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Types of Mesothelioma

Asbestos cancer is designated by location in the body and types of cells involved, which directly influences the treatment options and prognosis.

There are four main types of mesothelioma — pleural (lungs), peritoneal (abdominal), pericardial (heart) and testicular (testes) — and three predominate cell types that make up cancerous tumors. All of these factors, along with the patient’s age, general health and cancer stage, play vital parts in treatment plans and the general prognosis. Using these details, mesothelioma specialists can target medical care.

Mesothelioma by Location in Body

Mesothelioma is most often found around the lungs and in the stomach/abdominal area. Of the 3,000 or so mesothelioma cases diagnosed in the United States every year, about 75 percent of cases develop in the lungs, and about 20 percent develop in the abdominal area. The remaining five percent of cases develop around the heart and testes.

Each type of mesothelioma presents different symptoms and is equally difficult to detect in the early stages. Specialists focus on tailoring treatments to individual cases.

Pleural Mesothelioma

  • Location – Pleural mesothelioma forms tumors on the pleura, which is the lining that encases the chest and lungs. The pleura produces fluids that allow organs to move smoothly inside the body.
  • Organs and tissues involved – The predominate tissues involved are the two layers that make up the pleura. Asbestos fibers become trapped between the parietal and visceral pleural membranes and slowly form tumors. Eventually, the cancer spreads around the lungs, to nearby lymph nodes and other organs.
  • Early symptoms – Shortness of breath, persistent cough, chest pains, fever, weight loss.
  • Treatment Options – In the early stages of the disease (Stages I, II and sometimes III), some specialists will recommend removing the pleura, the diaphragm, the pericardium and an entire diseased lung in a procedure called an extrapleural pneumonectomy (EPP). Other specialists will advocate for a pleurectomy/decortication (P/D) procedure, which removes just the tumors and the pleura.

All patients also typically undergo multi-modal treatment, which includes chemotherapy and radiation. In some cases, immunotherapy and clinical trials are recommended.


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Peritoneal Mesothelioma

  • Location – Peritoneal mesothelioma forms in the lining around the abdominal area called the peritoneum.
  • Organs and tissues involved – The lining that surrounds and supports the abdominal area, called the peritoneum, is predominately involved in peritoneal mesothelioma. In the later disease stages, mesothelioma tumors spread to bodily organs and lymph nodes.
  • Early symptoms – Abdominal pain, gas, bloating, diarrhea, nausea, abnormal vaginal bleeding, rectal bleeding.
  • Treatment Options – Specialists have had success with Hyperthermic Intraperitoneal Chemotherapy (HIPEC). For the treatment, surgeons remove tumors and cancerous tissue and bathe the abdominal area with heated chemotherapy. Researchers have found patients who undergo the procedure have a better chance at surviving for five or more years.

Pericardial Mesothelioma

  • Location – Also known as malignant heart cancer, pericardial mesothelioma forms in the pericardium, which is the thin layer of tissue that surrounds the heart.
  • Organs and tissues involved – The lining around the lungs, called the pericardium, is mainly involved in pericardial mesothelioma.
  • Early symptoms – Chest pains, heart murmurs, shortness of breath, irregular heartbeat, night sweats.
  • Treatment Options – There are limited treatment options for pericardial mesothelioma because of the close proximity between the pericardium and the heart. In some cases, small tumors can be removed via surgery in a procedure called a pericardiectomy. Since radiation treatment is usually not an option due to the close proximity to the heart, many patients undergo rounds of chemotherapy.

Testicular Mesothelioma

  • Location – Testicular mesothelioma, also known as mesothelioma of the tunica vaginalis testis, attacks the membranous lining that surrounds the testes.
  • Organs and tissues involved – The membrane lining of the testes, called the tunica vaginalis, is predominately involved in testicular mesothelioma. Cancerous nodules can also encase the testicles, nearby blood vessels and the spermatic cord.
  • Early symptoms – The most recognizable symptom is an abnormal lump inside the scrotum and swelling. A buildup of fluids in the scrotum, called hydrocele, is also common.
  • Treatment Options – The most effective treatment is a radical inguinal orchiectomy, which requires the removal of the testicle and the entire spermatic chord. Surgery may be followed by chemotherapy and radiation treatment.

Mesothelioma by Cell Types

In addition to location, cell types also characterize the different types of mesothelioma. Each cell type has a distinct pattern and plays a vital role in the diagnosis, treatment and prognosis of the disease. Mesothelioma tumors are made up of three main cell types:

Epithelioid Cells

  • Prevalence – Epithelioid cells form when epithelial cells mutate as a result of mesothelioma. Up to 70 percent of all mesothelioma cases involve epithelial cells. This cell type responds best to treatment.
  • Arrangement – Under a microscope, epithelioid cells appear elongated with a clearly defined nucleus.
  • Behavior – Epithelioid tumors multiply faster than other cell types, but the cells also respond well to treatment because they spread (or metastasize) slower.
  • Common subtypes – Adenoid, papillary, deciduoid, cystic.

Sarcomatoid Cells

  • Prevalence – Sarcomatoid tumors account for up to 20 percent of all mesothelioma diagnoses. The tumors begin as small nodules but grow to form sheets across the pleura. It is the least common cell type for mesothelioma cancer.
  • Arrangement – Sarcomatoid cells appear spindle shaped with an elongated nucleus and often overlap.
  • Behavior – Sarcomatoid tumors are aggressive and difficult to treat. Patients diagnosed with sarcomatoid mesothelioma have poor survival rates. The cells resemble the shape of other cells, making them difficult to diagnose.
  • Common subtypes – Desmoplastic

Biphasic Cells

  • Prevalence – Malignant mesothelioma cancer with biphasic cells account for up to 35 percent of all cases. The biphasic, or mixed, cell type is the second most common cell type and is more common among pleural mesothelioma patients.
  • Arrangement – Biphasic tumors contain both epithelioid and sarcomatoid cells in close proximity or in distinct areas of a tumor.
  • Behavior – The behavior of biphasic tumors largely depends on the ratio of cells. The prognosis is better if there are more epithelioid cells than sarcomatoid cells.
  • Common subtypes – none

Disease Location, Cell Types and Compensation

The location of mesothelioma cancer in the body and the cell types involved not only play an important role in treatment, they are vital to financial compensation for the asbestos exposure that caused the disease.

Anyone seeking access to asbestos cancer trust funds must have an official diagnosis of mesothelioma or other types of asbestos-related diseases from a board-certified physician. With the diagnosis, asbestos victims are able to file claims on asbestos bankruptcy trust funds to pay for necessary treatments, living expenses, and advanced care. Contact us now for more information about how all mesothelioma victims may be eligible for compensation.

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