OVERVIEW

What is malignant pleural mesothelioma?

Malignant pleural mesothelioma is a tumor that develops in the thin layer of tissue surrounding the lungs and is a highly aggressive malignant disease. Patients are typically over 50 years old at the time of diagnosis. The disease is almost exclusively caused by exposure to asbestos, a mineral.

Asbestos was once used in various building materials, including insulation and ceiling tiles. Asbestos fibers are extremely small and, when released into the air, can be inhaled into the lungs, where they become trapped and cause health problems.

Generally, high-level or prolonged asbestos exposure, especially combined with smoking, significantly increases the risk of developing pleural mesothelioma. Symptoms often appear many years after asbestos exposure.

Treatment options, including surgery, radiation therapy, or chemotherapy, are selected based on the patient's specific condition. Malignant pleural mesothelioma is rarely curable. Most cases are difficult to treat because the majority of patients are diagnosed at an advanced stage.

Is malignant pleural mesothelioma common?

The vast majority of malignant pleural mesothelioma cases occur in patients aged 50 or older. These patients often seek medical attention due to gradually worsening nonspecific respiratory symptoms, such as chest pain, difficulty breathing, cough, hoarseness, night sweats, or difficulty swallowing, decades after asbestos exposure.

What are the types of malignant pleural mesothelioma?

Malignant pleural mesothelioma is classified histologically into:

• Epithelioid type: Accounts for about 60% of cases.

• Sarcomatoid type: Accounts for about 10% of cases.

• Biphasic type: Accounts for about 30% of cases. This is a mixed subtype containing both epithelioid and sarcomatoid components, with each making up more than 10%. If either component is less than 10%, it is classified as sarcomatoid-predominant or epithelioid-predominant.

SYMPTOMS

What are the common manifestations of malignant pleural mesothelioma?

The main symptoms of malignant pleural mesothelioma include shortness of breath and chest pain. Having these symptoms does not necessarily mean one has malignant pleural mesothelioma, as many common conditions can also cause shortness of breath and chest pain, most of which are far more common than malignant pleural mesothelioma.

Some patients may also experience chest pain, difficulty breathing, coughing, hoarseness, night sweats, or difficulty swallowing, as well as systemic symptoms such as fatigue and weight loss.

How does malignant pleural mesothelioma develop?

Malignant pleural mesothelioma is often caused by asbestos exposure. Asbestos fibers are extremely small and, when dispersed in the air, can be inhaled into the lungs, where they remain and may cause disease many years later.

The onset may involve shortness of breath and chest pain, which are easily overlooked. Later, symptoms such as difficulty breathing, coughing up blood, and other concerning signs may develop, necessitating medical attention.

What complications can malignant pleural mesothelioma cause?

Malignant pleural mesothelioma is often diagnosed at an advanced stage, by which time pleural effusion is usually present. Local invasion of critical structures may also occur. For example, tumor growth through the diaphragm may lead to intestinal obstruction, causing abdominal pain, bloating, and vomiting.

Compression of the superior vena cava may cause symptoms such as a feeling of fullness in the head or facial swelling. Heart involvement may lead to arrhythmias or heart failure.

CAUSES

What causes malignant pleural mesothelioma?

Malignant pleural mesothelioma has the following causes:

• Asbestos exposure: Asbestos exposure is usually occupational. Asbestos was once used in various building materials, including insulation, ceiling tiles, etc. People exposed to these materials include plumbers, pipefitters, electricians, insulation workers, construction workers, roofers, welders, and many other types of workers.
  Asbestos fibers are very small. When these fibers disperse in the air, they are inhaled into the lungs and remain there, causing disease many years later.

• Radiation therapy to the supra-diaphragmatic area for treating malignant tumors such as Hodgkin's lymphoma, non-Hodgkin's lymphoma, or testicular cancer.

• BAP1 gene mutation: Malignant pleural mesothelioma has been confirmed to be associated with BAP1 gene mutations.

Is malignant pleural mesothelioma contagious?

No.

Is malignant pleural mesothelioma hereditary?

Malignant pleural mesothelioma can be hereditary, with the most common mutated gene being BAP1. Genetic testing for BAP1 is recommended for patients without a history of asbestos exposure.

DIAGNOSIS

How is malignant pleural mesothelioma diagnosed?

For patients with a history of asbestos exposure presenting respiratory symptoms and showing pleural thickening or effusion on chest imaging, doctors will strongly suspect malignant pleural mesothelioma. A definitive diagnosis requires pathological examination combined with immunohistochemistry (immunohistochemical characteristics).

What tests are needed to diagnose malignant pleural mesothelioma?

In addition to a physical examination and symptom assessment, doctors may perform some or all of the following tests:

• Chest X-ray and other imaging tests, which may include CT scans, PET scans, or MRI. These tests provide images of the lungs and surrounding areas.

• Pulmonary function tests to assess lung performance, during which the patient must exhale forcefully into a tube.

• Bronchoscopy, where a thin tube (bronchoscope) is used to examine the inside of the airways.

• Biopsy, where a small tissue sample is taken from the pleura or the space between the lungs and examined under a microscope to confirm the presence of malignant pleural mesothelioma.

Which diseases can malignant pleural mesothelioma be easily confused with? How to differentiate them?

• Malignant pleural mesothelioma can be mistaken for benign conditions such as chronic empyema. Cytopathological examination is needed to distinguish them.

• Malignant pleural mesothelioma can be confused with malignant diseases like pleural metastases. Immunohistochemical analysis is required for differentiation.

TREATMENT

Which department should I visit for malignant pleural mesothelioma?

Respiratory medicine or oncology.

Can malignant pleural mesothelioma heal on its own?

Malignant pleural mesothelioma is a very serious condition that can worsen over time. If symptoms like shortness of breath, chest pain, coughing up blood, or severe breathing difficulties occur, immediate medical attention is required, as these may indicate a critical condition.

How is malignant pleural mesothelioma treated?

Main treatment methods include:

• Surgery: Many patients with malignant pleural mesothelioma are not healthy enough to undergo surgery. During surgery, doctors may:

• Remove part or all of the tissue containing mesothelioma.

• Drain fluid from around the lungs.

• Fill the space around the lungs with talc to help prevent fluid buildup.

• Radiation therapy: Radiation can kill cancer cells.

• Chemotherapy: Chemotherapy uses drugs to kill cancer cells or stop tumor growth.

Some patients receive a combination of treatments, such as radiation or chemotherapy after surgery. The approach depends on the patient's age, overall health, and other symptoms. While doctors may not completely eliminate malignant pleural mesothelioma, these treatments can improve breathing or relieve pain.

How long does it take to recover after surgery for malignant pleural mesothelioma?

Recovery time after surgery varies from person to person.

Each patient's condition and physical circumstances differ, so the required recovery period also varies, depending largely on treatment effectiveness, immune function, emotional state, and other factors.

However, proper postoperative care can help patients regain physical function more quickly.

How effective is treatment for malignant pleural mesothelioma? Can it be cured?

• Very few patients with malignant pleural mesothelioma can be cured. Most affected individuals die due to local spread and respiratory failure.

• The prognosis (predicted course and outcome of the disease) for malignant pleural mesothelioma is poor, with the pure epithelioid subtype having the best outlook, especially if the tumor can be completely removed.

• Poor prognosis is often indicated by poor daily physical function, age over 75, elevated lactate dehydrogenase levels, and hematologic abnormalities.

DIET & LIFESTYLE

What should patients with malignant pleural mesothelioma pay attention to in daily life and diet?

• Quit smoking.

• Avoid environments with asbestos exposure.

• Avoid excessive fatigue and maintain a balance between work and rest.

• Pay attention to diet, eat smaller and more frequent meals, and consume light, easily digestible, high-protein, and nutritious foods as well as whole grains and fiber. Avoid greasy and hard foods.

• Prevent colds and consider getting pneumonia and flu vaccines.

Does malignant pleural mesothelioma affect normal daily life, study, and work?

Patients with stable conditions can carry out normal daily life, study, and work. As long as they maintain a regular routine, balance work and rest, and focus on nutrition, they can live like healthy individuals.

Do patients with malignant pleural mesothelioma need follow-up examinations? How are they conducted?

Follow-up examinations are necessary. Depending on clinical needs, these may include complete blood count and chemistry tests, radiological imaging, and nutritional consultations.

Can patients with malignant pleural mesothelioma travel by plane, engage in strenuous exercise, or visit high-altitude areas?

Most patients with malignant pleural mesothelioma have underlying conditions such as pulmonary heart disease, so air travel should be avoided if possible.

Strenuous exercise and high-altitude travel should also be avoided, as patients often struggle to recover fully after treatment and may find it difficult to adapt to such environments.

PREVENTION

How to Prevent Malignant Pleural Mesothelioma?

You can take certain measures to reduce the risk of developing malignant pleural mesothelioma, including:

• Quit smoking: Smoking significantly worsens problems caused by asbestos exposure. Quitting can slow disease progression and improve your comfort.

• Consult your doctor to determine whether your current job may involve asbestos exposure. If so, wear masks and protective clothing at work, or consider changing jobs.

• Get an annual flu vaccine in the fall and at least one pneumococcal vaccine. Since the lungs may struggle with infections like flu or pneumonia, preventing them is crucial.

Will Everyone Exposed to Asbestos Develop Malignant Pleural Mesothelioma?

Generally, asbestos-related illness requires high-level or prolonged exposure. Many people exposed to asbestos do not develop the disease, especially if they do not smoke.