Malignant Mesothelioma

Written by Stephanie Langmaid
Medically Reviewed by Jabeen Begum, MD on June 30, 2025
6 min read

Malignant mesothelioma is a cancer that most often forms in the thin layers of tissue that line your lungs, chest, or abdomen. In rare cases, it starts in the membranes that surround the heart or testicles.

There are several types of malignant mesothelioma. Doctors know which type you have based on where the cells are located and how they're arranged.

Malignant pleural mesothelioma. Cancer cells are limited to the lining of your chest cavity and the outside of your lungs. This is by far the most common type.

Malignant peritoneal mesothelioma. Cancer cells are in the lining of your abdominal wall and around your organs, including your stomach, liver, and intestines. It is much less common.

Malignant pericardial mesothelioma. This is a very rare type. It affects the lining of the outside of your heart.

Malignant testicular mesothelioma. This is also a very rare type. It involves the lining of your testicles.

In addition, malignant mesothelioma has three subtypes based on how the cancer cells look under a microscope.

Epitheloid is the most common subtype. It's more likely to respond well to treatment.

Sarcomatoid is the least common subtype. It's very aggressive and likely to respond poorly to treatment.

Biphasic means a combination of cells from the other two subtypes. The outlook depends on which kind of cell you have more of.

You're more likely to develop malignant mesothelioma if you or someone you live with has been exposed to asbestos (in the workplace, for example) over a long period. This mineral fiber is found in rock and soil. It was once used in a number of products, such as construction materials, auto parts, and heat-resistant fabrics.

The use of asbestos these days is limited, by law. But it's still used in some industries. And it can be found in older buildings, including homes. Almost everyone comes into contact with it at some point. You might have inhaled or swallowed asbestos particles if you lived or worked in an affected area. Or maybe you or someone in your home worked in construction, auto repair, or shipbuilding.

You can't see asbestos fibers, as they're too small. But they can get stuck in your clothing or shoes, or cling to your body.

Doctors believe these tiny, needle-like fibers can get inside your body's tissues. This causes irritation that can lead to cancer .

You may not have any symptoms for 20-30 years. If you have pleural mesothelioma (the cancer is in the lining of your lungs) or abdominal mesothelioma, you may experience any of the following:

  • Shortness of breath (caused by fluid buildup around your lungs)
  • Dull chest ache or pain under your rib cage
  • Lumps in your abdomen
  • Unexplained weight loss
  • A mass in your scrotum

Your doctor will take a detailed patient history and run several tests, including a chest X-ray, biopsy, CT or PET scan, and blood tests.

If you have malignant mesothelioma, your doctor will test to see whether the cancer has spread to other parts of your body, such as other tissues or the lymph system.

The stage of the cancer, the size of the tumor, your age, and your heart health, among other things, will figure into your treatment.

Standard options are surgery, chemotherapy (chemo), immunotherapy, and radiation therapy. Your doctor might also recommend a combination of surgery and chemo or radiation.

Surgery

If your cancer is found early, you may find long-term benefits from surgery. That's because your surgeon is more likely to remove most or all of the cancerous cells. Many times in advanced cases, surgery is not helpful.

For malignant mesothelioma in the chest (the most common form of this cancer), here are some of the surgical options:

Wide local excision (WLE). Surgeons remove the cancer and some of the healthy tissue around it.

Pleurectomy and decortication. Doctors remove some of the covering of the lungs. They'll also take out part of the lining of the chest and some of the outer covering of the lungs.

Extrapleural pneumonectomy. Your surgeon will remove one of your lungs entirely, along with part of the lining of your chest, your diaphragm, and the lining around your heart.

Pleurodesis. Your doctor will use a catheter to drain fluid that has built up in the space between your chest wall and lungs. Then, chemicals placed into this space will make a scar to help prevent fluid from building up again.

Chemotherapy

This treatment kills fast-growing cells in your body, including cancer cells. It can be used before surgery to shrink tumors, after surgery to kill any remaining cancer cells, or as the main treatment when surgery isn't an option. For malignant mesothelioma, it can be given in two ways. 

Systemic chemotherapy. Anticancer medications are delivered through a needle inserted into a vein, allowing them to travel throughout your body. Drugs are often used in combinations and include:

  • Carboplatin
  • Cisplatin
  • Gemcitabine (Gemzar)
  • Pemetrexed (Alimta)
  • Vinorelbine

Regional chemotherapy. Drugs are delivered directly to the cancer through a tube placed into either your chest or abdominal cavity. The drugs are often heated to make them work better.

This technique is used mainly with malignant peritoneal mesothelioma and is referred to as hyperthermic intraperitoneal chemotherapy (HIPEC). The most common regional chemotherapy drugs for malignant mesothelioma are:

  • Cisplatin plus doxorubicin
  • Paclitaxel
  • Pemetrexed

Radiation

This treatment uses high-energy X-rays to damage the DNA of cancer cells and kill them. It's used less often for malignant mesothelioma because areas of cancer are often widespread and difficult to target. But you may have it after surgery to help destroy any remaining cancer cells. It can also help lessen symptoms such as pain and trouble breathing.

Tumor Treating Fields (TTFields)

This treatment uses a device that you wear on your back or chest. It creates mild electrical currents that disrupt the division of cancer cells, killing them. The Optune Lua device is approved for use in combination with chemotherapy for some people with malignant pleural mesothelioma that can't be treated with surgery.

Immunotherapy 

Immunotherapy drugs use your body's immune system to fight the cancer. They may help you if you have malignant mesothelioma that can't be treated with surgery or has gotten worse after other treatment. They're delivered through a needle inserted in a vein in your arm. Approved drugs include:

  • Ipilimumab (Yervoy) 
  • Nivolumab (Opdivo)
  • Pembrolizumab (Keytruda)

Targeted therapy 

Drugs in this class are designed to take advantage of certain weaknesses in cancer cells. For example, bevacizumab (Avastin) blocks a protein that tumors need to form new blood vessels, so they can't survive. It can be used along with chemotherapy for malignant mesothelioma. Researchers are working on other ways to target mesothelioma cells.

How much asbestos exposure causes mesothelioma?

That's something doctors can't say. Some people with very little exposure have developed asbestos-related diseases. But in general, the heavier and longer your exposure, the higher your chances of having mesothelioma.

What causes mesothelioma other than asbestos​?

While asbestos exposure is by far the most common cause of mesothelioma, some people who get it have never been exposed. Doctors think some cases may be caused by radiation exposure from other cancer treatments. Certain gene changes may also raise your risk.

Is mesothelioma curable?

Most of the time, no. If it's found very early, it may be possible to remove all of the cancer, but there's a very good chance it will come back. For most people, treatment aims to ease symptoms and keep the disease from worsening for as long as possible.

What are the survival rates of malignant mesothelioma?

Survival rates are different depending on the type of malignant mesothelioma, how early it's detected, and how it's treated. Most people live for at least a year with treatment. However, after five years, someone with malignant pleural mesothelioma is only 12% as likely to be alive as someone who doesn't have it. Peritoneal mesothelioma tends to be less aggressive, with a five-year survival rate of 65%.