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Mesothelioma

Malignant mesothelioma is a rare cancer that starts in the mesothelium—the thin tissue lining the chest (pleura), abdomen (peritoneum), and less commonly the heart (pericardium) or testicles. Most U.S. cases involve the pleura (lining of the lungs and chest wall). Because every patient’s situation is unique, our team at Illinois CancerCare focuses on timely diagnosis, accurate staging, and personalized treatment plans designed to give you the best possible outcome.  

Where Mesothelioma Starts (Types) 

Pleural mesothelioma (most common)

Forms in the lining of the chest cavity and lungs.

Squamous cell carcinoma  

Forms in the lining of the abdomen.

Pericardial and tunica vaginalis (testicular) mesotheliomas

Very rare. 
Pathology may report epithelioid, sarcomatoid, or biphasic (mixed) cell types; epithelioid generally has a more favorable outlook than other histologies.  

Signs & Symptoms

Symptoms depend on location and may include: 

  • Pleural mesothelioma: chest pain, shortness of breath, persistent dry cough, pleural effusion (fluid around the lung).  
  • Peritoneal mesothelioma: abdominal swelling or pain, early satiety, changes in bowel habits, or bowel obstruction.  

These symptoms are not specific to mesothelioma; evaluation by a clinician is important if they persist or worsen.  

Risk Factors

  • Asbestos exposure (primary risk factor), including occupational and secondhand exposures; disease can appear decades after exposure. 
  • Less commonly, prior radiation or inherited changes that increase susceptibility may play a role. 

Not everyone with exposure develops mesothelioma, and some people are diagnosed without a known exposure history.  

Screening

There is no established population screening for mesothelioma. People with significant past asbestos exposure should discuss symptom awareness and individualized monitoring with their clinician.  

Diagnosis

Diagnosis typically involves: 

(often polyp removal at the same time)

(gold standard for diagnosis) 

to assess spread. These tests help determine cancer type, stage, and treatment planning.

Staging

For pleural mesothelioma, doctors use the AJCC TNM system (tumor extent, lymph nodes, metastasis) to group disease from Stage I–IV; this guides whether surgery is feasible and helps select therapy. Peritoneal, pericardial, and testicular mesotheliomas do not have universally accepted TNM staging systems and are staged more descriptively.  

Treatment Options

Your plan is personalized based on site (pleura vs peritoneum), stage, histology, overall health, and your goals. Care is coordinated by a multidisciplinary team (thoracic/oncologic surgery, medical oncology, radiation oncology, interventional pulmonology/thoracic surgery, radiology, pathology). 

For Pleural Mesothelioma 

  • Surgery (in selected patients): procedures may include pleurectomy/decortication (lungsparing) or extrapleural pneumonectomy in specialized settings; candidacy depends on stage, performance status, and anatomy.  
  • Systemic therapy:  
  • Chemotherapy (commonly pemetrexed + platinum) remains a backbone in many plans.  
  • Immunotherapy (checkpoint inhibitors) can be used in appropriate scenarios, including advanced or unresectable disease.  
  • Targeted/adjunctive options, and Tumor Treating Fields (TTF) for unresectable pleural disease, may be considered based on current evidence and availability.  
  • Radiation therapy: used selectively for symptom relief or as part of a combined strategy.  
  • Symptom focused procedures: thoracentesis, indwelling pleural catheter, or pleurodesis to manage recurrent fluid and improve breathing.  

For Peritoneal Mesothelioma 

In carefully selected patients, cytoreductive surgery with HIPEC (heated intraperitoneal chemotherapy) at high volume centers may offer durable control; others may receive systemic therapy and/or palliative procedures to manage symptoms. (Approach varies by center and candidacy.)  

Because mesothelioma is rare and complex, many patients benefit from evaluation at centers with specialized expertise and access to clinical trials, which may offer innovative therapies. Your Illinois CancerCare physician will discuss trial options and coordinate referrals when helpful. Current Clinical Trials – Illinois CancerCare

Prognosis

Outcomes depend on site, stage, cell type (epithelioid vs sarcomatoid/biphasic), performance status, and response to therapy. For pleural mesothelioma in U.S. data, the 5year relative survival is roughly 23% (localized), 15% (regional), and 11% (distant); your doctor will explain how these population estimates relate to your individual situation.  

Follow Up Care

Follow-up plans may include: 

  • Regular visits with imaging and symptom review to monitor for recurrence/progression 
  • Pulmonary/respiratory therapy, nutrition support, pain and symptom management, and psychosocial services 
  • Guidance on workplace/environmental safety and available support resources for patients and families 

We’ll create a personalized survivorship plan and connect you with resources that support your quality of life throughout care.  

Why Choose Illinois CancerCare

  • Experienced multidisciplinary team coordinating evaluation, treatment, and supportive care 
  • Access to clinical trials and referral pathways to high volume surgical/HIPEC or thoracic programs when appropriate 
  • Compassionate, patient-centered care focused on your goals and quality of life  

Sources & Patient Friendly References

All information was taken from the NCI (National Cancer Institute) and ACS (American Cancer Society).