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Mesothelioma (Pleural Mesothelioma): Symptoms, Diagnosis and Treatment
Sources reviewed by: Assoc. Prof. Dr. Ali OğulLast updated: October 2026
Pleural mesothelioma symptoms, link with asbestos and erionite, diagnosis, immunotherapy, chemotherapy and surgery options. Medical oncology in Mersin.
Key information
| Definition | A malignant tumour arising from the lining of the lung or abdomen |
|---|---|
| Main risks | Asbestos and erionite exposure, hereditary changes such as BAP1 |
| Common symptoms | Shortness of breath, chest pain, pleural fluid, weight loss |
| Diagnosis | Chest CT, pleural fluid analysis, thoracoscopic biopsy |
| Treatment | Immunotherapy, chemotherapy, surgery in selected patients, supportive care |
What is mesothelioma?
Mesothelioma is a cancer that develops from the membrane surrounding the lungs (pleura) and, less often, the lining of the abdomen (peritoneum). In Türkiye it is more common than the world average, particularly in some rural areas, because of environmental exposure to asbestos and erionite fibres in the soil. There is often a period of 20–40 years between exposure and disease [1][2].
Risk factors
The most important risk factor is asbestos exposure, which may be occupational (construction, shipyards, brake linings) or environmental. In Türkiye, asbestos exposure from ‘white soil’ used in the past for whitewashing and erionite exposure in some villages of the Cappadocia region have been described. Hereditary mutations such as BAP1 can also increase the risk [2][3].
What are the symptoms?
Shortness of breath (often due to pleural fluid), chest or back pain, cough, fatigue, fever, night sweats and weight loss may occur. In people with a history of asbestos exposure, unexplained pleural fluid should always be investigated [1][3].
Most of these complaints can also be caused by other conditions; complaints that persist or get worse need to be assessed by a doctor.
How is it diagnosed?
After chest CT and analysis of pleural fluid, a definitive diagnosis is usually made by thoracoscopic (VATS) pleural biopsy. Pathology distinguishes epithelioid, sarcomatoid and biphasic subtypes; the subtype affects treatment choice and prognosis. PET-CT and, when needed, MRI are used to assess spread [1][4].
Staging
Staging follows the AJCC/UICC TNM system; however, treatment decisions take into account subtype, general condition and tumour extent together [1][4].
Treatment options
- Systemic treatment: In advanced pleural mesothelioma, first-line options in guidelines include nivolumab + ipilimumab immunotherapy (especially in the sarcomatoid/biphasic type), platinum + pemetrexed chemotherapy, or adding pembrolizumab to chemotherapy.
- Surgery: In selected epithelioid patients with limited disease, pleurectomy/decortication may be considered at experienced centres as part of multimodal treatment.
- Radiotherapy: May be used for symptom relief, such as pain control.
- Management of pleural fluid: In recurrent fluid build-up, pleurodesis or an indwelling pleural catheter can control shortness of breath.
- Supportive treatment: Management of pain and breathlessness and early involvement of the palliative care team contribute to quality of life [4][5].
Treatment is planned individually, taking into account the stage, tumour characteristics, general condition and the patient’s preferences. Not every option listed here is suitable for every patient.
Recent developments
Immunotherapy and chemo-immunotherapy combinations have become standard options in advanced pleural mesothelioma in recent years. The role of surgery is being assessed more selectively in the light of recent studies [4][5].
Support and follow-up during treatment
During treatment, not only the anti-cancer drugs but also the patient’s general condition is monitored. Nausea, fatigue, loss of appetite, pain, infection risk and changes in mood are asked about at every visit; when needed, preventive medication, nutritional support, physiotherapy and psychosocial support are planned. In situations such as fever, shortness of breath, uncontrollable diarrhoea or vomiting, or new severe pain, it is advisable to contact the treatment team without waiting for the scheduled visit. Herbal products and supplements can interact with some cancer drugs, so the treatment team should be consulted before using them.
During and after treatment, clinical assessment and CT to monitor response are carried out every 2–3 months.
Frequently asked questions
No. Exposure increases the risk, but most exposed people do not develop the disease. It is important for people with a history of exposure to mention it to their doctor when they have complaints such as shortness of breath or chest pain.
No. Mesothelioma develops from the membrane surrounding the lung; it is a different disease from lung cancer and is treated differently.
Yes. Nivolumab + ipilimumab and pembrolizumab with chemotherapy are options included in guidelines for advanced disease; suitability is determined by subtype and general condition.
Procedures such as pleurodesis or an indwelling pleural catheter can control fluid build-up and the resulting shortness of breath.
Call +90 530 250 54 85 or write to the same number via WhatsApp. The outpatient clinic is open Monday to Friday, 08:00–16:00.
At the medical oncology outpatient clinic of Mersin University Faculty of Medicine Oncology Hospital, Çiftlikköy Campus, 33110 Yenişehir/Mersin, Türkiye. The assessment is done in person.
When needed, yes. The multidisciplinary tumour board meets every Friday from 09:00 to 13:00, and the sequence of surgery, radiotherapy and drug treatment is planned jointly.
Yes. A second opinion is a common way to clarify a treatment plan. Bring your pathology, imaging and discharge reports to the clinic for the assessment.
Pathology report, imaging reports and, if possible, the image CDs, discharge summary, recent blood tests and a list of the medicines you take. Translated copies are helpful if your documents are not in Turkish or English.
Medical oncology consultation for mesothelioma in Mersin
If you have been diagnosed with mesothelioma, or your diagnostic work-up is ongoing, you can apply for a medical oncology consultation with Assoc. Prof. Dr. Ali Oğul at Mersin University Faculty of Medicine Oncology Hospital (Çiftlikköy Campus, 33110 Yenişehir/Mersin, Türkiye). Medical oncology covers the planning of drug treatments such as chemotherapy, targeted therapy, immunotherapy and hormone therapy, the monitoring of side effects and follow-up after treatment. The hospital has a day treatment unit where drug treatments are given.
Treatment decisions are made by a team. When needed, patient files are discussed at the multidisciplinary tumour board, which meets every Friday from 09:00 to 13:00 with specialists from the relevant departments.
For appointments, call +90 530 250 54 85 or send a WhatsApp message to the same number with your name, diagnosis and reason for the request; you can also send your reports. The outpatient clinic is open Monday to Friday, 08:00–16:00. No diagnosis or treatment recommendation is given via WhatsApp; the assessment takes place in person at the clinic. Consultations are held in Turkish.
Appointment
Evaluation and second opinion
If you have been diagnosed with mesothelioma or would like a second opinion on your current treatment plan, you can contact Assoc. Prof. Dr. Ali Oğul with your pathology report and imaging results.
This content is for information only; please consult your physician for diagnosis and treatment.
References
- ESMO Clinical Practice Guidelines – Pleural mesothelioma. Accessed: October 2026. https://www.esmo.org/guidelines/esmo-clinical-practice-guidelines-lung-and-chest-tumours
- NCI – Malignant Mesothelioma (PDQ). Accessed: October 2026. https://www.cancer.gov/types/mesothelioma
- WHO – Asbestos: elimination of asbestos-related diseases. Accessed: October 2026. https://www.who.int/news-room/fact-sheets/detail/asbestos-elimination-of-asbestos-related-diseases
- NCCN Guidelines – Mesothelioma: Pleural. Accessed: October 2026. https://www.nccn.org/guidelines/category_1
- ASCO Guideline – Treatment of Pleural Mesothelioma. Accessed: October 2026. https://www.asco.org/practice-patients/guidelines
Links open external sources. The references were accessible as of October 2026.