Pleural mesothelioma

What is pleural mesothelioma?

Pleural mesothelioma is defined as a malignant tumor of the pleura, which lines the inside of the chest and surrounds the lungs. It consists of a thin layer of special mesothelial cells. Malignant changes in these mesothelial cells are the cause of pleural mesothelium.

Causes and symptoms

By far the most common cause of pleural mesothelioma is asbestos, a very harmful mineral fiber that was used in the past, for example to insulate houses or in industry, but has been banned for many years. Thus, in more than half of the patients, the underlying cause is the unconscious inhalation of asbestos. In rare cases, workers may still be exposed to asbestos during the demolition of old buildings, but strict regulations are in place to prevent this scenario. However, mesothelioma does not appear in affected patients until after a latency period of several decades, so the onset of this disease is due to previous use of the toxic material. Other causes may be viral infections or radioactive radiation, and a genetic predisposition may also play a role.

Typical symptoms include difficulty breathing, coughing, chest pain, fatigue and weight loss.

How is pleural mesothelioma treated?

Treatment of this type of cancer is complicated because the malignant cell changes spread diffusely throughout the pleura and can also metastasize (spread to other organs).

Nevertheless, there are treatment options that must be individually adapted to each patient, i.e. to the stage of his or her cancer and other circumstances.

A distinction is made between curative therapy, which aims to cure the cancer and extend life expectancy, and palliative therapy, which is mainly used to relieve symptoms.

In order to initiate curative treatment, the benefits to the patient and the health consequences and risks of such treatment must always be carefully weighed first. The curative approach can be considered, especially for younger, healthier patients in the early stages. It usually combines surgical measures with chemotherapy and radiotherapy to increase the chances of success. On the one hand, this aggressive treatment approach places a considerable burden on the patient, but on the other hand, it holds the promise of improved life expectancy.

However, if the benefits of such therapy do not outweigh the associated consequences and burdens for the patient, palliative therapy can be pursued in agreement with the patient. Here, pleurodesis is in the forefront, i.e., the two layers of the pleura are surgically glued together to prevent fluid accumulation in the pleural space. Although this does not cure the disease, breathing problems improve dramatically and patients can cope better with their daily lives.

Prognosis and chances of recovery

Because symptoms often do not appear until later in the course of the disease, the cancer often goes undetected for a long time and can spread to both larger areas of the pleura and to other organs (metastases).

In most cases, this leads to a poor prognosis with little chance of cure. Nevertheless, all curative therapeutic measures must be weighed and exhausted in order to achieve the best possible chance of recovery. In palliative therapy, all options for pain relief and symptomatic treatment must be applied consistently.

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