Pleural Mesothelioma

Pleural mesothelioma is a rare and aggressive cancer that develops in the thin lining surrounding the lungs, known as the pleura. It is most commonly associated with prior exposure to asbestos, although symptoms may not appear until many years after exposure.

Diagnosis typically begins with imaging studies such as CT scans of the chest, followed by additional imaging or procedures to characterize the disease. A definitive diagnosis generally requires tissue obtained through biopsy, which is examined by a specialized pathologist. Staging studies are then used to determine the extent of disease and help guide treatment.

Treatment is individualized and often involves a multidisciplinary approach incorporating thoracic surgery, medical oncology, radiation oncology, and other specialists. Depending on the stage and characteristics of the disease, treatment may include surgery, chemotherapy, immunotherapy, radiation therapy, or combinations of these modalities.

At the Institute for Thoracic Surgery in Miami, Florida, Mark R. Dylewski, M.D., provides specialized surgical care for patients with pleural mesothelioma. When surgery is appropriate, the treatment strategy is carefully integrated with systemic and radiation therapies to address the disease comprehensively. Our goal is to provide individualized, evidence-based treatment while preserving pulmonary function and quality of life whenever possible.

Mesothelioma: Diagnosis and Multimodality Treatment

Mesothelioma is a rare and aggressive cancer that develops from the mesothelial lining of the body's internal cavities. The disease most commonly arises in the pleura, the lining surrounding the lungs, but may also develop in the peritoneum, which lines the abdominal cavity, or, much less commonly, the pericardium, which surrounds the heart.

At the Institute for Thoracic Surgery in Miami, Florida, Mark R. Dylewski, M.D., provides specialized evaluation and surgical care for patients with mesothelioma, with an emphasis on individualized, multidisciplinary treatment.

The Three Major Types of Mesothelioma

Pleural Mesothelioma
Pleural mesothelioma is the most common form and develops along the lining of the chest cavity and lungs. Patients may experience shortness of breath, chest discomfort, persistent cough, or recurrent pleural effusions. Evaluation typically includes chest imaging, particularly CT scanning, followed by tissue biopsy to establish the diagnosis. Thoracoscopy may be used when additional tissue is needed for definitive diagnosis and characterization.

Peritoneal Mesothelioma
Peritoneal mesothelioma develops within the lining of the abdominal cavity. Evaluation may include abdominal imaging and biopsy, with treatment determined by the extent of disease and whether complete cytoreduction is feasible. In appropriately selected patients, treatment may include cytoreductive surgery combined with heated intraperitoneal chemotherapy (HIPEC).

Pericardial Mesothelioma
Pericardial mesothelioma is exceptionally rare and develops in the lining surrounding the heart. Because of its location and rarity, evaluation and treatment require highly specialized multidisciplinary expertise. Management is individualized according to the extent of disease and the patient's overall condition.

How Is Mesothelioma Diagnosed?

Diagnosing mesothelioma requires careful evaluation because its symptoms and imaging findings can overlap with other diseases, including lung cancer and other causes of pleural or abdominal abnormalities.

The diagnostic process may include:

• Detailed medical and occupational history, including potential asbestos exposure
• Chest or abdominal CT imaging
• PET imaging or other staging studies when appropriate
• Thoracoscopy or other minimally invasive procedures to evaluate abnormal tissue
• Biopsy for definitive pathologic diagnosis
• Specialized immunohistochemical testing to distinguish mesothelioma from other cancers
• Evaluation of the tumor's histologic subtype and extent of disease

The histologic subtype is also important. Mesothelioma is generally classified as epithelioid, sarcomatoid, or biphasic, with biphasic tumors containing both epithelioid and sarcomatoid components. Histology, stage, tumor distribution, lymph-node involvement, and the patient's overall health all contribute to treatment planning and prognosis.

Multimodality Treatment of Mesothelioma

Mesothelioma often requires more than a single form of treatment. At the Institute for Thoracic Surgery, treatment planning emphasizes a multidisciplinary, multimodality approach, bringing together thoracic surgery, medical oncology, radiation oncology, radiology, pathology, and other specialists as appropriate.

Depending on the type, stage, and extent of disease, treatment may incorporate:

• Surgery to remove visible tumor in appropriately selected patients
• Chemotherapy to treat cancer systemically
• Immunotherapy to stimulate the immune system's ability to recognize and attack cancer cells
• Radiation therapy for selected patients, either as part of a multimodality treatment strategy or for symptom control
• Intracavitary therapies, including HIPEC for selected patients with peritoneal mesothelioma
• Supportive and palliative treatments to control symptoms such as pleural effusions, pain, and shortness of breath

For selected patients with potentially resectable pleural mesothelioma, surgery may be incorporated into a multimodality treatment plan that can include systemic therapy and, in selected circumstances, radiation therapy. Surgical approaches may include pleurectomy and decortication or other carefully selected procedures based on disease distribution and the patient's individual circumstances.

Specialized Surgical Care

When surgery is appropriate, the objective is to achieve the greatest possible reduction of tumor burden while carefully considering pulmonary function, overall health, tumor distribution, and the risks and potential benefits of an aggressive operation.

At the Institute for Thoracic Surgery, Dr. Dylewski combines specialized thoracic surgical expertise with advanced minimally invasive techniques when appropriate. The surgical approach is determined by the extent of disease and the requirements of the operation rather than by technology alone.

Our goal is to develop an individualized treatment strategy that combines the appropriate surgical, systemic, and radiation therapies to provide comprehensive cancer care while preserving quality of life whenever possible.

Because mesothelioma is a complex and uncommon malignancy, treatment decisions should be made through a multidisciplinary evaluation at a center with appropriate expertise in the management of this disease.