Pleural mesothelioma
Pleural mesothelioma starts in the pleura, the thin lining around the lungs and inside the chest wall. It is the most common type, making up more than 8 in 10 cases.
Last reviewed October 27, 2026 against the sources listed at the end of this page.
In short
- Common symptoms: pain in the side of the chest or lower back, shortness of breath, cough, hoarseness, and trouble swallowing.
- Fluid around the lung (a pleural effusion) is often the first finding.
- It is the only type with a formal staging system (AJCC stages I to IV).
- Treatment can include surgery, chemotherapy, immunotherapy, radiation, and procedures to control fluid.
Symptoms
The American Cancer Society lists these possible symptoms of pleural mesothelioma:
- pain in the side of the chest or the lower back
- shortness of breath
- cough
- trouble swallowing, or a feeling that food gets stuck
- hoarseness
General symptoms such as fever, night sweats, tiredness, and weight loss without trying can also occur. These problems are more often caused by something other than cancer. Still, anyone with a history of asbestos exposure who has them should tell a doctor about that exposure.
How it is found
A chest x-ray or CT scan often shows fluid around the lung (a pleural effusion) or thickening of the pleura. Draining the fluid with a needle (thoracentesis) relieves breathing and lets the lab look for cancer cells, but the American Cancer Society notes that fluid alone often cannot confirm the diagnosis. A tissue sample taken through a small camera in the chest (thoracoscopy, also called VATS) is commonly used. More on diagnosis.
Staging
Pleural mesothelioma is the only type with a formal staging system, the American Joint Committee on Cancer (AJCC) TNM system. Stages run from I to IV. Lower numbers mean the cancer is more limited. Doctors also talk about whether a tumor is resectable (can be removed with surgery). The American Cancer Society says most stage I and II and some stage III tumors are resectable, with exceptions.
Treatment
NCI describes these options for pleural mesothelioma, used alone or together:
- Surgery, such as pleurectomy and decortication (removing the lining and the tumor on the lung's surface) or extrapleural pneumonectomy (removing a whole lung, part of the chest lining, the diaphragm, and the lining around the heart).
- Immunotherapy with nivolumab and ipilimumab for advanced disease.
- Chemotherapy, sometimes with the targeted drug bevacizumab.
- Radiation therapy, including to relieve symptoms.
- Pleurodesis or a drainage catheter to stop fluid from building up again.
- Clinical trials testing new treatments.
See treatment options for a plain-English guide to each.
For veterans and shipyard workers
Pleural mesothelioma is the type most often linked to heavy workplace exposure, including Navy ships and shipyards. If you served in the military, read VA benefits for asbestos exposure. Free help from an accredited Veterans Service Organization is available.
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Start the free reviewThis page is general health information, summarized from the sources below. It is not medical advice. Talk with your own doctor or care team about your situation.