Pleural mesothelioma is a type of cancer that develops from the thin layer of tissue that covers the lungs and chest wall. Signs and symptoms may include shortness of breath due to fluid around the lung, chest pain, cough, and fatigue. This cancer is caused by exposure to asbestos.
It can often take around 40 years for pleural mesothelioma to begin. Imaging studies such as X-rays or CT scans may help in the diagnosis, but the disease is usually confirmed by a tissue biopsy.
Pleural mesothelioma occurs in about 2,000 people in the United States every year. Rates of pleural mesothelioma vary throughout the world and are highest in Australia and the United Kingdom. The disease occurs more often in men than women. Diagnosis typically occurs in people over the age of 60, but pleural mesothelioma has occurred in people in their twenties.
Conventional treatment may include surgery, radiation therapy, and chemotherapy (cisplatin and Alimta). According to medical studies, the median survival with conventional treatment is little more than a year.
There is a lot of depressing information on the internet about pleural mesothelioma and the survival associated with this cancer. Reading it, you would think that no one has ever survived pleural mesothelioma beyond a year or so. This information is far from comprehensive and can be misleading. To help balance the negative information that is so prevalent on the web, we present some case histories of long-term pleural mesothelioma survival, as published in the peer reviewed medical literature.
The medical literature are articles written by doctors and scientists for doctors and scientists. These pleural mesothelioma case histories are instructional in two ways:
- they remind us that, like Paul Kraus, there are long term survivors of this cancer;
- they allude to the importance that the immune system may play in mesothelioma.
Cases of Pleural Mesothelioma
12+ Years with Pleural Mesothelioma
In 1994, a 58 year old man complained of chest pain and shortness of breath. He had been exposed to asbestos previously through his work and was eventually diagnosed with malignant pleural mesothelioma. The patient decided not to have any active treatment at that time and continued with his life. Five years later he had an enlarging painless mass on his chest wall. A needle biopsy confirmed it was malignant. The patient had a left thoracotomy, multiple pleural biopsies, and chest wall resection. Pathology reconfirmed that the mass was malignant pleural mesothelioma. Seven years after the chest wall resection and 12 years after the initial diagnosis, the patient has no symptoms and no evidence of recurrence. No chemotherapy or radiation had been given.
The doctors who wrote up this case history for publication noted that there was “moderate host inflammatory response” and that “spontaneous regression may be an immune-mediated phenomenon.” In other words, the doctors hypothesized that the patient’s own immune system may have played a factor in his survival.
See: Pilling, J.E., et al., Prolonged Survival Due to Spontaneous Regression and Surgical Excision of Malignant Mesothelioma, Ann Thorac Surg, 2007; 83: 314-5.
14 Years of Pleural Mesothelioma
In 1986, a 65 year-old women had pain in her left chest wall. A chest X-ray revealed a small pleural effusion on this side. The patient declined an open biopsy and no diagnosis could be reached. She was treated for tuberculosis because of the high rate of this disease in her area. Her symptoms partially improved. In 1988 she had increasing pain over her chest. A biopsy was performed and malignant infiltration of the pleura was confirmed. She turned down treatment. In 1998, 10 years after the diagnosis of malignant pleural mesothelioma, she had an enlarging mass over her left chest wall. Biopsy confirmed the diagnosis of pleural mesothelioma. She had a course of radiation and died in January 2000, 14 years after her initial symptoms.
The doctors who wrote this report counseled their colleagues that long-term survivors can occur with pleural mesothelioma and “one should not hold the belief that it is always the intervention that prolongs survival.” In other words, these doctors suggested that in some cases the intervention (i.e. chemo, radiation, surgery) may not be the factor that prolongs survival in pleural mesothelioma, but other factors may be at work.
See: Wong, C.F., et al., A Case of Malignant Pleural Mesothelioma with Unexpectantly Long Survival without Active Treatment, Respiration March/April 2002; 69, 2: 166-168.
Over 7 Years with Malignant Pleural Mesothelioma
In 1970, a 53 year-old man had shortness of breath and a sharp pain on his right side. An X-ray revealed a right side pleural effusion. The patient had worked at a plant adjacent to the Brooklyn Navy Yard from 1955-1966 where asbestos had been used. In 1972 a thoracotomy was performed and a pleural biopsy was taken. The patient was diagnosed with malignant pleural mesothelioma. The patient never received any specific treatment for pleural mesothelioma. The report was written up in 1977 and apparently information about the continued life of this patient was not published after. We do not know how many more years or decades he lived.
The doctors noted in their discussion that, “This unusual course may be explained either by the presence of low-grade malignancy or by the unusual host resistance… Our findings are consistent with the concept that normal immunological function may effectively impede dissemination of the disease (malignant pleural mesothelioma).” In other words, these doctors are again alluding to how the immune system may play a role in managing pleural mesothelioma.
See: Fischbein, A,. et al., Unexpected Longevity of a Patient with malignant Pleural Mesothelioma, Cancer 1978; 42:1999-2004.
Spontaneous Regression of Malignant Pleural Mesothelioma
In 2015, an article was written by researchers at the Mayo Clinic and published in the Annals of the American Thoracic Society titled “Spontaneous Regression of Malignant Pleural Mesothelioma in a Patient with New-Onset Inflammatory Arthropathy.” In this article, they described how a case of mesothelioma regressed by itself after the patient experienced an inflammatory arthropathy. Inflammatory arthropathies are usually associated with increases in joint fluid, associated with increases in joint fluid
Infection and Spontaneous Regression
In an article about Spontaneous Regression of thoracic malignancies written by doctors at the Department of Medicine, North Shore University Hospital and Long Island Jewish Medical Center, the authors stated, “Infection may cause an immunologic reaction resulting in eventual fibrosis of the metastatic lesions.” In other words, an infection could trigger the immune system to help contain a metastatic thoracic cancer like mesothelioma.
See: Kumar, T., et al., Spontaneous regression of thoracic malignancies. Respir Med. 2010 Oct;104(10):1543-50.
This concept was first suggested by Dr. William B. Coley over a century ago:
In 1891, Coley injected streptococcal bacteria into a patient with inoperable cancer. He thought that the infection would have the side effect of shrinking the malignant tumor. He was successful, and this was one of the first examples of immunotherapy.
The Father of Immunotherapy
According to Dr. Edward F, McCarthy of the Department of Pathology and Orthopaedic Surgery, The Johns Hopkins Hospital:
“Over the next forty years, as head of the Bone Tumor Service at Memorial Hospital in New York, Coley injected more than 1000 cancer patients with bacteria or bacterial products. These products became known as Coley’s Toxins. He and other doctors who used them reported excellent results, especially in bone and soft-tissue sarcomas.
Despite his reported good results, Coley’s Toxins came under a great deal of criticism because many doctors did not believe his results. This criticism, along with the development of radiation therapy and chemotherapy, caused Coley’s Toxins to gradually disappear from use. However, the modern science of immunology has shown that Coley’s principles were correct and that some cancers are sensitive to an enhanced immune system. Because research is very active in this field, William B. Coley, a bone sarcoma surgeon, deserves the title ‘Father of Immunotherapy.'”
See: Edward F McCarthy, MD, The Toxins of William B. Coley and the Treatment of Bone and Soft-Tissue Sarcomas. Iowa Orthop J. 2006; 26: 154–158.