15044 Pleural Mesothelioma

Overview

Pleural mesothelioma is a rare type of cancer that affects the pleura — the thin lining that covers the outside of your lungs and the inside of your chest wall. It is almost always caused by breathing in asbestos dust. Asbestos fibres can become stuck in the pleura and, many years later, cause cells to grow abnormally and form a tumour.

No. Pleural mesothelioma is rare. In the UK, several thousand people are diagnosed each year, most often after long-term asbestos exposure.

It most often affects men over 75, especially those who worked with asbestos in construction, shipbuilding, or industry. However, anyone who has been around asbestos — even for a short time — can develop it.

Symptoms

Common symptoms

• Shortness of breath
• Chest pain, often under the ribcage or in the lower back
• A persistent cough
• Unintentional weight loss
• Extreme tiredness (fatigue)
• A feeling of fullness or tightness in the chest
• Hoarseness or difficulty swallowing

Symptoms in children

• Pleural mesothelioma is extremely rare in children. Breathing problems and coughs in children are nearly always caused by common infections or other non-cancerous conditions. But if your child has persistent breathing symptoms, chest pain, or an unexplained fever, see a paediatrician.

Symptoms in older adults

• In older adults, symptoms like breathlessness and tiredness may be mistaken for normal ageing or a chronic chest condition. Do not ignore new or worsening breathlessness, unexplained weight loss, or chest discomfort — these deserve a medical check-up.

Causes

Main causes

• Breathing in asbestos fibres that get trapped in the pleura
• Working with asbestos in jobs like construction, shipbuilding, plumbing, insulation, or roofing
• Living with someone who worked with asbestos — dust on their clothes or skin can be breathed in by family members
• In rare cases, no clear asbestos exposure can be identified

Risk factors

• Long-term or repeated exposure to asbestos, often in the workplace
• Working around asbestos-containing materials before safety rules were introduced (before the 1980s in many countries)
• Living or working in older buildings where asbestos materials are broken or disturbed
• Being exposed to asbestos and also smoking — smoking greatly increases the risk of lung disease, though it does not directly cause pleural mesothelioma

When to see a doctor

See a doctor urgently if:

• Persistent chest pain that doesn't go away
• Shortness of breath that is getting worse
• Coughing up blood
• Unexplained weight loss or feeling extremely ill

Book a routine appointment if:

• A dry cough lasting more than three weeks
• Breathlessness that is starting to affect daily activities
• A feeling of heaviness or pressure in the chest that keeps returning

Diagnosis

Diagnosing pleural mesothelioma often takes time because symptoms can resemble other lung conditions. Your doctor will ask you about your symptoms, your general health, and your work history — especially whether you may have been exposed to asbestos. They will listen to your chest and likely order some initial tests. If those suggest a problem, you will be referred to a specialist chest or cancer team for further testing.

Tests that may be done

• Chest X-ray — to look for fluid, scarring, or thickening in the pleura
• CT scan — a detailed scan of your chest to see any abnormal areas
• Blood tests — to assess your overall health and help guide decisions
• Lung function tests — to measure how well your lungs are working
• Pleural fluid sample — a needle is used to remove some fluid for testing if fluid is present around the lung
• Biopsy — a small piece of tissue is taken and examined under a microscope to confirm whether cancer cells are present

What to expect at your appointment

You may need several tests over a few weeks. It can be an anxious time, but your care team should explain each step and keep you informed. If you feel unsure at any point, ask questions — you have a right to understand what is happening and why.

Treatment

Treatment for pleural mesothelioma depends on the stage of the cancer, your general health, and your personal wishes. The aims may be to try to cure the cancer if it is caught very early, to slow its growth, or to control symptoms and keep up your quality of life. A team of specialists — including a respiratory doctor, an oncologist, a surgeon, and a nurse specialist — will talk through the options with you.

Self-care at home

• If you smoke, try to stop — this helps your lungs handle any treatment more easily
• Stay as active as feels comfortable; gentle movement can help your energy and mood
• Ask your healthcare team about vaccinations against flu, pneumonia, and COVID-19
• Get plenty of rest and ask for help with daily tasks when you need it

Medical treatments

Treatments may include surgery to remove part or all of the pleura, chemotherapy — medicines that travel through the body to target cancer cells, radiotherapy — high-energy rays aimed at the tumour, and immunotherapy — treatments that help your body's immune system fight the cancer. Some people receive a combination of these. A procedure may also be done to drain fluid from the chest to relieve breathlessness. Your team will explain the potential benefits and side effects of any treatment so you can make an informed choice.

When is surgery considered?

Surgery may be an option if the cancer has not spread and you are fit enough for an operation. The surgeon may remove the lining of the lung and nearby tissue, or in some cases the whole lung and its lining. This is a major decision, and your team will help you weigh up whether surgery is right for you.

Living with this condition

Living with pleural mesothelioma can feel overwhelming at times. Try to take things one day at a time. Keep a routine that balances rest and activity. Use a notebook to record your symptoms, questions, and what your care team tells you — this helps you feel more in control. Don't be afraid to accept offers of help from family and friends.

Lifestyle tips

• Pace yourself: break tasks into smaller steps and rest between them
• Use breathing or relaxation techniques recommended by your care team to help reduce breathlessness
• Talk to a counsellor or support group if you're feeling anxious or low
• Do things you enjoy — listening to music, spending time with loved ones, or gentle hobbies

Diet and exercise

Eating well can be challenging if you feel tired or short of breath. Small, frequent meals are often easier than three large ones. If you are losing weight, ask to speak to a dietitian. Gentle exercise such as short walks, stretching, or sitting in the fresh air can boost your energy and mood, but listen to your body and rest whenever you need.

Mental health and emotional wellbeing

A cancer diagnosis can bring fear, sadness, anxiety, and uncertainty. All these emotions are normal. It is important to let yourself feel them and to talk about them — with a trusted friend, a family member, or a professional. Your healthcare team can connect you with psychological support, and many people find it helpful to join a support group where they can share experiences.

Prevention

Most cases of pleural mesothelioma are caused by breathing in asbestos fibres, so the best way to prevent it is to avoid asbestos exposure. If you live or work in an older building that may contain asbestos, do not disturb it yourself — have it inspected and managed by qualified professionals. If your job involves asbestos, use all recommended protective equipment and follow safety guidelines.

Vaccines

There is no vaccine to prevent pleural mesothelioma. However, keeping up to date with vaccines against flu, pneumonia, and COVID-19 is strongly recommended — especially if you have a lung condition or are receiving cancer treatment — because infections can be serious for you.

Screening programmes

There is no routine national screening test for pleural mesothelioma. If you have had significant asbestos exposure in the past, your doctor may consider regular check-ups or imaging scans to monitor your lung health. This is usually offered on an individual basis after discussing your risk.

Complications

If left untreated

• Fluid can build up in the space around the lungs, causing severe breathlessness
• The cancer can spread to nearby tissues and other parts of the body
• Chest infections such as pneumonia may become more likely
• Weight loss, weakness, and loss of appetite can become severe

Long-term outlook

A diagnosis of pleural mesothelioma is serious, and every person's experience is different. Treatments have improved in recent years, and many people live with the condition for years while keeping a good quality of life. Even when a cure is not possible, there is always something that can be done to control symptoms, support your wellbeing, and help you and your family through this. Your care team will walk with you and make a plan based on your wishes and your health.

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