negative surgical margins. Nodal status is an important prognostic factor. Studies have shown the median survival of patients with malignant pleural disease is 16 months.

Pleural effusions and peritoneal effusions are experienced by two-thirds of patients. Hemothorax - the collection of blood in the pleural cavity - also is a symptom. To get a diagnosis, doctors use imaging technologies as well as histological analysis and molecular biologic analyses. A pleural smear examines a sample of pleural fluid under the microscope to detect for abnormal organisms. The test is performed when infection of the pleural space is suspected or when an abnormal collection of pleural fluid is noticed by chest X-ray. Sometimes the tumor grows through the diaphragm, making the site of origin difficult to assess.

More on symptoms of pleural mesothelioma.

Pleural Mesothelioma Treatment Options

Extrapleural pneumonectomy is surgery to remove a diseased lung, part of the pericardium (membrane covering the heart), part of the diaphragm (muscle between the lungs and the abdomen), and part of the parietal pleura (membrane lining the chest). Extrapleural pneumonectomy may improve survival, but its impact on long-term survival is unknown. Aggressive treatment help some people, but even experienced oncologists still aren’t sure which treatments provide the best benefits. It is likely that different patients do better with different therapies, which is why treatment plans are individualized. Combinations of treatments (e.g. surgery plus combination chemotherapy) are often employed.

Doctors often recommend pleurectomy and decortication (removal of part or all of the external surface of the lung or mesothelium) to remove the bulk of the malignant tissue, which reduces pressure in the chest and can reduce pain experienced by the patient. There is always a risk with surgery, but experience with pleurectomy/decortication shows that less than 2% of patients die during the surgery. The more radical extrapleural pneumonectomy has a mortality rate between 6% and 30% according to the National Cancer Institute.

Radiation therapy and chemotherapy are usually done after surgery but they have not been effective in improving survival. Radiation therapy has been shown to alleviate pain in most patients for a limited time.

Doctors have tried to find an optimal chemotherapy regimen, and both single-agent (one drug) and combination (two or more drugs) regimens have been evaluated in clinical trials. While there is no definitive chemotherapy regimen for pleural mesothelioma patients, the most common technique employed by oncologists uses the anti-folate pemetrexed and the alkylating agent cisplatin. Your doctor may recommend a different regimen if your condition warrants.

More on treatment of pleural mesothelioma

Prognosis for those with pleural mesothelioma

Age and morphology (epithelial, biphasic, or sarcomatoid) are the main prognostic factors. Scientists have attempted to find a more rigorous way (histology and hematologic parameters) of predicting the course of the disease, and studies have found noval biomarkers for pleural mesothelioma, but these have not proved effective in clinical use. Advanced imaging (PET-CT) can be used in diagnosis and helps doctors establish a prognosis. Oncologists generally use either the Cancer and Leukemia Group B or the European Organization for Research and Treatment of Cancer scoring system to predict outcomes of treatment.

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