Pericardial Mesothelioma

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

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Written by Jenna Campagna, RN

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What Is Pericardial Mesothelioma?

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

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

Researchers are still investigating specifics about this disease. According to a study published by the Case Reports in Oncology, men are three times more likely than women to be diagnosed with pericardial 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 tumors. Any damage to the heart during surgery could be fatal.

As science evolves, specialists and surgeons continue making improvements to the surgical process.

Other treatment options includes chemotherapy and other palliative therapies for pain management.

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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. Johns Hopkins Hospital has conducted research showing that a pericardiectomy is a safe procedure. The hospital reported perioperative mortality rates of around 5%.

Johns Hopkins Hospital has conducted research showing that a pericardiectomy is a safe procedure. The hospital reported perioperative mortality rates of around 5%.

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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.

The Journal of Clinical Oncology reported that 39% of pericardial patients underwent chemotherapy treatment.

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Palliative Treatments

Since pericardial mesothelioma often isn’t discovered until late stages, most patients receive palliative care. These therapies manage pain and preserve the patient’s quality of life.

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

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

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Radiation

Mesothelioma radiation is not often used for this disease. One study reported that 8% of patients have this type of treatment.

Symptoms of Pericardial Mesothelioma

Pericardial mesothelioma involves symptoms common with other heart conditions. The most common symptom is fluid buildup around the heart. This is called pericardial effusions and can hinder normal cardiac function.

Other symptoms include:

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

How Is Pericardial Mesothelioma Diagnosed?

Physicians face challenges diagnosing pericardial mesothelioma. This is due to the disease’s rarity and symptoms not being noticeable right away.

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 learn if the pericardium is diseased.

An echocardiogram is an ultrasound of the heart. This test lets doctors hear the patient’s heartbeat and shows how well the heart is working. Many patients 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 diagnose pericardial mesothelioma.

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.

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.

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.

Anyone who has mesothelioma and wants to learn how others have outlived their prognosis can request our free Survivors Guide book.

Last Edited: June 22, 2020.

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