About Mesothelioma and Pleural Disease Treatment at Penn Medicine

Mesothelioma and Pleural Disease Treatment at Penn Medicine

When treating patients with mesothelioma or pleural disease, Penn Medicine pleural specialists offer more treatment options than most other health systems across the country and around the world.

Penn Medicine's Mesothelioma and Pleural Program and Penn's Abramson Cancer Center in Philadelphia, PA bring together internationally renowned experts in medical, surgical and radiation oncology and pulmonology who collaborate in the diagnosis, treatment and research of mesothelioma and pleural disease.

Focus on Mesothelioma

Mesothelioma is a rare type of cancer that affects the lining of the chest or abdominal cavities. It is most often attributed to exposure to airborne asbestos particles and occurs in both men and women. Asbestos fibers are naturally occurring fibrous minerals that were commonly used in construction and thermal insulation as a fire retardant until the 1970s. Asbestos is still used in products, but regulations in place since the 1980s limit its use.

Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

Penn's multidisciplinary approach to cancer diagnosis and treatment provides better outcomes and gives patients access to the most advanced treatment, surgical techniques and clinical trials.


Mesothelioma and Pleural Disease Risk and Prevention

There is no guaranteed way to prevent mesothelioma or pleural disease. However, by avoiding asbestos exposure, people can significantly reduce their chances of developing these conditions.

Patients who feel they are at risk may benefit from consulting with a risk assessment specialist.

Mesothelioma and Pleural Disease Risk Factors

Risk factors affect a person's chance of getting mesothelioma or pleural disease. Having a risk factor, or even several, does not mean that someone will get cancer.

There are different kinds of risk factors. Some factors, like family history, can't be changed. Risk factors for mesothelioma and pleural disease include:

  • Asbestos exposure. Asbestos is the primary risk factor for mesothelioma and is a particular concern for individuals who worked in construction or shipbuilding prior to 1980 when asbestos use in these industries was prominent.
  • Living with someone who works with asbestos. Living with someone who works with asbestos may also increase an individual's risk for developing mesothelioma because asbestos particles can travel on skin and clothing.
  • Radiation exposure. Radiation exposure – particularly to the radioactive substance thorium dioxide, which was used with X-rays to diagnose health conditions between the 1920s and 1950 – may increase the risk of developing mesothelioma.
  • A family history of mesothelioma. A family history of mesothelioma may increase an individual's risk of developing cancer.

Mesothelioma and Pleural Disease Prevention

While there's no guaranteed way to prevent mesothelioma and pleural disease, there are steps people can take to reduce their risk of developing the disease.

  • Avoid asbestos exposure. Individuals who work with asbestos should use all protective equipment – such as respirators or coveralls – provided by their employers and follow recommended workplace practices and safety procedures. To avoid bringing asbestos particles home, workers should shower and change clothes before they leave work; store their street clothes in a separate area of the workplace; and wash their work clothes separately from other laundry at home.
  • Quit smoking. Quitting smoking can decrease the risk of developing lung cancer, which has been associated with asbestos exposure. Patients can get help to stop smoking through the Penn Lung Center or through a smoking cessation research program at the Abramson Cancer Center.

Mesothelioma and Pleural Disease Risk Assessment

The Cancer Risk Evaluation Programs at Penn Medicine offer knowledge about the presence of genetic risk factors for cancer and provide patients with important, sometimes life-saving options.

Patients at increased risk for mesothelioma or pleural disease may benefit from meeting with a cancer risk assessment counselor.

Types of Mesothelioma and Pleural Disease

  • Benign and malignant primary tumors of the pleural space
  • Empyema
  • Hemothorax
  • Mesothelioma
    • Epithelioid
    • Sarcomatoid
    • Biphasic
    • Desmoplastic
  • Metastatic cancers to the pleural space
  • Pleural effusion
  • Pleurisy
  • Pneumothorax

Mesothelioma

Mesothelioma is a rare type of cancer that affects the lining (mesothelium) of the chest (called the pleura) or abdomen (called the peritoneum). There are several different subtypes of mesothelioma, including epithelioid, sarcomatoid, biphasic and desmoplastic. Mesothelioma is most often attributed to exposure to airborne asbestos particles and occurs in both men and women. Asbestos is a group of naturally occurring fibrous minerals used as a fire retardant.

Respiratory system

Abramson Cancer Center

Symptoms of pleural mesothelioma include decreased appetite, weight loss, fatigue, shortness of breath and pain in the chest due to an accumulation of fluid in the pleura. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

Treatment options for mesothelioma include chemotherapy, radiation therapy, surgery or participation in clinical trials testing new therapies.

Metastatic Cancers to the Pleural Space

There are several cancers that can spread to the pleural space. These cancers present a challenge for the health care team caring for these patients. Some of the cancers that have been known to spread to the pleura include: colon cancer, breast cancer, thymic cancer and sarcomas.

Treatment for these metastatic cancers can range from palliative care to aggressive multimodal treatments. The Penn Mesothelioma and Pleural Program specialists work closely with the oncologists at the Abramson Cancer Center in developing the most appropriate treatment plan for every individual.

Benign and Malignant Primary Tumors of the Pleural Space

While mesothelioma is the most common primary tumor of the pleural space, other tumors of the pleural space include:

  • Adenomatoid tumor
  • Benign solitary fibrous tumors of the pleura
  • Calcifying fibrous tumor
  • Desmoids tumor
  • Lipomatous tumors
  • Multicystic mesothelioma
  • Nodular pleural plaque
  • Pleural thymoma
  • Schwannoma
  • Simple mesothelial cysts
  • Well-differentiated papillary mesothelioma

Uncommon primary pleural neoplasms can mimic each other, as well as mimic metastatic cancers to the pleura and diffuse malignant mesothelioma. Correct diagnosis is important because of differing treatment options for the various tumors.

Pleural Effusion

A pleural effusion occurs when the pleural fluid that lubricates the surfaces of the pleura builds up to abnormal, excessive amounts. Pleural effusions can be caused by congestive heart failure, pulmonary embolism, cirrhosis, cancer, infections, open-heart surgery, and physical trauma.

Symptoms of pleural effusion include:

  • Chest pain that worsens with coughing or deep breathing
  • Coughing
  • Fever
  • Hiccups
  • Rapid breathing
  • Shortness of breath

Treatment for pleural effusion depends on the cause for the condition and can include chemotherapy or surgery. Management of a pleural effusion by drainage and/or chest tube placement is very important.

Pleurisy

Pleurisy – also called pleuritis – occurs when the membrane (pleura) that lines the chest cavity and surrounds the lungs becomes inflamed. It can be related to a variety of underlying symptoms including asbestos-related disease, certain cancers, chest trauma, pulmonary embolus, and rheumatic disease.

The main symptom of pleurisy is sharp pain that occurs when inhaling and exhaling or coughing. Some people experience pain in the shoulder. When fluid collects in the chest cavity as a result of pleurisy, it can cause additional symptoms including shortness of breath, rapid breathing, coughing or bluish skin (cyanosis).

Relieving pleurisy involves treating the underlying problem, if known. Current treatment options include antibiotics, acetaminophen and anti-inflammatory drugs, and thoracentesis.

Pneumothorax

A pneumothorax, or collapsed lung, is the collection of air in the space around the lungs. This buildup of air puts pressure on the lung so it cannot expand as much as it would normally when breathing. A pneumothorax may be caused by chest trauma, rib fracture, certain medical procedures, select lung conditions and, in come cases, there may be no direct cause. Additionally, some activities such as scuba diving, smoking, and high-altitude biking and flying can cause a pneumothorax.

The symptoms of pneumothorax include sharp chest pain and shortness of breath. Large pneumothorax can cause chest tightness, easy fatigue, rapid heart rate, and bluish skin (cyanosis).

In less severe cases, the pneumothorax may go away with oxygen and rest. When the patient is experiencing a large pneumothorax, Penn surgeons place a chest tube between the ribs in the space around the lungs to help drain the air and allow the lung to re-expand. The tube may be left in place for several days and often requires hospitalization. In select cases, Penn surgeons operate on the patient to repair the leak.

Hemothorax

A hemothorax is a collection of blood in the space between the chest wall and the lung as a result of chest trauma. Hemothorax can also be caused by a defect of blood clotting, pulmonary infarction, lung or pleural cancer, placement of a central venous catheter, thoracic or heart surgery, and tuberculosis.

Hemothorax is associated with:

  • Anxiety
  • Chest pain
  • Low blood pressure
  • Rapid heart rate
  • Rapid, shallow breathing
  • Restlessness
  • Shortness of breath
  • Pale, cool and clammy skin

A chest tube, inserted through the chest wall, is used to remove the blood and air in the pleural space. It remains in place for several days to re-expand the lung. When a hemothorax is severe, a thoracotomy may be needed to stop the bleeding.

Empyema

Empyema is a collection of pus in the pleural space, caused by an infection that spreads from the lung and leads to a buildup of pus in the pleural space. Risk factors for empyema include bacterial pneumonia, lung abscess, previous thoracic surgery, or trauma or injury to the chest. Empyema can occur when a needle is inserted through the chest wall to draw fluid from the pleural space.

Symptoms of empyema include:

  • Chest pain
  • Dry cough
  • Excessive sweating
  • Fever and chills
  • Shortness of breath
  • Fatigue
  • Unintentional weight loss

Treatment for this condition includes both systemic and local treatment.

Mesothelioma and Pleural Disease Symptoms

Mesothelioma Symptoms

Symptoms of pleural mesothelioma may include:

  • Abdominal pain and swelling
  • Anemia
  • Blood clotting abnormalities
  • Bowel obstruction
  • Fever
  • Pain in the chest
  • Shortness of breath
  • Weight loss without dieting

If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

Pleural Effusion Symptoms

Symptoms of pleural effusion include:

  • Chest pain that worsens with coughing or deep breathing
  • Coughing
  • Fever
  • Hiccups
  • Rapid breathing
  • Shortness of breath

Pleurisy Symptoms

The main symptom of pleurisy is sharp pain that occurs when inhaling and exhaling or with coughing. Some people experience pain in the shoulder. When fluid collects in the chest cavity as a result of pleurisy, it may cause additional symptoms including:

  • Shortness of breath
  • Rapid breathing
  • Coughing
  • Bluish skin (cyanosis)

Pneumothorax Symptoms

Sharp chest pain and shortness of breath are the main symptoms of a pneumothorax, or collapsed lung. Large pneumothorax can cause chest tightness, easy fatigue, rapid heart rate, and bluish skin (cyanosis).

Hemothorax Symptoms

There are several possible symptoms associated with a hemothorax including:

  • Anxiety
  • Chest pain
  • Low blood pressure
  • Pale, cool and clammy skin
  • Rapid heart rate
  • Rapid, shallow breathing
  • Restlessness
  • Shortness of breath

Staging Mesothelioma & Pleural Disease

"Staging" is a system that provides doctors with a common language for describing tumors. After cancer is first diagnosed, a series of tests are used to investigate the extent of the cancer and to see whether it has spread to other parts of the body from where it started.

Staging is a way of recording the size and growth of a cancer, and determining the plan for treatment. Mesothelioma is broadly staged into two categories: localized (the tumor is restricted to the membrane surface where it originated) and advanced (the tumor has spread to neighboring structures and distant organs and tissues). By understanding the stage of their cancer, patients can make informed decisions about their treatment.

Staging mesothelioma attempts to discover the following:

  • The size of the tumor
  • Whether the cancer has spread to nearby tissues
  • Whether the cancer has spread to other parts of the body

Mesothelioma and Pleural Disease Treatment at Penn

Patients under the care of Penn's Mesothelioma and Pleural Program benefit from a multidisciplinary team of specialists who are committed to providing the most advanced treatment options available for these conditions. At Penn, patients and their families receive the support and education that they need to understand the diagnosis as well as the vast resources available to them through the health system.

In addition to the physician, the Penn Medicine Mesothelioma and Pleural Program's internationally recognized specialists are supported by an experienced and dedicated health care team that includes:

  • Nurses with advanced training and experience in treating mesothelioma and pleural disease
  • Patient navigators who help patients navigate their treatment
  • Respiratory therapists who evaluate, treat, and care for patients with breathing or other cardiopulmonary disorders
  • Registered dieticians to provide nutritional counseling
  • Cancer counselors to provide individual or family counseling for issues many patients face
  • Speech/swallow specialists who specialize in the diagnosis and treatment of physical effects from cancer and its treatments

Research plays an important role within Penn's Mesothelioma and Pleural Program. When appropriate, patients are enrolled in clinical trials that help to improve current treatments or obtain information about new treatments.

At Penn, researchers are exploring ways to improve and expedite the diagnostic process through a greater understanding of mesothelioma's genetic links. They are also aggressively studying the use of photodynamic therapy and proton therapy – two technologies that are showing promise in the treatment of mesothelioma.

Diagnosing Mesothelioma and Pleural Disease

An accurate diagnosis is the key to providing patients with the high level of care that they require for mesothelioma or pleural disease. At Penn, specialists who have extensive experience diagnosing and treating these complex conditions employ the latest tests and tools to provide patients with a timely, accurate diagnosis.

Read more Mesothelioma and Pleural Disease Diagnosis

Mesothelioma and Pleural Disease Treatment

Penn Medicine's pleural specialists develop personalized treatment plans for patients with mesothelioma and pleural disease, designed to give every patient the best possible outcome. Penn's treatment options for mesothelioma and pleural disease include:

  • Surgery
    • Extrapleural pneumonectomy
    • Indwelling pleural catheter (IPC)
    • Lung-sparing surgery
    • Minimally invasive surgery
    • Peritoneal cytoreductive surgery
    • Pleural sclerosis and fibrinolytics
    • Therapeutic thoracentesis
    • Thoracotomy
    • Video-assisted thoracoscopic surgery (VATS)
  • Radiation Therapy
    • Brachytherapy
    • Intensity-modulated radiation therapy (IMRT)
    • Photodynamic therapy (PDT)
    • Proton therapy
    • Volumetric-modulated arc therapy (VMAT)
  • Chemotherapy and Biologic Therapies
    • Combination chemotherapy
    • Immunotherapy
    • Targeted therapies
    • Gene therapy
    • Adjuvant therapy
  • Interventional Pulmonology Treatments
    • Endobronchial ultrasound-guided biopsy and mediastinal staging
    • Pleuroscopy and pleurodesis
  • Clinical Trials
  • Other Treatments
    • Integrative medicine and wellness
    • Palliative care
    • Penn Home Care and Hospice

Patients who come to Penn Medicine for their cancer care benefit from coordinated care across disciplines and modalities. The expertise of Penn's Abramson Cancer Center in cancer diagnosis, treatment planning and integrated medicine, helps patients who come to Penn Mesothelioma and Pleural Program receive nationally recognized care that leads to better outcomes and improved quality of life.

Read more Mesothelioma and Pleural Disease Treatment

Mesothelioma and Pleural Disease Survivorship

At Penn Medicine, significant research in the diagnosis and treatment of mesothelioma and pleural disease is giving patients with these conditions new hope for long-term survival.

To meet patients' varied physical, emotional and financial needs, Penn's robust network of navigation specialists includes social workers, stress management specialists, alternative medicine practitioners and clergy. Additionally, the support groups and survivorship programs at Penn provide patients and their families with a valuable network that serves to enhance and extend the quality of life following a cancer diagnosis.

Read more Mesothelioma and Pleural Disease Survivorship


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