Pleural Mesothelioma: Symptoms, Diagnosis and Treatment

Author: Ian C. Langtree - View Credentials
Published: 31 Mar 2009 - Updated: 3 Oct 2026
Publication Type: Informative

Table of Contents:
Synopsis - Definition - Overview - FAQs - Insights, Updates - Related Content

Synopsis

This information describes pleural mesothelioma, a rare cancer in which malignant cells form in the pleura, the thin layer of tissue that lines the chest cavity and covers the lungs. Asbestos is the main cause, with a history of workplace exposure reported in roughly 70 to 80 percent of cases, and symptoms such as shortness of breath and chest pain from fluid buildup may not show up until 30 to 50 years after that exposure. The material walks through how the disease is diagnosed, how it is staged and what the standard treatments are, which makes it a practical reference for patients, families and caregivers trying to make sense of a diagnosis. It is especially relevant to older adults who worked around asbestos decades ago and to anyone applying for disability benefits, since the U.S. Social Security Administration lists pleural mesothelioma as a Compassionate Allowance condition, which speeds up the handling of a claim.

At a Glance

• 1 - Mesothelioma occurs more often in men than in women, and the risk rises with age, although it can appear in either sex at any age.
• 2 - Treatment depends on where the cancer is, the size of the tumor, how much fluid is in the chest, the stage of the disease, and the person's age and general health.
• 3 - Stages II, III and IV are all classed as advanced disease. By stage IV the cancer has reached distant organs or tissues, and survival is generally limited to less than two years.
• 4 - A biopsy is needed to confirm pleural mesothelioma. Doctors often obtain the tissue sample by thoracoscopy, passing a thin, lighted tube between two ribs to look inside the chest.

Topic Definition

Pleural Mesothelioma

Pleural mesothelioma is a rare, aggressive cancer that develops in the pleura, the thin two-layered membrane that lines the inside of the chest wall and wraps around the lungs. It is the most common form of mesothelioma and is caused in most cases by inhaling asbestos fibers, which become lodged in the pleural tissue and trigger cell damage that can take 30 to 50 years to turn into cancer. As tumors spread across the pleura, fluid often collects in the chest and restricts the lungs, producing the shortness of breath and chest pain that typically lead to diagnosis.

Overview

Pleural Mesothelioma is a rare type of cancer in which malignant cells are found in the pleura (the thin layer of tissue that lines the chest cavity and covers the lungs).

The U.S. Social Security Administration (SSA) has included Pleural Mesothelioma as a Compassionate Allowance to expedite a disability claim.

Exposure to airborne asbestos particles increases one's risk of developing malignant mesothelioma. Mesothelioma remains a relatively rare cancer. About 2,000 new mesothelioma cases are diagnosed annually in the United States.

Mesothelioma occurs more often in men than in women, and risk increases with age, but this disease can appear in either men or women at any age.

Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without known exposure to asbestos.

Symptoms of mesothelioma may not appear until 30 to 50 years after asbestos exposure. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma.

Diagnosing pleural mesothelioma is often difficult because the symptoms are similar to those of several other conditions.

Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT scan or an MRI may also be useful.

A biopsy is needed to confirm a diagnosis of pleural mesothelioma. In a biopsy, a surgeon or medical oncologist (a doctor specializing in diagnosing and treating cancer) removes a tissue sample for examination. The doctor may perform a thoracoscopy if the cancer is in the chest. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. More extensive diagnostic surgery may be necessary if the procedure does not yield enough tissue.

Treatment for pleural mesothelioma depends on the cancer's location, the tumor's size, the amount of fluid in the chest, the stage of the disease, and the individual's age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Surgery is associated with a median survival time of 15-24 months.

Pleural mesothelioma patients who undergo lung-sparing surgery in combination with photodynamic therapy (PDT) show better overall survival than patients treated with the conventional therapy of extrapleural pneumonectomy (EPP) (or en bloc removal of the lung and surrounding tissue) with PDT - Pleural Mesothelioma Combination Therapy Shows Promise

Advanced malignant mesothelioma includes stages II, III, and IV.

• In stage II, cancer is found in the lining of the chest wall and the lymph nodes on the same side of the chest. Cancer may also be found in the lining of the lung, the lining of the diaphragm, or the sac lining that covers the heart on the same side of the chest.
• In stage III, cancer has spread to any of the following areas: the chest wall, the mediastinum, the heart, beyond the diaphragm, and the peritoneum. Cancer may have also spread to lymph nodes on the other side of the chest or outside the chest.
• In stage IV, cancer has spread to distant organs or tissues. The prognosis is poor, with a limited survival time of fewer than two years.

Social Security Disability and the Compassionate Allowance for Pleural Mesothelioma

Pleural mesothelioma is one of 314 conditions on the Social Security Administration's Compassionate Allowances list [Social Security Administration, 2026b]. The list covers diseases that, by definition, meet Social Security's standard for disability, so a claim can be approved on confirmation of the diagnosis instead of a lengthy review of how the illness limits a person's ability to work [Social Security Administration, n.d.-b].

What the Compassionate Allowance Does - and Does Not Do

A Compassionate Allowance is not a separate benefit and it does not pay extra money. It is a fast-track route to a decision on an ordinary Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) claim. SSA rates malignant mesothelioma of the pleura under listing 13.15A of its adult cancer listings, which is met by the diagnosis alone, with no requirement that the cancer has spread or returned after treatment [Social Security Administration, n.d.-a].

How to Apply

There is no special Compassionate Allowance form. You file a standard disability application, and SSA's software screens each claim for conditions on the list, with staff also able to flag a case by hand [Social Security Administration, 2018]. It helps to state the diagnosis exactly as it appears on the pathology report. You can apply in any of these ways [Social Security Administration, 2026a]:

• Online at ssa.gov/disability
• By phone at 1-800-772-1213, Monday through Friday, 8 a.m. to 7 p.m.
• By TTY at 1-800-325-0778 if you are deaf or hard of hearing
• In person at a local Social Security office, by appointment

SSA advises applying as soon as the condition prevents you from working. Have ready the names, addresses and phone numbers of your doctors, hospitals and clinics, your medical records and lab results, a summary of your work history, and your most recent W-2 [Social Security Administration, 2026a].

Medical Evidence SSA Looks For

For pleural mesothelioma, SSA's guidance to its disability examiners asks for two things: a biopsy, and a pathology report confirming the diagnosis. The guidance states that pathology alone is enough to decide the claim [Social Security Administration, 2025]. Asking your oncologist or hospital to send the pathology report promptly is the single most useful thing you can do to avoid delay.

How Long a Decision Takes

SSA does not publish a guaranteed timeframe for Compassionate Allowance decisions. A standard disability application takes six to eight months on average [Social Security Administration, 2026a]. Fast-track claims are handled differently - state disability offices are instructed to assign them to an examiner the same day they arrive where possible [Social Security Administration, 2018].

A fast decision does not mean an immediate payment. SSDI has a five-month waiting period, with the first benefit paid for the sixth full month after the date SSA finds the disability began [Social Security Administration, 2022]. Medicare coverage follows automatically after two years of disability benefits [Social Security Administration, 2026a].

SSDI and SSI - Which One Applies

The Compassionate Allowance works the same way for both programs, but the non-medical rules differ:

• SSDI is based on your work record. You generally need to have worked at least 5 of the last 10 years [Social Security Administration, 2026c].
• SSI is based on financial need. It is for people with little or no income and resources of no more than $2,000 for an individual or $3,000 for a couple [Social Security Administration, 2026d].

Some people qualify for both. Certain family members, including a spouse aged 62 or older and unmarried children under 18, may also be eligible for benefits on an SSDI recipient's record [Social Security Administration, 2026a].

References

• Social Security Administration. (n.d.-a). 13.00 Cancer - Adult. Disability Evaluation Under Social Security.
• Social Security Administration. (n.d.-b). Compassionate Allowances.
• Social Security Administration. (2018). DI 23022.030 Identifying and Receipting Compassionate Allowances (CAL) and Quick Disability Determinations (QDD) Cases. Program Operations Manual System.
• Social Security Administration. (2022). Is There a Waiting Period for Social Security Disability Insurance (SSDI) Benefits?
• Social Security Administration. (2025). DI 23022.275 Pleural Mesothelioma. Program Operations Manual System.
• Social Security Administration. (2026a). Disability Benefits (Publication No. 05-10029).
• Social Security Administration. (2026b, August 11). Social Security Adds 14 Conditions to Compassionate Allowances List.
• Social Security Administration. (2026c). Who Can Get Disability.
• Social Security Administration. (2026d). Who Can Get SSI.

Frequently Asked Questions

Is pleural mesothelioma the same as lung cancer?

No. Lung cancer starts inside the lung tissue itself, while pleural mesothelioma starts in the pleura, the thin lining around the lungs and chest wall. The two cancers behave differently and are staged and treated in different ways.

What are the cell types of pleural mesothelioma?

There are three main cell types - epithelioid, sarcomatoid and biphasic, which is a mix of the two. Epithelioid is the most common and generally responds best to treatment, while sarcomatoid tumors tend to grow faster and are harder to treat.

Is immunotherapy used to treat pleural mesothelioma?

Yes. In 2020 the FDA approved the combination of nivolumab and ipilimumab as a first treatment for adults with pleural mesothelioma that cannot be removed by surgery. Immunotherapy drugs help the immune system recognize and attack cancer cells.

Can family members of asbestos workers develop pleural mesothelioma?

Yes. Asbestos fibers can be carried home on work clothes, shoes, skin and hair, exposing other people in the household. This is often called secondhand or take-home exposure, and cases have been reported in the spouses and children of asbestos workers.

Which jobs carry the highest risk of asbestos exposure?

Historically, the highest risks were in shipbuilding, construction, insulation work, asbestos mining and milling, and the manufacture of asbestos products. Plumbers, pipefitters, electricians, mechanics who handled brake linings and Navy veterans who served aboard older ships were also heavily exposed.

What is a pleural effusion and how is it treated?

A pleural effusion is a buildup of fluid between the layers of the pleura that presses on the lung and causes breathlessness. Doctors can drain it with a needle in a procedure called thoracentesis, and may use pleurodesis or a small indwelling catheter to stop the fluid from returning.

Is pleural mesothelioma hereditary?

Pleural mesothelioma is not usually inherited. However, people born with a mutation in a gene called BAP1 have a higher risk of developing mesothelioma and certain other cancers, particularly if they are also exposed to asbestos.

Can veterans with pleural mesothelioma receive VA benefits?

Veterans who were exposed to asbestos during military service and later develop pleural mesothelioma may qualify for VA disability compensation and health care. A claim generally needs medical evidence of the diagnosis and evidence linking the asbestos exposure to service.

Insights, Analysis, and Developments

Editorial Note: Pleural mesothelioma is hard to catch early for two reasons - its symptoms resemble those of several far more common chest conditions, and the exposure that caused it usually happened so long ago that neither patient nor doctor thinks to connect the two. That is why a full work and medical history matters as much as the chest X-ray, CT or MRI that follows, and why anyone who ever handled asbestos, or worked near people who did, should say so at the first sign of persistent breathlessness or chest pain. It is also worth remembering that the disease has been reported in people with no known asbestos exposure at all. Surgery, radiation therapy and chemotherapy remain the standard options, and one study found that lung-sparing surgery combined with photodynamic therapy was associated with better overall survival than removal of the entire lung, a sign that less radical approaches may have a growing role.

Author Credentials: Ian C. Langtree is a writer, editor, and the founder and Editor-in-Chief of Disabled World, which he established in 2004 as one of the longest-running independent resources for disability news and information. Over more than two decades, he has written and edited thousands of articles on disability rights, health, accessibility, and assistive technology. Drawing on a global perspective shaped by extensive travel and lived experience, Ian is a committed advocate of the Social Model of Disability, the framework developed by disabled activists in the 1970s that focuses on removing societal barriers rather than on individual impairments. His writing is grounded in that framework and in a lasting commitment to disability rights, accessibility, and social inclusion. To learn more about Ian's background, expertise, and accomplishments, visit his full biography.