Pericardial mesothelioma is a rare type of asbestos cancer that grows in the pericardium, which is the membrane that surrounds the heart. Pericardial mesothelioma is the rarest type of mesothelioma and accounts for only 1-2% of all mesothelioma diagnoses. Just 50 people are diagnosed with the condition annually, on average.
Primary pericardial mesothelioma is rare, but this disease can also be caused by the spread or extension of other forms of asbestos cancer. Unfortunately, the prognosis for pericardial mesothelioma is very poor. Most cases of this disease can only be diagnosed with an autopsy, and life expectancy is poor. Patients survive approximately six months after diagnosis with pericardial mesothelioma.
If you have a pericardial mesothelioma diagnosis, below is critical information to know.
Pericardial Mesothelioma Prognosis
All patients with mesothelioma have a poor prognosis, but primary pericardial mesothelioma has the worst prognosis of all – six months. There are few cases reported of patients living beyond a year with this disease.
Vital factors that affect the prognosis of pericardial mesothelioma are:
- Disease stage
- Cell type
- Patient specifics, such as gender and age
Symptoms of Pericardial Mesothelioma
It can take decades for symptoms of pericardial mesothelioma to appear, as with other forms of mesothelioma cancer. Because pericardial mesothelioma is so rare, clinical researchers do not know how asbestos can get into the pericardium around the heart. The symptoms of the disease can vary if there are secondary pericardial tumors.
Pericardial mesothelioma grows between two membranes that encase the heart. Clinical studies show tumors may make the membrane thicker. This problem can reduce your heart function and cause severe symptoms, including heart failure. Because pericardial mesothelioma develops in the membrane around the heart, you could have severe symptoms early in the disease.
Symptoms of pericardial mesothelioma are:
- Heart compression by fluid build-up (cardiac tamponade)
- Chest pain
- Pericardium inflammation (constrictive pericarditis)
- Reduced appetite and weight loss
- Dyspnea (difficulty breathing)
- Sweating at night
- Pericardial effusion (fluid build-up)
Diagnosing Pericardial Mesothelioma
All types of mesothelioma are hard to diagnose because they are so rare. However, pericardial mesothelioma is even more difficult to diagnose. Because the asbestos cancer affects the heart, symptoms can have a huge effect on the body fast as the disease gets worse. Sadly, many patients with this disease cannot be diagnosed until an autopsy is done. One study determined that just 10-20% of pericardial mesothelioma cases are diagnosed before the patient dies.
The diagnosis for pericardial mesothelioma is made with X-rays and CT scans, in most cases. These scans can pinpoint pericardial effusion or fluid build-up around the heart. Scans also can reveal any tumors present around the heart. A blood test can be done to differentiate asbestos cancer from other forms of the disease.
Pericardial mesothelioma also can be diagnosed with an echocardiogram. This procedure uses sound waves to check for various heart problems, such as heart disease, atrial fibrillation, and pericardial mesothelioma. The echocardiogram allows the healthcare professional to hear how your heart is beating to make sure enough blood is being pumped. (Mesotheliomaguide.com)
The most important step for a mesothelioma diagnosis is a biopsy. Your doctor will obtain a tissue sample and perform an analysis under a microscope. As part of the analysis, your pathologist will identify the cell type and how the asbestos cancer may advance. But in some cases, there could be no cancer cells present in the fluid sample. A tissue biopsy may be used if the liquid biopsy is negative. A fluid biopsy by itself is only valid in 25% of cases.
A tissue biopsy is more invasive than a fluid biopsy. The tissue is taken directly from the area that is thought to have cancer. This form of biopsy is the most accurate for diagnostic purposes.
Stages of Pericardial Mesothelioma
Deciding the stage of pericardial mesothelioma is a vital aspect of the process of diagnosis. It helps to determine treatment options and prognosis. Few cases of the cancer are reported annually, so pericardial mesothelioma does not have a staging system. However, doctors may use general cancer and mesothelioma signs to decide how advanced this type of cancer is.
Stage 1 or 2 pericardial mesothelioma suggests cancer that is more localized. With more limited metastasis, patients usually have better treatments available, such as surgical resection. Because pericardial mesothelioma is hard to diagnose, many recorded cases show a late-stage diagnosis, where mesothelioma has gone to other organs and lymph nodes. As asbestos cancer advances, patients could have just palliative treatments available.
Pericardial Mesothelioma Treatment Options
As with common types of mesothelioma, the pericardial form of the disease is often treated with chemotherapy and surgery. Most patients have a later stage of the disease, so these treatments may be used simply to extend life and reduce pain.
If you are diagnosed at an earlier stage, a pericardectomy surgery can be a possible treatment option. A pericardiectomy involves a surgeon removing part or all of the heart lining. If possible, the surgery removes all tumors.
The pericardiectomy is often followed by chemotherapy to destroy any cancer cells that remain. Pemetrexed and cisplatin are most often used to slow or halt the growth of tumors in the pericardium.
Another effective cancer drug for pericardial mesothelioma patients is gemcitabine. This drug has shown mediocre results in clinical studies. That same clinical study from 2017 indicated that 38% of patients had chemotherapy. This treatment often was performed in addition to surgery for a multimodal therapy plan.
A 2017 analysis of 102 pericardial cases found 47% of cancer patients had surgery, and 37% had chemotherapy. Both cancer treatments showed better survival from the typical six-month prognosis. One report noted a patient who lived for more than 1.5 years. Another report mentioned a patient who lived four years after having a surgical resection.
Another option is pericardiocentesis, which is palliative surgery. A fluid build-up around the heart is a common sign of the disease. This symptom can put pressure on the heart and reduce heart function. Pericardiocentesis can reduce pressure on the heart by taking away excess fluid. The procedure is mostly non-invasive, with a needle stuck into the pericardium. The fluid is taken out with a catheter.
Radiation therapy can be applied, too. But radiation has not been successful to extend life. For some cancer patients, pericardiocentesis may be a good option to relieve symptoms.
Unfortunately, clinical trials designed for pericardial mesothelioma are infeasible because there are few cases diagnosed annually. In many situations, pericardial mesothelioma patients can participate in clinical trials for pleural mesothelioma.
It is also possible that newer treatments usually reserved for other types of mesothelioma could be effective, such as immunotherapy. More research is being done to determine the best treatment options for this rarest form of mesothelioma.
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References
- Pericardial Mesothelioma. (n.d.). Retrieved from https://www.mesothelioma.com/mesothelioma/types/pericardial/
- Mesothelioma Guide. (n.d.). Retrieved from https://www.mesotheliomaguide.com/mesothelioma/pericardial/