Mesothelioma develops in different locations throughout the body, with pleural mesothelioma (lung lining) accounting for 75-80% of cases and peritoneal mesothelioma (abdominal lining) comprising 15-20% [3]. These two primary types differ significantly in symptoms, treatment approaches, and survival outcomes—with peritoneal patients often achieving better prognosis due to specialized HIPEC surgery that can extend median survival beyond 5 years [2].
Executive Summary
The location of mesothelioma fundamentally affects your treatment options and outcomes. Pleural mesothelioma develops in the lung lining, causing breathing difficulties and chest pain, and is treated with lung surgeries, chemotherapy, and immunotherapy [1]. Peritoneal mesothelioma develops in the abdominal lining, causing swelling and digestive symptoms, but often has better outcomes because of HIPEC surgery—a procedure combining tumor removal with heated chemotherapy that achieves 5-year survival rates of 50-67% at specialized centers [2]. Rare forms include pericardial (heart lining) and testicular mesothelioma, together comprising less than 5% of cases. Understanding which type you have is essential for connecting with the right specialists and treatment centers.
10 Key Facts About Mesothelioma Types
- Pleural Mesothelioma Prevalence: 75-80% of all cases [3]
- Peritoneal Mesothelioma Prevalence: 15-20% of all cases [3]
- Pericardial/Testicular Combined: Less than 5% of cases [3]
- Pleural Median Survival: 12-21 months with treatment [5]
- Peritoneal Median Survival with HIPEC: 53-92 months at specialized centers [2]
- HIPEC 5-Year Survival Rate: 50-67% for eligible patients [4]
- Pleural Main Symptoms: Shortness of breath, chest pain, cough
- Peritoneal Main Symptoms: Abdominal swelling, pain, digestive issues
- HIPEC Centers in US: Approximately 100+ offer the procedure [4]
- Cause for All Types: Asbestos exposure (20-50 year latency period)
What Is Pleural Mesothelioma?
Pleural mesothelioma is the most common form of this cancer, developing in the pleura—the thin, two-layered membrane surrounding the lungs [1]. When asbestos fibers are inhaled, they can lodge in lung tissue and migrate to the pleura, causing cellular damage that leads to cancer over 20-50 years.
Percentage of mesothelioma cases that are pleural
Pleural Mesothelioma Symptoms
Symptoms develop as tumors grow and fluid accumulates between the pleural layers:
- Shortness of breath (dyspnea): Most common early symptom; worsens over time
- Chest pain: Often one-sided; may worsen with breathing or coughing
- Persistent dry cough: Typically without mucus production
- Pleural effusion: Fluid buildup causing pressure on lungs
- Unexplained weight loss: Often 10+ pounds without diet changes
- Fatigue: Persistent tiredness affecting daily activities
- Night sweats: Particularly as disease progresses
Early symptoms often mimic common respiratory conditions, leading to diagnostic delays. The mesothelioma symptoms guide provides detailed information on warning signs.
Pleural Mesothelioma Treatment Options
Treatment depends on stage and cell type but may include:
- Surgery: Extrapleural pneumonectomy (EPP) removes the affected lung, pleura, diaphragm, and pericardium. Pleurectomy/decortication (P/D) removes the pleura while preserving the lung.
- Chemotherapy: Pemetrexed plus cisplatin or carboplatin is standard first-line treatment
- Immunotherapy: Nivolumab plus ipilimumab (Opdivo + Yervoy) approved for unresectable pleural mesothelioma
- Radiation: Used as part of multimodal treatment or for symptom control
- Tumor Treating Fields (TTFields): FDA-approved device therapy showing survival benefits
Pleural Mesothelioma Prognosis
Survival varies significantly based on stage and treatment:
| Stage | Median Survival | Treatment Approach |
|---|---|---|
| Stage 1 | 21+ months | Surgery + chemotherapy + radiation |
| Stage 2 | 15-19 months | Surgery possible; multimodal treatment |
| Stage 3 | 12-16 months | Chemotherapy/immunotherapy; palliative surgery |
| Stage 4 | 4-12 months | Palliative care; clinical trials |
"First and foremost, we make sure the family is receiving the best medical care available. For pleural patients, that means connecting with thoracic oncology centers experienced in mesothelioma—not every cancer center has this expertise. My own father died of asbestos lung cancer, so I understand how critical proper specialist care is."
— David Foster, Executive Director of Client Services, Danziger & De Llano
What Is Peritoneal Mesothelioma?
Peritoneal mesothelioma develops in the peritoneum—the membrane lining the abdominal cavity and covering abdominal organs [2]. It occurs when ingested or inhaled asbestos fibers reach the abdomen, either through the digestive tract or by migration through the body.
Five-year survival rate with HIPEC surgery for eligible patients
Peritoneal Mesothelioma Symptoms
Symptoms reflect the abdominal location of tumors:
- Abdominal swelling (distension): Often the first noticeable symptom
- Abdominal pain: Can be diffuse or localized
- Ascites: Fluid accumulation in the abdominal cavity
- Nausea and vomiting: As tumors affect digestive function
- Changes in bowel habits: Constipation or diarrhea
- Loss of appetite: Leading to significant weight loss
- Feeling full quickly: Even after small meals
- Fatigue: Worsening as disease progresses
These symptoms are often mistaken for irritable bowel syndrome, ovarian cancer (in women), or other gastrointestinal conditions.
Peritoneal Mesothelioma Treatment: The HIPEC Advantage
Peritoneal mesothelioma treatment has been revolutionized by HIPEC (Heated Intraperitoneal Chemotherapy), a specialized procedure combining:
- Cytoreductive Surgery (CRS): Surgeons remove all visible tumor tissue from the abdominal cavity
- Heated Chemotherapy: After tumor removal, heated chemotherapy (104-109°F) circulates through the abdomen for 60-90 minutes
This approach achieves dramatically better outcomes than systemic chemotherapy alone [4]:
| Treatment Approach | Median Survival | 5-Year Survival |
|---|---|---|
| HIPEC at specialized center | 53-92 months | 50-67% |
| Systemic chemotherapy only | 12-15 months | 10-15% |
| Best supportive care | 6-8 months | <5% |
The mesothelioma treatment overview provides additional information on treatment options.
Who Qualifies for HIPEC?
HIPEC eligibility depends on several factors:
- Peritoneal Carcinomatosis Index (PCI): Lower tumor burden scores indicate better HIPEC candidacy
- Cell type: Epithelioid cell type responds best to HIPEC
- Overall health: Good performance status needed for extensive surgery
- Complete cytoreduction feasibility: Surgeons must be able to remove all visible tumor
"When I work with peritoneal mesothelioma patients, HIPEC eligibility assessment is one of the first conversations we have. Getting to a specialized HIPEC center quickly is critical because eligibility can change as disease progresses. The survival difference between HIPEC and standard treatment is dramatic."
— David Foster, Executive Director of Client Services, Danziger & De Llano
What Are the Rare Mesothelioma Types?
Two rare mesothelioma types account for less than 5% of cases combined [3].
Pericardial Mesothelioma
Develops in the pericardium—the membrane surrounding the heart:
- Prevalence: 1-2% of mesothelioma cases
- Symptoms: Chest pain, heart palpitations, difficulty breathing, fatigue
- Diagnosis challenge: Often found during surgery or autopsy
- Treatment: Limited surgical options; primarily palliative care
- Prognosis: Generally poor; median survival 6-10 months
Testicular Mesothelioma
Develops in the tunica vaginalis—the membrane surrounding the testes:
- Prevalence: Less than 1% of mesothelioma cases
- Symptoms: Testicular swelling, hydrocele, scrotal mass
- Diagnosis: Often discovered incidentally during hernia repair or hydrocele surgery
- Treatment: Surgical removal (orchiectomy); chemotherapy may follow
- Prognosis: Variable; some patients achieve long-term survival with early detection
How Do Symptoms Compare Between Types?
Understanding symptom differences helps with earlier recognition and diagnosis:
| Symptom | Pleural Mesothelioma | Peritoneal Mesothelioma |
|---|---|---|
| Primary location of pain | Chest/side | Abdomen |
| Breathing difficulty | Common (primary symptom) | Less common (late-stage) |
| Swelling/fluid buildup | Chest (pleural effusion) | Abdomen (ascites) |
| Digestive symptoms | Uncommon | Common |
| Cough | Common | Uncommon |
| Weight loss | Common | Common |
| Fatigue | Common | Common |
Which Type Has Better Prognosis?
Peritoneal mesothelioma often has significantly better outcomes than pleural mesothelioma—a counterintuitive finding given that both are caused by asbestos exposure [2].
Why Peritoneal Outcomes Are Often Better
- HIPEC effectiveness: Direct abdominal chemotherapy delivery achieves high tumor cell kill rates
- Complete cytoreduction: Abdominal surgery allows more thorough tumor removal than lung surgery
- Lower metastasis rates: Peritoneal mesothelioma tends to stay localized longer
- Higher epithelioid rates: More peritoneal cases are the treatable epithelioid cell type
Median survival for peritoneal mesothelioma with HIPEC at specialized centers
Prognosis Comparison
| Measure | Pleural Mesothelioma | Peritoneal Mesothelioma |
|---|---|---|
| Median survival (all stages) | 12-18 months | 31 months |
| With optimal treatment | 21+ months | 53-92 months |
| 5-year survival | 10-15% | 50-67% |
| Long-term survival possible | Yes (rare) | Yes (more common) |
The mesothelioma prognosis guide provides detailed survival statistics.
How Do Treatment Centers Differ?
The type of mesothelioma determines which specialists and treatment centers are appropriate [1][4].
Pleural Mesothelioma Centers
Require expertise in:
- Thoracic surgery (EPP, P/D procedures)
- Thoracic oncology
- Chest radiation therapy
- Mesothelioma immunotherapy protocols
Top pleural mesothelioma centers include MD Anderson Cancer Center, Memorial Sloan Kettering, and Brigham and Women's Hospital.
Peritoneal Mesothelioma Centers
Require expertise in:
- HIPEC procedure capabilities
- Peritoneal surface malignancy surgery
- Cytoreductive surgical techniques
- Post-HIPEC care protocols
Specialized HIPEC centers include Wake Forest Baptist Medical Center, University of Pittsburgh, and MD Anderson. The mesothelioma treatment centers guide lists facilities by specialty.
Frequently Asked Questions
What is the difference between pleural and peritoneal mesothelioma?
Pleural mesothelioma develops in the pleura (lung lining) and accounts for 75-80% of all mesothelioma cases. It causes chest pain, shortness of breath, and coughing. Peritoneal mesothelioma develops in the peritoneum (abdominal lining) and accounts for 15-20% of cases. It causes abdominal swelling, pain, and digestive problems. Both are caused by asbestos exposure but require different treatment approaches and specialists.
Which type of mesothelioma has better survival rates?
Peritoneal mesothelioma often has significantly better survival rates, primarily due to HIPEC surgery effectiveness. With HIPEC at specialized centers, peritoneal patients can achieve median survival of 53-92 months and 5-year survival rates of 50-67%. Pleural mesothelioma median survival typically ranges from 12-21 months even with aggressive treatment. This difference makes early HIPEC eligibility assessment critical for peritoneal patients.
What is HIPEC surgery for mesothelioma?
HIPEC (Heated Intraperitoneal Chemotherapy) is a specialized two-part procedure for peritoneal mesothelioma. First, surgeons perform cytoreductive surgery to remove all visible tumor tissue from the abdominal cavity. Then, heated chemotherapy (104-109°F) is circulated through the abdomen for 60-90 minutes to kill remaining cancer cells. The procedure takes 6-12 hours and requires 2-3 weeks of hospital recovery, but outcomes dramatically exceed standard treatment.
Can pleural mesothelioma spread to the abdomen?
Yes. As pleural mesothelioma advances to stage 3-4, it can metastasize to the peritoneum, liver, and other abdominal structures. Similarly, peritoneal mesothelioma can spread to the pleura. When cancer spreads, it's still classified by its original (primary) location. Metastatic spread typically indicates advanced disease and limits treatment options.
How do doctors determine which type of mesothelioma I have?
Doctors determine mesothelioma type through imaging and biopsy. CT scans and PET scans show tumor locations—whether in the chest cavity (pleural), abdominal cavity (peritoneal), or elsewhere. Biopsy confirms diagnosis and identifies cell type. The primary site where cancer originated determines your mesothelioma type, even if it has spread to other areas. Accurate typing is essential for treatment planning.
Are treatment centers different for pleural vs peritoneal mesothelioma?
Yes. Pleural mesothelioma requires thoracic oncology centers with expertise in lung surgery (EPP, P/D), chest radiation, and mesothelioma immunotherapy. Peritoneal mesothelioma requires centers with HIPEC capabilities and peritoneal surface malignancy expertise—a specialized surgical field. Some comprehensive cancer centers (like MD Anderson) treat both types, but many excellent centers specialize in one or the other.
Next Steps: Getting the Right Care
Understanding whether you have pleural or peritoneal mesothelioma is essential for accessing appropriate specialists and treatment options. The significant survival differences—especially for peritoneal patients eligible for HIPEC—make rapid, accurate diagnosis and specialist referral critical.
Our patient advocates help families connect with the right specialists based on their specific mesothelioma type and ensure they can access treatment without financial barriers.
Related Resources
- Asbestos Trust Funds — Financial resources for treatment
- Veterans Benefits for Mesothelioma — VA compensation for military exposure
- Find Mesothelioma Lawyers — Connect with specialists nationwide
- Free Case Assessment — Evaluate your options
Learn More
- Pleural Mesothelioma — Comprehensive lung lining cancer information
- Peritoneal Mesothelioma — Abdominal mesothelioma details
- Treatment Centers — Find specialists by type
Sources:
- National Comprehensive Cancer Network. (2025). Malignant Pleural Mesothelioma: Diagnosis and Treatment Guidelines.
- Annals of Surgical Oncology. (2025). Peritoneal Mesothelioma: HIPEC Outcomes and Survival.
- American Cancer Society. (2025). Mesothelioma Epidemiology and Outcomes.
- Journal of Clinical Oncology. (2024). Cytoreductive Surgery and HIPEC for Peritoneal Mesothelioma.
- National Cancer Institute. (2025). SEER Cancer Statistics: Mesothelioma.
Last updated: January 4, 2026
About the Author
David FosterExecutive Director of Client Services with 18+ years experience helping mesothelioma patients navigate diagnosis and treatment
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