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Pericardial Mesothelioma

Pericardial mesothelioma is a cancer of the lining that surrounds the heart. This lining is known as the pericardium. Pericardial mesothelioma is the rarest form of mesothelioma.

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What Is Pericardial Mesothelioma?

Researchers are still investigating the link between asbestos exposure and the development of pericardial mesothelioma, including how asbestos fibers enter the pericardium.

This cancer is especially rare, accounting for only 1% of all mesothelioma diagnoses. There are around 3,000 new mesothelioma cases in the United States each year. So the number of pericardial mesothelioma cases each year is minimal.

Researchers are still investigating specifics about this disease. According to a study published by the Case Reports in Oncology, men are around three times more likely than women to be diagnosed with this form of mesothelioma.

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Treatment for Pericardial Mesothelioma

Since this type of mesothelioma forms near the heart, treatment options are limited. The heart is often one of the first organs impacted by metastasizing tumors. Any damage to the heart during surgery could be fatal.

However, Johns Hopkins Hospital has conducted research showing that a pericardiectomy is a safe procedure, with perioperative mortality rates of around 5%. As science evolves with time, specialists and surgeons continue making improvements to the surgical process to lower this percentage.

Most of the time, treatment includes chemotherapy and other palliative treatments for pain management if surgery is ruled out.

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Pericardiectomy

A pericardiectomy is the only widely used surgery for this disease. This operation involves removing part or all of the pericardium, along with any surrounding cancerous tissue. If patients are deemed eligible and their cancer has not progressed into the heart, they could have the tumors surgically removed.

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In one study published in the Journal of Clinical Oncology in 2017, approximately 46% of pericardial mesothelioma patients underwent surgery.

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Chemotherapy

Chemotherapy is a standard treatment option for pericardial mesothelioma. There are two chemotherapy drugs, pemetrexed and cisplatin, approved by the U.S. Food and Drug Administration. These drugs can slow or halt tumor growth in the pericardium.

Another chemotherapy drug for patients is gemcitabine, which has shown mixed results in clinical trials. As of March 2020, the FDA has yet to approve general use of gemcitabine for any form of mesothelioma.

The same review in the Journal of Clinical Oncology from 2017 reported that 39% of pericardial patients underwent chemotherapy treatment. Doctors may use chemotherapy as the primary treatment, or they may use it as a secondary care method before or after surgery.

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Palliative Treatments

Since pericardial mesothelioma often isn’t discovered until it’s a late-stage disease, most of the diagnosed patients are given palliative treatments. Palliative treatments manage pain and preserve the patient’s quality of life.

Most of the pain comes from the thickening of tissue in the pericardium. This effect restricts normal heart function and can lead to an irregular heartbeat or chest pain.

One palliative surgery is pericardiocentesis, which involves removing excess fluid in the pericardium to improve cardiac functions.

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Radiation

Mesothelioma radiation is not often used for this disease. The aforementioned study reports that only 8% of patients have this type of treatment.

Symptoms of Pericardial Mesothelioma

Pericardial mesothelioma involves symptoms common with other heart conditions, which is why misdiagnosis occurs regularly. The most common symptom is the buildup of fluid around the heart, an effect known as pericardial effusions. This symptom can hinder normal cardiac function.

Other common symptoms include:

  • Chest pain
  • Shortness of breath
  • Fatigue
  • Irregular heartbeat
  • Heart murmurs

If you are experiencing any of these symptoms, particularly those relating to your heart, seek immediate medical attention.

How Is Pericardial Mesothelioma Diagnosed?

Physicians have difficulty diagnosing pericardial mesothelioma. They face challenges due to the disease’s rarity and symptoms not being noticeable until the cancer is well-developed.

Pericardial mesothelioma has been confused with constrictive pericarditis, cardiac tamponade (pressure from fluid buildup) and cardiac failure.

Imaging Tests

Doctors use imaging tests like a CT scan, an X-ray, and an echocardiogram to determine the possibility of pericardial mesothelioma’s presence.

An echocardiogram is an ultrasound of the heart. This test shows how well the patient’s heart is working by allowing the doctor to hear the heartbeat. Many patients with this form of mesothelioma experience chest pain because their heart is unable to pump blood at maximum capacity due to pericardial effusions.

Biopsies

Imaging tests can show certain abnormalities in a patient, but mesothelioma biopsies are the only way to confirm a diagnosis.

Doctors may perform either a tissue biopsy or fluid extraction. Tissue biopsies are more invasive but more definitive in accurately diagnosing mesothelioma. If the doctor performs a fluid extraction, they’ll likely remove fluid from the patient’s pericardial sac.

Pericardial Mesothelioma Prognosis

The prognosis for patients with this cancer is the poorest of all forms of mesothelioma.

The survival time for patients following their initial showing of symptoms is often less than six months. Diagnosis is difficult and often occurs during autopsy after the patient passes away.

With the help of early diagnosis and treatment, some peritoneal mesothelioma patients have survived for numerous years.

Esteemed mesothelioma specialist Dr. Raphael Bueno of Brigham and Women’s Hospital participated in a pericardial mesothelioma study. The review, published in the Annals of Thoracic Surgery, found that resections have been performed at early stages and can be curative for localized tumors.

The study noted the case of a 54-year old woman who underwent a resection for her pericardial mesothelioma. As of the November 2018 publication date, the patient had survived for four years since her operation.

Taking part in clinical trials can offer unique treatments and is one way for patients to improve their prognosis. Anyone who has mesothelioma and wants to learn how others have outlived their prognosis can request our free Survivors Guide book.

Last Edited: April 22, 2020.

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