Pleural Mesothelioma Symptoms

Of the three typical forms of malignant mesothelioma - pleural mesothelioma (in the lungs), peritoneal mesothelioma (in the abdomen), and pericardial mesothelioma (around the heart) - the pleural form is the most common, representing about 75 percent of malignant mesothelioma cases.

Common symptoms include trouble swallowing, a harsh voice, shortness of breath, persistent cough, blood in sputum, weight loss, fever, and swelling of the face and neck. Diagnosis in the early stages is often impeded by the fact that they symptoms mimic other illnesses and diseases, including allergies, some cardiac conditions, immune system failures, and persistent pneumonias of unknown etiology.

Getting a Pleural Mesothelioma Diagnosis

When patients get to the doctor for pleural mesothelioma (even before they know they have it), they typically have dyspnea – shortness of breath. Chest wall pain is the second most common symptom. These symptoms are due to pleural effusion – the buildup of fluid inside the chest. The fluid sits in the pleural cavity surrounding the lungs. The cavity normally contains some fluid, but some diseases cause excess fluid to accumulate and increased pressure.

Doctors can figure out a patient has a pleural effusion by listening with a stethoscope and taking a chest x-ray or ultrasound.

There are two types of effusions – transudutive and exudative. Transudutive is when the blood leaks from blood vessels because of high pressure in the vessels. This increased pressure is usually due to congestive heart failure. Exudative effusions (which is what mesothelioma patients get) are also from blood vessels, but because the pleura becomes inflamed. Thoracentesis (inserting a needle between the ribs to remove a sample of fluid) can be used to extract pleural fluid for analysis. Protein-rich fluid indicates transudutive effusion.

One reason pleural mesothelioma is so tough for doctors to diagnose is that pleural effusions are symptoms of many more common diseases, including pneumonia, tuberculosis, kidney disease, and lung cancer. The National Cancer Institute says there are 100,000 cases of pleural effusion in the United States every year.

Other disorders of the pleura that may prove confusing for the diagnosing physician are hemothorax (build-up of blood), pneumothorax (build-up of air) and pleurisy (general inflammation of the pleura, most often caused by viral infection.

Pleural mesothelioma is more common on the right side of the chest than the left side. Over 80% of pleural mesothelioma patients have pleural effusions that show up on chest radiographs. The fluid looks like effusions causes by empryema and other medical conditions, which is another confusing situation obscuring a clear diagnosis of mesothelioma. In later stages of the disease, the amount of pleural fluid decreases.

Other Symptoms

Other symptoms associated with pleural mesothelioma include:

  • Hoarse voice
  • Difficulty swallowing (dysphagia)
  • Frequent coughing
  • Coughing up blood
  • Fluid buildup in the chest region (pleural effusion)
  • Loss of appetite
  • Unexplained weight loss
  • Fever
  • Fatigue
  • Superior vena cava syndrome – the compression of the vein that carries blood to the right atrium of the heart
  • Phrenic nerve paralysis

Chest pain and shortness of breath occur in 90 percent of patients and pleural effusion is the second most prevalent symptom, affecting 84 percent (based on a survey conducted in Canada – P. Ruffie et al. Journal of Clinical Oncology, August 1, 1989:1157-1168).. Weight loss affected 29 percent of all patients surveyed. All other symptoms were present in three percent of patients or less. Additionally, three percent of all patients displayed no symptoms at the time of diagnosis.

If symptoms point to pleural mesothelioma, then the doctor will order x-rays, CT scans and/or an MRI to look for abnormalities in the lining of the lungs. If found, a biopsy will be conducted to test for the presence of mesothelioma cancer cells.

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