Pleural is the most common mesothelioma type. About 70% to 75% of cases occur in the pleura, the tissue surrounding and protecting the lungs. Researchers have conducted more clinical trial studies on this mesothelioma tumor than any of the other variants.

Aggressive surgery came out with the best outcome for early-stage pleural mesothelioma, but doctors often diagnose patients after symptoms show in later stages. Typical symptoms can be shortness of breath, chest pain, weight loss, fever and fatigue.

Most patients are allowed for chemotherapy or radiation therapy. Based on health history, many are also allowed for clinical trials or immunotherapy. These therapies can add months or years to life expectancy. With quick and regular treatment, patients can live for three or more years at stage 1 versus approximately 12 months at stage 4.

Facts About Pleural Mesothelioma

• Pleural mesothelioma is the most common type of mesothelioma cancer.
• Symptoms of pleural mesothelioma include shortness of breath, chest pain, dry cough, wheezing and fatigue.
• Pleural mesothelioma is not curable. It is managed with cancer treatment, which can improve life expectancy and alleviate symptoms.
• The average life expectancy with pleural mesothelioma is four to 18 months, and the five-year survival rate is 10%.

Doctors discover approximately 3,000 new patients with pleural mesothelioma every year in the United States.

Causes Of Pleural Mesothelioma

The cause of pleural mesothelioma is exposure to asbestos fibers, which a person can inhale or sniffed into the lungs. After the microscopic mineral fibers are inhaled, their sharp, pointed shape causes them to lodge in the lungs and gradually migrate into the pleural lining.

Over many years, these fibers cause irritation, chronic inflammation and genetic changes in DNA that turn healthy pleural cells cancerous. It usually takes from 20 to 50 years for malignant pleural mesothelioma to develop after a person’s first exposure to asbestos. Because of this latency period, the disease usually affects people older than 75.

The pleural lining of the lungs consists of two layers:

A malignant tumor can develop on either layer and may spread to the other layer. As nodules develop on the pleural surface, they grow to form tumor masses around the affected lung. The tumors can also lead pleural fluid to accumulate in the chest cavity.

The combination of tumor mass on the lung and a collection of pleural fluid increases pressure in the chest and prevents the lung from expanding, which causes breathing difficulties.

When abandoned untreated, malignant cells can increase and damage nearby healthy tissues or spread through the blood and lymph system, forming new tumors on distant organs.

Signs And Symptoms Of Pleural Mesothelioma

People with pleural mesothelioma have symptoms that make it almost impossible to breathe, such as shortness of breath and chest pain, but they also encounter struggling swallowing and a dry, raspy cough. For many people, mesothelioma symptoms are not noticeable until the cancer is in a later stage.

Pleural mesothelioma symptoms can include:

Patients hardly mention weight loss and fatigue during their early doctor visit. These symptoms might only show if the cancer is advanced. Some patients also develop swelling of the face or arms, back pain or nerve pain.

Several pleural cancer symptoms and conditions may show a person’s story of asbestos exposure and the potential of a mesothelioma diagnosis. This includes pleural plaques, pleural effusions and pleural thickening.

Pleural Plaques

Small areas of thickening on the pleura are the most common sign someone has a history of asbestos exposure. Pleural plaques are not cancerous and usually do not cause symptoms, but they might show an high risk for cancer.

Pleural Effusion

Irritation from asbestos fibers can lead to excess fluid to build up between the two layers of the pleura. This condition, called pleural effusion, is present in many pleural mesothelioma cases. A little fluid between the pleural layers is healthy. Too much puts pressure on the lungs, causing chest pain that worsens when you cough or take deep breaths.

Pleural Thickening

When large areas of the pleura stiffen because of scarring, it may become difficult and painful to breathe. Pleural thickening around both lungs is often a sign of significant asbestos exposure. Repeated episodes of pleural effusion can cause the pleural thickening to worsen as scar tissue collects.

Asbestosis

Asbestosis is a pulmonary disease marked by progressive scarring of lung tissue caused by asbestos exposure. This condition does not affect the pleural lining. There is an advanced risk for someone diagnosed with asbestosis to develop asbestos-related lung cancer rather than pleural mesothelioma, but the latter has been documented in medical literature.

Diagnostic Process For Pleural Mesothelioma

The diagnostic process for pleural mesothelioma starts when a doctor evaluates the initial symptoms of the disease. Chest pain and breathing difficulty warrant a chest X-ray, revealing fluid buildup or tumors around a lung. A primary care physician refers a patient to a specialist when they require further testing.

Specialists must use advanced imaging scans and tissue biopsies to confirm a pleural mesothelioma diagnosis. In addition to identifying cancer, determining the cancer stage and cell type is vital to creating an effective treatment plan.

Cell Types

Tissue biopsies recognize the three various cell types that can make up pleural mesothelioma tumors, and this information is important in deciding treatment plans. Most cases of malignant mesothelioma are diagnosed with a high number of epithelial cells, also called epithelioid cells. This cell type responds best to cancer treatment.

The least common cell type is sarcomatoid mesothelioma. It is aggressive and challenging to treat, and most of these cases occur in pleural patients.

The biphasic cell type is a blend of these two cell types. How it responds to treatment depends on the ratio of cells. If more epithelioid cells are present, it will respond better than tumors composed of more sarcomatoid cells.

Several pleural cancer symptoms and conditions may specify a person’s history of asbestos exposure and the potential of a mesothelioma diagnosis, including pleural plaques, pleural effusions and pleural thickening.

In a 2020 study published in Case Reports, researchers discovered a case of pleural mesothelioma through testing of metastatic gastric and colonic polyps identified in imaging scans. These polyps were the only sign that the patient had pleural mesothelioma.

Stages Of Pleural Mesothelioma

 

Pleural mesothelioma staging is how doctors get to know the development of cancer in a patient’s body. The stage determines what treatment options doctors might choose to prescribe.

The International Mesothelioma Interest Group created the TNM staging system, the most widely used staging system for pleural mesothelioma.

Stages 1 and 2, which are regarded as the early stages, show localized tumors. Stages 3 and 4, which denote the later stages, classify spreading tumors.

When doctors diagnose patients in stages 1 or 2, they have more options for treating pleural mesothelioma, involving surgery, which offers the best chance at increased survival. In the later stages, treatment options are limited since cancer has begun to spread throughout the body.

Pleural Mesothelioma Treatment Options

Quality pleural mesothelioma treatment options can include surgery, radiation therapy and chemotherapy.

Chemotherapy is the most major type of pleural treatment. Doctors often prescribe a combination of medicines known as multimodal therapy if they diagnose a patient early in the disease process. These treatments can improve symptoms, such as chest pain and breathing difficulties, and improve survival.

Patients can access these therapies at top cancer centers across the nation that specialize in pleural mesothelioma treatment.

Peritoneal mesothelioma is a rare asbestos-related cancer that forms on the abdominal lining, known as the peritoneum. An even rarer form of this cancer spread in a layer of the abdominal membrane, the omentum, that includes the stomach and other organs.

Peritoneal mesothelioma is also known as abdominal mesothelioma or mesothelioma of the stomach.

Peritoneal mesothelioma accounts for 10% to 20% of all cases. There is less research on peritoneal mesothelioma than the pleural variant; however, the prognosis for this tumor type is better. This cancer forms in the tissue that surrounds the abdominal organs.

Primary symptoms of peritoneal mesothelioma include abdominal pain and swelling, bloating, loss of appetite and bowel changes.

According to research, around half of peritoneal mesothelioma patients eligible for surgery with heated chemotherapy, a procedure known as HIPEC, live five or more years after diagnosis.

Facts About Peritoneal Mesothelioma

The initial cause of peritoneal mesothelioma is swallowing airborne asbestos fibers or drinking contaminated water. The digested fibers become trapped in the peritoneum.

Causes Of Peritoneal Mesothelioma

The major cause of malignant peritoneal mesothelioma is ingesting asbestos fibers. Current research suggests that asbestos fibers travel from the digestive tract and remain trapped in the abdomen, causing cancer after years of inflammation.

Process of Peritoneal Mesothelioma Development

Like other asbestos-related diseases, peritoneal mesothelioma develops over a long period of time. The trapped asbestos fibers cause inflammation and irritation, damaging and degrading DNA.

Damaged DNA can lead to abnormal and unregulated cell growth. These errors cause tumors to form, and the tumors can grow uncontrollably and spread to other areas of the body.

Research on peritoneal mesothelioma is still ongoing. Other sources of this disease may include abdominal radiation and fibrous minerals besides asbestos, such as erionite.

Signs And Symptoms of Peritoneal Mesothelioma Cancer

Early symptoms of peritoneal mesothelioma include bloating, pain or tenderness around the abdomen, and digestion issues such as constipation or diarrhea.

These symptoms tend to imitate many other abdominal disorders. An accurate diagnosis often needs a mesothelioma specialist and a biopsy sample.

Anyone with a history of asbestos exposure should observe their health and see their doctor for new or worsening symptoms.

Pericardial mesothelioma is a rare type of cancer that affects the lining of the heart.

Almost all mesotheliomas can be traced to asbestos exposure, but medical researchers continue to study the link between asbestos and cancer of the pericardium. About 25 percent of people with this disease have a history of asbestos exposure. Studies are clear on how inhaled microscopic fibers reach the lungs but less clear on how the fibers may reach the heart.

This form of cancer is most often diagnosed in people between the ages of 50 and 70, with the median age being 55. According to a 2017 study published in the Journal of Clinical Oncology, approximately 60 percent of cases occur in men.

Like the other types of mesothelioma, the disease is typically discovered at a later stage. Symptoms include chest pain, fatigue and shortness of breath. Diagnosis is difficult because symptoms mimic those of other heart disorders.

Pericardial treatment options include surgery, chemotherapy, palliative treatments to control symptoms and rarely radiation therapy. Surgery is the most common treatment with about 46 percent of patients electing surgery. About 37 percent receive chemotherapy and only 8 percent receive radiation therapy because it is risky to apply near the heart. Nearly 25 percent of patients elect no treatment.

A 2021 research study reported that patients with primary pericardial mesothelioma have a median survival of about two months. However, some people have lived for years with this cancer after undergoing surgery or chemotherapy.

To date, less than 150 cases of pericardial mesothelioma are described in medical literature, that’s 1 percent of all known diagnosed mesotheliomas.

Causes Of Pericardial Mesothelioma

The primary cause of pericardial mesothelioma remains a mystery. The causal relationship between asbestos exposure and this type of mesothelioma is not fully understood. Researchers confirm the pleural and peritoneal types are primarily caused by exposure to asbestos, yet the causes of the pericardial type are less definitive.

A 2017 review of medical literature on pericardial mesothelioma reported asbestos exposure in 25 percent of cases. Another 2017 study published in the Annals of Epidemiology reported the majority of patients with pericardial mesothelioma have no history of asbestos exposure.

Signs And Symptoms of Pericardial Mesothelioma

Most pericardial mesothelioma patients experience no symptoms when the cancer first develops, a fact that contributes to a late-stage diagnosis. The symptoms also resemble those of other heart conditions, making the cancer difficult to accurately diagnose. Most symptoms are caused by fluid buildup around the heart and thickening of the pericardial layers.

Most symptoms are caused by the buildup of fluid and the thickening of pericardial layers. The presence of any of these symptoms should be followed by a visit to the doctor with recommended screenings such as an X-ray, CT scan or echocardiogram (ultrasound of the heart).

If you are going through any of these symptoms, especially heart-related symptoms, schedule an appointment with your doctor immediately. Screening tests like X-rays, CT scans and echocardiograms can usually show the underlying cause of these health problems.

Diagnostic Process For Pericardial Mesothelioma

To diagnose pericardial mesothelioma, doctors make an overall assessment of your symptoms, medical history and current medical condition. Next, you will receive a physical examination, imaging tests and biopsy to determine the location of tumors and confirm whether or not they are cancerous.

When you see a doctor to discuss heart-related symptoms, one of the first diagnostic tests you will receive is an echocardiogram, which is essentially an ultrasound for your heart. This noninvasive test uses sound waves to help doctors see the size and shape of your heart and determine how well it is working overall.

Although an echocardiogram can reveal fluid buildup around the heart and help guide a pericardiocentesis, which is the procedure doctors perform to drain the fluid, other imaging scans are needed to determine if potential tumors are present. If doctors spot abnormal growths, they need to take a fluid or tissue sample and perform a biopsy, which can confirm a mesothelioma diagnosis.

These tumors generally are not localized, and they tend to cover most of the heart. Furthermore, this cancer type accounts for approximately half of all pericardial tumors.

Physical Examination

Unfortunately most cases of pericardial mesothelioma are only found at autopsy. Nonetheless, about 10-20 percent of these cases are diagnosed before a patient dies. Some of the challenges with early and accurate diagnosis of the pericardial type include the small number of people with the disease and the late presentation of symptoms.

Imaging Tests

Computed tomography (CT) scans are effective for detecting pericardial tumors, making them a preferred diagnostic tool. Magnetic resonance imaging (MRI) can also yield successful results in identifying the cancer.

Radionuclide imaging is a detection method involving the injection of gallium, a radioactive material, to identify cancerous cells. It was reportedly used to detect at least one case of this type of cancer. Patterns of radioactivity show possible tumor sites in the human body.

Biopsy

A biopsy is a crucial diagnostic procedure that can be more suitable in determining the cancer’s point of origin. A surgeon will remove tissue or fluid from the pericardium, examine its cells under a microscope to positively confirm the presence of pericardial mesothelioma. According to a 2016 study in the Journal of Cardiac Failure, fluid biopsies often turn up cancer free even when pericardial tumors are present. A tissue sample of the tumor itself is usually required to confirm pericardial mesothelioma.

Misdiagnosis

Because pericardial mesothelioma symptoms such as chest pain, cough and difficulty breathing are shared with various other diseases, it’s crucial to meet with a specialist to confirm your diagnosis. To ensure an accurate diagnosis and prompt treatment, you need to speak with an expert who knows the intricacies of this rare cancer.

If you have been diagnosed with any of these conditions, always seek a specialist to confirm the diagnosis. Working with a specialist may get you access to a wider range of treatment options, but it might also lead to improved survival.

Pericardial Mesothelioma Treatments Options

Mesothelioma treatment options are limited because the heart lining rests so closely to the heart itself that most therapies can easily damage this delicate organ. Slightly more than half of patients with pericardial mesothelioma are not ideal candidates for surgery, which is often the most effective treatment for this cancer. However, there are rare cases where the cancer is diagnosed early and surgery can be carried out to remove small, localized tumors.

The primary treatment options for pericardial mesothelioma are pericardiectomy or tumor removal, chemotherapy and palliative treatment such as fine needle aspiration. Radiation therapy is considered minimally effective for this rare cancer and is risky to administer without harming the heart.

Pericardiectomy or Tumor Removal

Patients whose doctors determine they are good candidates for surgery are treated with a pericardiectomy or tumor removal.

A pericardiectomy is the surgical process of removing part or all of the pericardium. A pericardiectomy can relieve pressure and minimize fluid buildup, allowing the heart to continue functioning properly.

Tumor removal, also called tumor resection, can involve removal of the cancer without removing the pericardium. A 2017 review reported longer survival in patients who underwent tumor removal than patients who had a pericardiectomy.

Chemotherapy: The benefits of chemotherapy are minimal for most patients with pericardial mesothelioma. The chemotherapy drugs pemetrexed and cisplatin have shown a survival benefit, and gemcitabine has produced mixed results. A handful of cases have responded well to chemotherapy. One woman lived longer than two years thanks to a combination of the chemotherapy drugs cisplatin, gemcitabine and vinorelbine. Pembrolizumab, a new checkpoint inhibitor form of immunotherapy, has shown some benefit in cases of pleural mesothelioma. It may have some utility in this disease as well.

Palliative Treatment: Palliative treatment options aim to minimize pain and reduce symptoms caused by the buildup of fluid in the pericardium. Essentially, palliative care can improve quality of life and make patients more comfortable.

Palliative treatments can include therapies that relieve pain and pressure around the heart such as a pericardiocentesis or pain medication. A pericardiocentesis removes excess fluid from the pericardium to relieve pressure around the heart.

Medical Prognosis Of Pericardial Mesothelioma

The common prognosis for the pericardial type is poor, compared to that of peritoneal or pleural mesothelioma. Nearly 50 to 60 percent of pericardial patients pass away within six months of receiving a diagnosis. However, this is not the case for everyone.

Hope exists for some patients because researchers have cited positive results after surgery to remove local tumors. Smaller, less impactful benefits have been demonstrated from chemotherapy, except for one case in which a 47-year-old woman was living two years after chemotherapy with cisplatin, gemcitabine and vinorelbine.

A 1995 case report of a 27-year-old woman who underwent surgery and radiation therapy for pericardial mesothelioma states that she had no evidence of recurrence during 28 years of follow-up.

A 1992 case report of a 12-year old boy with pericardial mesothelioma who underwent surgery and chemotherapy says that he remained free of symptoms and showed no sign of disease one year later.

Surgery to remove part of the heart’s lining combined with radiation therapy improved survival in two patients in the late 1960s and early 1970s. One patient lived a year after treatment, and another was alive five years after treatment.

Testicular mesothelioma develops in the outer lining of the testes called the tunica vaginalis. This form of mesothelioma is the rarest. Less than 100 cases are reported in the medical literature, making up less than 1% of all mesothelioma cases.

Symptoms include scrotal swelling and painless testicular lumps. Treatment options include surgery and chemotherapy, which can help people live more than two years after diagnosis, on average.

Causes Of Testicular Mesothelioma

Unlike pleural or peritoneal mesothelioma, which can easily be traced to asbestos exposure, doctors do not yet understand how asbestos exposure can cause a primary tumor to develop on the tunica vaginalis, the pouch of serous membrane that covers the testes.

It appears as firm, white-yellow nodules on the surface of the tunica vaginalis. The nodules can eventually encase the contents of the scrotum and cause the membrane to thicken.

Local trauma and inflammation also may play a role in its development. Some cases present without any identifiable risk factors.

Medical Prognosis and Survival Rate for Testicular Mesothelioma

Men with this cancer have a significantly better prognosis than most people with other types of mesothelioma.

Nearly 49% of patients survive five years after diagnosis, and 33% survive 10 years, according to a 2019 study published in the journal Urology.

Patients with the biphasic cell type of the cancer were associated with worse overall survival compared to other mesotheliomas and the epithelioid subtypes.

Of the 113 testicular mesothelioma patients in the study, 75% of cases had the epithelioid cell type. Older patients and those with tumors greater than or equal to 4 centimeters in size were associated with a worse survival.

Signs, Symptoms And Diagnostic Process For Testicular Mesothelioma

There is no set of symptoms unique to testicular mesothelioma cancer. Many people with this cancer initially receive the wrong diagnosis because doctors mistake it for a more common condition such as a hernia.

The most common testicular mesothelioma symptom is a hydrocele, a buildup of fluid in the scrotum.

More than half of the patients in the 2019 Urology study had a hydrocele. About one-third of patients had a painless scrotal mass.

Because it is so rare and doesn’t present unique symptoms, testicular mesothelioma is often diagnosed during or after surgery.

The definitive way of confirming a cancer diagnosis is to perform a biopsy. This involves removing a tissue sample from the tumor and sending it to the lab for testing.

Evaluating the sample with a technique called immunohistochemical staining helps doctors determine if the patient has testicular mesothelioma or another disease.

Testicular Mesothelioma Treatment Option

The most common treatment for testicular mesothelioma is surgery. Nearly all of the 113 testicular mesothelioma patients (98.2%) in the 2019 study underwent surgical resection of the tumor.

This method detach the affected testicle and the entire spermatic chord. If the cancer has spread to nearby lymph nodes, doctors will separate them as well with a surgery called lymphadenectomy.

A 2021 research study noted that testicular mesothelioma requires extensive resection including metastatic surgery if complete resection is possible. The study suggested a multimodality treatment plan for the malignancy, similar to a multimodal approach to pleural mesothelioma, offers the best patient outcomes.

Surgery may be followed by chemotherapy with cisplatin and pemetrexed, the longstanding standard-of-care treatment for mesothelioma. Doctors may offer radiation therapy next to kill any remaining cancer cells and prevent the cancer from returning.

Only 5.3% of patients received radiation therapy in the 2019 study. Researchers could not determine if adjuvant therapy has an impact on overall survival, given such a small cohort.

In some cases, testicular mesothelioma is a secondary tumor, with the primary tumor located within the peritoneum (the membrane that lines the abdominal cavity). For situations like this, doctors have to treat the patient for peritoneal mesothelioma as well.