The presenting symptoms of malignant pleural mesothelioma can be as nondescript as a chest pain, slight fatigue or shortness of breath during physical activity. Early symptoms often mirror signs of less serious respiratory issues, such as pneumonia, bronchitis and emphysema, which are hardly unusual for seniors.
Once the cancer progresses to a late stage, however, the symptoms become much more specific and acute.
Patients with pleural mesothelioma may eventually experience some or all of the following:
Coughing or wheezingShortness of breath (dyspnea)Chest painFever or night sweatsFatigue or muscle weaknessUnexplained weight lossLoss of appetiteSwelling of the face and armsCoughing up blood (hemoptysis)Trouble swallowing (dysphagia)
Recognizing the First Signs of Pleural Mesothelioma
The vague nature of the early symptoms, combined with the fact that it can take 10 to 50 years for cancer to develop after exposure to asbestos, often causes medical professionals to misdiagnose this rare disease.
The American Cancer Society approximates that more than 3,000 people in the United States are diagnosed annually with this cancer, compared to the estimated 220,000 Americans diagnosed with lung cancer each year.
You should discuss any history of asbestos exposure or suspected asbestos exposure with your physician, who can refer you to a specialist right away. Early diagnosis is critical to survival because it can lead to more effective therapy options.
According to a 2011 study of 221 pleural mesothelioma patients, many reported similar symptoms in the early stages, often before it was diagnosed:
90 percent developed pleural effusions (excess fluid around the lungs)
79 percent experienced shortness of breath
64 percent suffered chest pain
36 percent had a chronic cough
30 percent experienced significant weight loss
If any of these symptoms appear, and you have a history of asbestos exposure, see a specialist as soon as possible.
The process of recognizing the symptoms and turning them into a definitive diagnosis so treatment can begin usually involves multiple procedures with different medical professionals, and it often takes several months. Early diagnostic methods, greater awareness and improved treatments allow some patients to live well beyond the average life expectancy of 12–21 months.
The most important thing is to find a specialist who understands the disease and all its intricacies and treatment options.
"It's important to have someone who is comfortable with the disease," said Dr. Hedy Kindler, director of the mesothelioma program at the University of Chicago Medical Center. "You need a quarterback who understands all the options."
Symptoms Across the Four Stages
Pleural mesothelioma cancer is caused by inhaled asbestos fibers that have lodged in the pleura, which is the thin lining around the lungs. Over time, the microscopic mineral fibers cause scarring and genetic mutation in the cells around them.
Pleural mesothelioma may take decades to develop after exposure to asbestos, but this rare cancer attacks quickly once taking hold. Symptoms vary by stage, which is often described in Roman numerals (stage I, stage II) or simple numbers.
Stage 1
In the first stage, the tumor burden is relatively minimal and may not cause any noticeable symptoms. When a patient is diagnosed in stage 1, it is usually because a doctor accidentally detected the cancer through a routine X-ray or other tests.
The two most common presenting symptoms of pleural mesothelioma are shortness of breath and chest pain. These symptoms usually develop as a result of fluid buildup in the area around the lungs, also known as pleural effusion, or tumors pressing against the lung and chest wall.
Stage 2
In the second stage, tumors spread beyond the pleural lung lining and into the lung and diaphragm. Chest pain may arise or increase, and pain may be felt in the shoulder or upper abdomen as well. Coughing and other breathing issues and may also arise or worsen at this stage.
Stage 3
During the third stage, tumors spread more thoroughly throughout the chest, placing pressure on the lungs and chest wall. These physical changes can lead to an increase in pain and difficulty breathing, a persistent dry cough, tightness in the chest, fatigue and weight loss.
Stage 4
By the fourth stage, tumors have spread throughout the chest and sometimes to distant locations around the rest of the body as well. The degree of tumor burden in the chest can severely worsen pulmonary symptoms such as shortness of breath.
Others symptoms may include lumps of tissue under the skin on the chest, pain in the lower back, fever and night sweats. Some patients experience a hoarse voice and difficulty swallowing. At this stage, patients often need help breathing and require continuous oxygen.
Symptom-Relieving Cancer Treatments
A palliative cancer treatment is specifically intended to alleviate cancer symptoms and improve a patient’s quality of life. Though palliative treatments have a different purpose than curative treatments, which aim simply to fight the cancer, medical professionals use the same general methods for both types of treatment. The difference is that with palliative treatments, the patient’s comfort is the highest priority.
Palliative Surgery
The shortness of breath, chest pain and coughing associated with malignant pleural mesothelioma are often caused by pleural effusion, and it can be eased by extracting the fluid through a tube in a surgical procedure called a thoracentesis.
Another procedure, called a pleurodesis, goes one step further by extracting the fluid and then sealing the space to keep fluid from collecting again. This procedure offers a more permanent fix to the problem, but it also involves a more painful period of recovery.
Palliative Radiation and Chemotherapy
As mesothelioma tumors grow, they can put painful pressure on the lungs and other nearby vital organs as well as the bones of the rib cage and the chest wall. Radiation and chemotherapy, often used in combination, can shrink cancerous tumors to reduce the pressure on the body parts around them.
Coping with the Symptoms of Pleural Mesothelioma
There are various other ways to ease and manage the symptoms of this asbestos-related cancer, including medication, self-care techniques you can learn and practice at home, and therapies offered by practitioners of complementary and alternative medicine.
Pain-Relief Medication
To alleviate cancer-related pain, your doctor may first recommend over-the-counter painkillers such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). For severe pain, your doctor can prescribe powerful opioids such as oxycodone (OxyContin, Percocet) or morphine.
Pain-Management Techniques
Simple actions, such as taking a warm bath or applying a cold pack, can reduce the aches and pains caused by pleural mesothelioma. One common recommendation for long-term pain management is to keep yourself busy with work or a hobby to engage your mind with something besides the pain.
Some patients benefit from visualization techniques in which they picture the pain they feel as a physical object and then they imagine diminishing it. For example, you could visualize your pain as a fire and then imagine gradually putting it out with cups of water.
Pulmonary Rehabilitation
Your medical team can help you manage breathing difficulties by teaching you techniques for controlling how you breathe and cough. Pulmonary rehabilitation is a holistic, multimodal approach in which you also focus on improving your nutrition, staying physically fit and keeping a positive emotional outlook.
If you smoke, your medical team can help you quit, which will be essential to managing your cancer symptoms.
Complementary and Alternative Medicine (CAM)
Many practices fall into this category — it refers to any healing practice outside of mainstream medical science and clinical trials. Many mesothelioma patients turn to CAM to improve their quality of life, and it shouldn’t be a problem for you as long as you are open and honest with your medical team about everything you consider. Before you begin any CAM therapy, you must check with your doctor to make sure it won’t interfere with your other medical treatments.
A few examples of complementary and alternative medicine:
Therapeutic massage: In addition to being a proven method of relieving stress, massage is now gaining popularity as a versatile healing art that can provide a strong support for conventional treatment.
Acupuncture: This Eastern practice has so far withstood the test of time, and some modern studies have concluded it can be an effective treatment for the symptoms that cancer patients experience.
Biofeedback therapy: This novel therapy involves learning how to consciously control bodily functions that are normally involuntary. This training has allowed some patients to better manage their symptoms and recover from surgery.
Nutritional therapeutics: It’s well known that eating a balanced diet improves the outcomes of cancer treatments. Some patients have gone further by following highly specific plans of nutrition designed to reduce cancer symptoms and promote natural healing.
Snehal Smart
Snehal Smart is the Pleural Mesothelioma Center’s in-house medical doctor, serving as both an experienced Patient Advocate and an expert medical writer for the website. When she is not providing one-on-one assistance to patients, Dr. Snehal stays current on the latest medical research, reading peer-reviewed studies and interviewing oncologists to learn about advancements in diagnostic tools and cancer treatments.
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