Pleural mesothelioma is not always cancer. It can be localized and benign or generalized and malignant.
When mesothelioma is localized and benign, it can be surgically removed and not generally life threatening.
Generalized and malignant mesothelioma, however, is an aggressive and dangerous cancer. While treatment options are available, life expectancy for patients is limited. Because of the aggressive nature of this form of cancer, treatment usually begins immediately upon diagnosis. Treatment may include a combination of any or all of the following: surgery, radiation, and chemotherapy. Even in cases where the malignancy cannot be completely removed, surgery is sometimes performed to reduce the size of tumors as a means of improving the patient’s quality of life. Additional treatment may involve draining fluid that builds up in the patient’s lungs.
The pleural mesothelium is an embryonic mesoderm-derived layer of cells which surrounds the lungs. There are two layers of pleural mesothelium. The most common illustration to explain the layers is that of a fist pushing into a balloon. As the fist presses inward, one layer of the balloon is directly against it. This is the visceral layer. The opposite side of the balloon, which mimics the shape of the inner layer is known as the parietal layer. Although the fist is surrounded by the balloon, it is not inside the balloon, or pleural cavity. The pleural cavity is classified as a serous cavity. The pleural cavities permit the lungs to contract and expand with minimal friction. The pleural cavity typically contains a small amount of air and fluid (approximately 10cc of fluid).
First, a high-index of suspicion is necessary after taking a thorough history of the patient, their symptoms and past exposures. Secondly, a chest x-ray will likely display pleural effusion and/or generalized thickening of the pleural tissue. Chest x-ray abnormalities should prompt further imaging studies including CT scan or MRI of the chest. These will then display the possiblility of mesothelioma as a diagnosis. At this juncture, a bronchoscopy may be an option. However, the definitive diagnosis can only be made with an actual tissue sample via biopsy. This is often done through a thoracoscope. Other methods of tissue biopsy include open biopsy and needle biopsy. Tissue biopsy is superior to fluid sampling.