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Written By: Devin Golden

Pericardial Mesothelioma

Pericardial mesothelioma is a rare cancer that forms in the protective lining around the heart, called the pericardium. This lining is made of mesothelial cells and fluid. Pericardial mesothelioma is a rare form of mesothelioma and one of the rarest types of cancer in general.

Karen Ritter, RN BSN

Medically Reviewed By

Karen Ritter, RN BSN

Registered Nurse

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Important Facts About Pericardial Mesothelioma

  • Pericardial mesothelioma is a cancer of the pericardium, which is a protective sac surrounding the heart and nearby blood vessels.
  • The average survival for pericardial mesothelioma is poor because of the tumors’ proximity to the heart. In one study, the median survival for patients was six months.
  • The treatment options for pericardial mesothelioma patients include chemotherapy and surgery to remove the pericardium.

Overview of Pericardial Mesothelioma

Pericardial mesothelioma accounts for only 1% of all diagnosed mesothelioma cases. There are approximately 2,500 cases of mesothelioma diagnosed in the United States every year, which means there are an estimated 25 cases of pericardial mesothelioma diagnosed annually.

The average survival of pericardial mesothelioma is just a few months. Scientists are still looking at how the cancer spreads, but the proximity to the heart can explain the poor survival outcomes.

Men are more likely than women to develop mesothelioma, and this disparity is true for pericardial mesothelioma as well. 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.

The same study reports that the median age of patients at the time of diagnosis is 46 years old. This is a younger median age than the two main types of mesothelioma: pleural mesothelioma (around 70 years old) and peritoneal mesothelioma (around 60 years old).

In a separate study, the median age at diagnosis was 55 years old, and 61% of patients were male.

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What Causes Pericardial Mesothelioma?

Asbestos is the only known cause of mesothelioma. When asbestos is disturbed, it can easily break apart, and tiny fibers are dispersed through the air. The disturbed asbestos fibers can be unknowingly inhaled or swallowed and get stuck in the linings of the lungs, abdomen or heart.

These linings are made of mesothelial cells. When the cells are irritated by the sharp asbestos fibers, they mutate and begin multiplying rapidly. The cells also don’t die at a regular pace, which leads to a growing clump of cells and the beginning of a tumor.

If untreated, the tumors will eventually spread beyond the heart and to other vital organs, leading to advanced-stage cancer.

What is the Pericardium?

The pericardium is the thin lining surrounding your heart and the roots of the major blood vessels extending from your heart. This lining, also called a membrane or sac, includes fluid between two layers of cells.

The pericardium has several functions:

  • Protects the heart and the surrounding blood vessels from outside pressure
  • Provide lubrication to prevent friction between the heart and surrounding tissues
  • Holds the heart in place within your chest
  • Protects your heart from expanding too much or filling with too much blood
  • Helps protect your heart from being infected

Some of the vessels that the pericardium protects includes your:

  • Aorta
  • Main pulmonary artery
  • Pulmonary veins
  • Superior and inferior vena cava

The pericardium has two layers:

  • Fibrous pericardium – Outermost layer made of connective tissue that prevents your heart from overexpanding and protects against infections
  • Serous pericardium – Inner layer, which produces fluid to lubricate the heart as it beats

The serous pericardium has two layers of tissue:

  • Parietal pericardium – Outer layer attached to the fibrous pericardium
  • Visceral pericardium – Inner layer covering the surface of the heart and blood vessel roots

The space between the parietal pericardium and the visceral pericardium is called the pericardial cavity. This space is filled with pericardial fluid, which reduces the friction between the two tissue layers to allow the heart to expand and contract.

Symptoms of Pericardial Mesothelioma

The symptoms of pericardial mesothelioma can be similar to other common heart conditions. The most common symptom is fluid buildup in the pericardium, which is the sac around the heart. This symptom is called pericardial effusions, and it can hinder normal cardiac function by adding pressure on the heart and preventing it from expanding like normal.

Most patients do not experience symptoms of pericardial mesothelioma until tumors have begun spreading beyond the pericardium. This usually results in an advanced-stage cancer diagnosis, making it difficult to treat.

Other pericardial mesothelioma symptoms include:

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

How Is Pericardial Mesothelioma Diagnosed?

Physicians often face challenges in diagnosing pericardial mesothelioma. This is due to the rarity of the disease and nonspecific symptoms. Some patients have been diagnosed during their autopsy.

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, a chest X-ray and an echocardiogram to learn if the pericardium is diseased. An echocardiogram is an ultrasound of the heart. It uses sound waves to show a graphic outline of your heart’s movement, blood flow and heartbeat.

This test allows doctors to determine how well the heart is working. Many patients with pericardial mesothelioma experience chest pain because their heart is unable to pump blood at maximum capacity due to pericardial effusions and tumor burden. An echocardiogram can reveal this issue.

Biopsies

Imaging tests can show certain abnormalities in a patient, but mesothelioma biopsies are the only way to diagnose pericardial mesothelioma. Doctors perform tissue biopsies to test for evidence of cancerous cells. They will remove tissue from within the pericardium and use a staining procedure to determine if the cells are diseased.

Due to the proximity of the heart, some doctors prefer to use a fluid biopsy to prevent damage to the heart by removing tissue. They’ll drain fluid and test it for signs of cancer. For pericardial mesothelioma, draining and testing the fluid is called a pericardiocentesis.

Treatment for Pericardial Mesothelioma

Treatment options are available for patients with pericardial mesothelioma. The two main options are surgery and chemotherapy. While immunotherapy is used for other types of cancer, including other types of mesothelioma, there is not enough information about its use for pericardial mesothelioma.

Patients can also receive palliative therapies to improve their quality of life and comfort.

Since pericardial mesothelioma forms near the heart, the options are limited. The heart is a vital organ, so any damage to it can be life-threatening. For this reason, doctors do not recommend radiation for pericardial mesothelioma.

They also are selective with which patients can have pericardial mesothelioma surgery. Any surgery involving the heart can be life threatening, so doctors must evaluate patients carefully.

Surgery for Pericardial Mesothelioma Icon

Surgery for Pericardial Mesothelioma

Surgery for pericardial mesothelioma is called a pericardiectomy, which involves removing part or all of the pericardium (sac around the heart). This sac, or lining, is where pericardial mesothelioma tumors first appear and begin spreading. Surgeons also remove any surrounding cancerous tissue, as long as doing so won’t damage the heart.

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In one study published in the Journal of Clinical Oncology, approximately 46% of 103 diagnosed pericardial mesothelioma patients underwent surgery. However, many patients are not diagnosed prior to passing away, which is why early diagnosis and response to symptoms are critical.

Chemotherapy for Pericardial Mesothelioma Icon

Chemotherapy for Pericardial Mesothelioma

Chemotherapy is a standard treatment option for pericardial mesothelioma. This treatment sends cancer-killing drugs into the patient’s body (usually the bloodstream).

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.

Chemotherapy can lead to side effects, such as:

  • Vomiting
  • Nausea
  • Fatigue
  • Weight loss
  • Body aches

More serious side effects include:

  • Low blood cell counts (anemia)
  • Mouth sores
  • Skin rashes
  • Increased risk of infection
  • Damage to the liver or heart

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

Radiation for Pericardial Mesothelioma Icon

Radiation for Pericardial Mesothelioma

Radiation uses high-energy beams to kill cancer cells. This treatment option is not often used for pericardial mesothelioma due to the proximity of the disease to the heart.

Radiation can cause “spray,” which causes damage to healthy tissue near the targeted tumors. Any damage from radiation beams to the heart can be severe and must be avoided.

Some patients have received radiation either as part of multimodal treatment (combining surgery, chemotherapy and radiation) or as a palliative therapy to slow the growth of tumors and reduce pain.

According to the study in the Journal of Clinical Oncology, approximately 8% of patients with pericardial mesothelioma received radiation.

Immunotherapy for Pericardial Mesothelioma Icon

Immunotherapy for Pericardial Mesothelioma

Immunotherapy is becoming more common for cancer in general, but there are no reported uses of immunotherapy for pericardial mesothelioma. Immunotherapy is FDA-approved for pleural mesothelioma, but only after clinical trials proved the treatment was effective and safe.

Due to the rarity of pericardial mesothelioma, there are no clinical trials accepting patients for this cancer. It is difficult to test the effectiveness of immunotherapy due to the low number of diagnosed cases.

Palliative Treatments for Pericardial Mesothelioma Icon

Palliative Treatments for Pericardial Mesothelioma

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.

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

Pericardial Window

Another palliative surgery for pericardial mesothelioma is the pericardial window. This procedure removes a small portion of the pericardium – rather than removing the entire pericardium in a pericardiectomy – to drain excess fluid in the pericardial cavity. By removing the small portion of the pericardium, the surgeon creates a “window” to drain the fluid and relieve the pressure around the heart.

A pericardial window can also be a method of delivering chemotherapy drugs directly into the pericardial cavity rather than through the bloodstream (the traditional method of chemotherapy).

During a pericardial window, doctors usually use general anesthesia on the patient. The surgeon can make a cut under the bottom of the breastbone or a cut between the ribs to reach the pericardium.

Doctors may also use a method of making several small incisions on the side of the chest, which is called a video-assisted thoracoscopy. They use small cameras and instruments to create the pericardial window.

Pericardial Mesothelioma Prognosis

The mesothelioma prognosis for patients with this cancer is poor due to the proximity of the tumors to the heart and the difficulty in recognizing symptoms and diagnosing the disease. According to a study in the Journal of Clinical Oncology, the median survival from diagnosis is 5.6 months.

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, said the prognosis is discouraging because patients often have a poor response to chemotherapy.

The study noted the case of a 54-year-old woman who underwent a resection for her pericardial mesothelioma. She also received chemotherapy and radiation. As of the November 2018 publication date, the patient had survived for four years.

Anyone diagnosed with mesothelioma and wants to learn how others have outlived their prognosis can get our free Survivors Guide book delivered directly to you.

Compensation for Pericardial Mesothelioma

Researchers are continuing to evaluate how pericardial mesothelioma tumors form, but the cancer is, in fact, linked to asbestos exposure. Asbestos is the only proven cause of mesothelioma, and the companies responsible for exposing people to this deadly mineral should be held accountable in the courts.

Expert mesothelioma lawyers can help you receive asbestos compensation for your or a loved one’s pericardial mesothelioma. While this cancer is rare, there are examples of patients taking asbestos companies to court and receiving deserved payments to recoup lost wages, medical bills and more.

There are two methods of receiving compensation for pericardial mesothelioma. Most patients file claims with asbestos trust funds, which are bank accounts with money set aside by bankrupt asbestos companies. Some patients file mesothelioma lawsuits if the at-fault companies are still in business.

Look for a lawyer with experience handling mesothelioma cases. Mesothelioma Guide has tips on how to find a mesothelioma lawyer so that you get the best possible legal representation and guidance.

Lawsuit Against Johnson & Johnson for Pericardial Mesothelioma

In 2023, a patient with pericardial mesothelioma filed a lawsuit against Johnson & Johnson, the manufacturer of health and hygiene products, for asbestos in the company’s talc-based products.

The victim used Johnson & Johnson Baby Powder, which was formerly made with talc. This is a naturally occurring mineral that often cohabitates with asbestos, leading to contamination when talc is ground into a powder for talcum powder products, such as Johnson & Johnson Baby Powder.

The patient, who was only 24 years old when he was diagnosed with pericardial mesothelioma, was allegedly exposed to asbestos through Johnson & Johnson Baby Powder as an infant. His parents used the powder on him, and the plaintiff’s lawyer told the court that this cancer will likely take his life.

This lawsuit against Johnson & Johnson led to a $18.8 million verdict for the victim. The jury found that the victim was entitled to compensation for medical bills in addition to pain and suffering.

Help for Patients with Pericardial Mesothelioma

If you’d like more information about pericardial mesothelioma, you can speak with our patient advocates. Registered nurse Karen Ritter works with mesothelioma patients and caregivers to find the best treatment options for their unique diagnosis, along with options for compensation and support groups.

Email Karen at karen@mesotheliomaguide.com. You can also request a free Complete Guide to Mesothelioma book for an in-depth explanation of pericardial mesothelioma and the other types of mesothelioma, the treatment options you could consider, and more.

Sources & Author

  1. Pericardial Window. Johns Hopkins Medicine. Retrieved from: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/pericardial-window. Accessed: 09/22/2023.
  2. Pericardium. Cleveland Clinic. Retrieved from: https://my.clevelandclinic.org/health/body/23561-pericardium. Accessed: 09/22/2023.
  3. Echocardiogram. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/tests-procedures/echocardiogram/about/pac-20393856. Accessed: 09/22/2023.
  4. Recurrence of Pericardial Mesothelioma Affecting the Myocardium After Pericardial Resection. Annals of Thoracic Surgery. Retrieved from: https://www.annalsthoracicsurgery.org/article/S0003-4975(18)30700-8/abstract. Accessed: 08/22/19.
  5. Primary Pericardial Mesothelioma: Report of a Patient and Literature Review. Case Reports in Oncology. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2918860/?tool=pmcentrez. Accessed: 08/22/19.
  6. Surgery for Malignant Mesothelioma. American Cancer Society. Retrieved from:
  7. https://www.cancer.org/cancer/malignant-mesothelioma/treating/surgery.html. Accessed: 08/22/19.
  8. Signs and Symptoms of Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/signs-symptoms.html. Accessed: 08/22/19.
  9. Tests for Malignant Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/how-diagnosed.html. Accessed: 08/22/19.
  10. Treatment and outcomes of primary pericardial mesothelioma: A systematic review. Journal of Clinical Oncology. Retrieved from: https://ascopubs.org/doi/abs/10.1200/JCO.2017.35.15_suppl.e20027. Accessed: 08/22/19.
  11. Johnson & Johnson must pay $18.8 million to California cancer patient in baby powder suit. CNN. Retrieved from: https://www.cnn.com/2023/07/18/business/johnson-and-johnson-baby-powder-suit/index.html. Accessed: 07/20/2023.
Devin Golden

About the Writer, Devin Golden

Devin Golden is a content writer for Mesothelioma Guide. He produces mesothelioma-related content on various mediums, including the Mesothelioma Guide website and social media channels. Devin's objective is to translate complex information regarding mesothelioma into informative, easily absorbable content to help patients and their loved ones.