Pericardial Mesothelioma
It's one of the rarest types of
asbestos-related cancers. Treatment options are few because the heart
lining, which is where tumors develop, is too close to the delicate
organ; however, there are some cases where surgery can help remove small
tumors.
Pericardial mesothelioma develops in the thin membrane surrounding
the heart, known as the pericardium. The membrane has two layers: An
outer layer called the parietal layer, heart sac or theca cordis; and an inner layer known as the visceral layer or epicardium.
There are four common forms of mesothelioma,
and pericardial and testicular are the rarest. To date, approximately
200 cases of pericardial mesothelioma are described in medical
literature — that's 1 percent of all known diagnosed mesotheliomas.
Almost all mesotheliomas can be traced to asbestos exposure, but
medical researchers continue to study the link between asbestos and
cancer of the pericardium. Studies are clear on how inhaled microscopic
fibers reach the lungs, but less clear on how the fibers reach the
heart.
This form of cancer strikes twice as many men as women, and is most
often diagnosed in people between the ages of 50 and 70. Like the other
types of mesothelioma, the disease develops over a long period of time —
one to five decades — and 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 disorders.
Pericardial treatment options: Surgery (if a
patient is deemed healthy enough), chemotherapy, radiation therapy or a
combination of all three modalities. About half of the people who
contract the pericardial type survive longer than six months.
What Are the Symptoms of Pericardial Mesothelioma?
Most pericardial mesothelioma patients experience no
symptoms when the cancer initially 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 or CT scan.
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 or CT scan.
The following symptoms may indicate pericardial mesothelioma:
- Heart palpitations or irregular heartbeat (arrhythmia)
- Difficulty breathing, even when at rest (dyspnea)
- Murmurs
- Cough
- Shortness of breath when lying flat
- Chest pain
- Fatigue
- Fever
- Night sweats
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How Does Asbestos Cause Pericardial Mesothelioma?
The causal relationship between asbestos exposure and this type
of mesothelioma is not fully understood. Researchers confirm the
pleural and peritoneal types of the cancers are primarily caused by
exposure to asbestos, yet the causes of the pericardial type are less
definitive. Some patients with this rare type of mesothelioma have a
history of exposure, but the limited number of reported cases prohibits
researchers from effectively analyzing the relationship between the two.
A 1982 study found a history of asbestos exposure in three of 15 cases,
and a 1994 study reported asbestos exposure in four of 15 cases.
Pericardial mesothelioma is thought to occur when asbestos lodges itself around the heart.
Asbestos fibers can become lodged in the membranes that surround the
heart. When this occurs, just as it does in the linings of the lungs and
abdomen, the body experiences extreme difficulty in eliminating the
fibers. They can remain stuck in the membranes, and over a long period
of time — sometimes up to 50 years — the asbestos fibers cause the cells
to undergo changes that may result in cancer.
Once cells become cancerous, they begin to divide more rapidly, without the restraint that regulates the growth cycles of healthy cells. As the mesothelioma cells continue to grow, they cause the lining of the heart to thicken, and eventually tumors develop. These changes in the membrane lead to the buildup of fluid between the pericardial layers, which combined with the thickening of the layers, puts pressure on the heart.
Once cells become cancerous, they begin to divide more rapidly, without the restraint that regulates the growth cycles of healthy cells. As the mesothelioma cells continue to grow, they cause the lining of the heart to thicken, and eventually tumors develop. These changes in the membrane lead to the buildup of fluid between the pericardial layers, which combined with the thickening of the layers, puts pressure on the heart.
Learn more about asbestos exposure
How Is Pericardial Mesothelioma Diagnosed?
To diagnose pericardial mesothelioma, doctors make a cumulative
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's working overall.
Although an echocardiogram can reveal fluid buildup around the heart and help guide pericardiocentesis, 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.
Computed tomography (CT) scans are effective for detecting
pericardial tumors, making them a preferred diagnostic tool. Magnetic
resonance imaging (MRI) can also yield extremely successful results in
identifying and assessing the cancer. 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.
Pericardial mesothelioma is often mistaken for more common heart illnesses, including:
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's working overall.
Although an echocardiogram can reveal fluid buildup around the heart and help guide pericardiocentesis, 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.
Physical Examination
A small percentage of all
heart-related mesothelioma diagnoses, between 10 and 20 percent, are
made before a patient dies. Some of the challenges with early and
accurate diagnosing of the pericardial type include the minuscule number
of people with the disease and the delayed presentation of symptoms.
Learn more
Imaging Tests
Radionuclide imaging is an
advanced detection method involving the injection of radiogallium, 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.
Learn more
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.
Learn more
Seek a Second Opinion to Avoid Misdiagnosis
Because pericardial mesothelioma symptoms like 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.Pericardial mesothelioma is often mistaken for more common heart illnesses, including:
- Heart failure
- Coronary heart disease
- Tuberculosis pericarditis
- Constrictive pericarditis
- Cardiac tamponade
- Intra-atrial myxoma
- Cardiomyopathy
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What Treatments Are Available?
Treatment options
are limited because the heart lining rests so closely to the heart
itself that most therapies can easily damage this delicate organ. Most
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. Still, any
surgery near this area is extremely dangerous because of the close
proximity to the heart.
The four primary treatment options for pericardial mesothelioma are pericardiectomy, chemotherapy, palliative treatment and fine needle aspiration.
The four primary treatment options for pericardial mesothelioma are pericardiectomy, chemotherapy, palliative treatment and fine needle aspiration.
- Pericardiectomy
- Chemotherapy
- Palliative Treatment
- Fine Needle Aspiration
Next Treatment
What Is the Average Prognosis?
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. In one study, surgery to remove part of the heart's lining combined with radiation therapy improved survival in two patients.
One patient lived a year after treatment, and another was alive five years after treatment. Smaller, less impactful benefits were demonstrated from chemotherapy.
Hope exists for some patients because researchers have cited positive results after surgery to remove local tumors. In one study, surgery to remove part of the heart's lining combined with radiation therapy improved survival in two patients.
One patient lived a year after treatment, and another was alive five years after treatment. Smaller, less impactful benefits were demonstrated from chemotherapy.
Early diagnosis can yield a more optimistic prognosis, often resulting in more treatment options.
Additional Resources
Free VA Claims Help for Mesothelioma
Financial Assistance for Mesothelioma
Join a Mesothelioma Support Group
Author
Karen Selby
Karen Selby is a registered nurse and a
Patient Advocate at The Mesothelioma Center. She worked in several
subspecialties within nursing before joining Asbestos.com in 2009.