Epithelioid mesothelioma is the most common subtype of malignant mesothelioma, accounting for 50% to 70% of all cases. Caused by asbestos exposure, it has the best prognosis and most treatment options of all mesothelioma cell types.
Written by Dr. Jeffrey Velotta, MD, FACS | Medically Reviewed by Dr. Jacques Fontaine | Edited by Amy Edel | Last Update:
“The survival rate for epithelial patients is overall significantly longer. Epithelial cell type is the best mesothelioma cell type to have. This patient will have more options, such as surgery, and is more likely to respond to treatment.”
Karen Selby, registered nurse and Patient Advocate at The Mesothelioma Center
“Epithelial subtype mesothelioma describes the type of cells the pathologist is seeing under the microscope when they look at a patient's tumor. The epithelial type does tend to be more favorable. It does tend to respond to chemotherapy a little more easily, but it also can metastasize or spread to other places such as the lymph nodes or other organs.”
Dr. Andrea Wolf, director of the Women’s Lung Cancer Program at Mount Sinai
“For nearly a year I was diagnosed as having pleurisy and pneumonia. I soon realised something wasn’t right… Eventually, after lots of tests …the result of the biopsy was mesothelioma. I even thought they had made a mistake and the doctor was also shocked… he asked me if I had worked in the shipyards. My father mixed asbestos cement at his work. He would come home in his overalls… He would lift my brother and me up when coming in from work to greet us.”
Christine S., epithelial mesothelioma survivor
“The survival rate for epithelial patients is overall significantly longer. Epithelial cell type is the best mesothelioma cell type to have. This patient will have more options, such as surgery, and is more likely to respond to treatment.”
Karen Selby, registered nurse and Patient Advocate at The Mesothelioma Center
“Epithelial subtype mesothelioma describes the type of cells the pathologist is seeing under the microscope when they look at a patient's tumor. The epithelial type does tend to be more favorable. It does tend to respond to chemotherapy a little more easily, but it also can metastasize or spread to other places such as the lymph nodes or other organs.”
Dr. Andrea Wolf, director of the Women’s Lung Cancer Program at Mount Sinai
“For nearly a year I was diagnosed as having pleurisy and pneumonia. I soon realised something wasn’t right… Eventually, after lots of tests …the result of the biopsy was mesothelioma. I even thought they had made a mistake and the doctor was also shocked… he asked me if I had worked in the shipyards. My father mixed asbestos cement at his work. He would come home in his overalls… He would lift my brother and me up when coming in from work to greet us.”
Christine S., epithelial mesothelioma survivor
Epithelial mesothelioma is an aggressive form of mesothelioma cancer that develops on the tissue that lines the organs of your body. This membrane, called the mesothelium, is made of cells like epithelial cells. Inhaled asbestos fibers can get stuck in that membrane and cause irritation that changes the DNA of the cells, making them cancerous.
Pathologists look at tumor and tissue samples and determine what cells they can see. If the majority of cells from your mesothelioma sample are epithelioid cells, your mesothelioma subtype is determined to be epithelioid mesothelioma.
“Epithelioid” and “epithelial” are sometimes used in ways that feel interchangeable. But epithelial cells are normal cells that line the skin and the inside of organs. Epithelioid cells can be found in both cancerous and non-cancerous conditions. Epithelioid cells look like epithelial cells, which are shaped like columns or cubes. However, epithelioid cells may come from different types of cells that have mutated or changed shape, taking on an appearance similar to epithelial cells.
The epithelioid subtype of mesothelioma has a more favorable prognosis. Epithelioid cells respond better to aggressive treatment than sarcomatoid cells. Having a combination of epithelioid and sarcomatoid cells is called biphasic mesothelioma. People with this subtype benefit if they have more epithelioid than sarcomatoid cells.
Epithelioid mesothelioma symptoms often include cough, shortness of breath and lack of appetite. Symptoms can depend on where on the mesothelium the cancer develops: the lining of the lungs (pleura), abdomen (peritoneum), heart (pericardium) or testes (tunica vaginalis).
Common Symptoms of Epithelioid Mesothelioma
Studies show early symptoms may be mild, making it difficult to diagnose. Late diagnosis can cause delays in treatment. As the disease progresses and tumors increase in size and spread, more severe symptoms may appear.
Mesothelioma cancer symptoms are the same, no matter the cell type. But the cell type affects which treatments are most helpful. Talk to your doctor if you experience any of these symptoms.
Connect with top-rated mesothelioma specialists at a cancer center near you, who will personalize treatment options based on your diagnosis.
Find Your CenterThe primary risk factor and cause of epithelioid mesothelioma is asbestos exposure. This is true for other types of mesothelioma as well. Inhaling or swallowing asbestos fibers causes inflammation and DNA damage. This can lead to cancer many years later.
People are commonly exposed to asbestos at work, in the environment, from contaminated talc or damaged asbestos products in homes, schools or other older buildings. Not everyone exposed to asbestos develops mesothelioma, though there is no safe amount of exposure. Additional risk factors can include the amount and length of exposure and possible genetic predispositions for developing cancer.
Many people with epithelioid mesothelioma worked with asbestos products years before their diagnosis. All mesothelioma cell types have a latency period of 20 to 60 years. The first symptoms may not appear for decades after the initial asbestos exposure.
Christine S.
Survivor Faces Malignant Epithelial Mesothelioma
Christine S. was diagnosed with epithelial mesothelioma after nearly a year of unanswered questions and pleurisy and pneumonia misdiagnoses. She remained resilient through 6 intense rounds of chemo. Today, she shares her experience to raise awareness about the risks of secondary asbestos exposure and advocate for earlier diagnosis of mesothelioma.
Christine S.
A tissue biopsy is the only way to diagnose epithelioid mesothelioma. This procedure involves taking samples of suspicious tissue. Pathologists examine the tissue samples under a microscope to identify specific cell characteristics.
Epithelioid mesothelioma cells clump together in groups and don’t tend to travel. These cell types are less likely to spread to other areas of the body. When a pathologist confirms the presence of specific cancer cells, an accurate diagnosis of your mesothelioma type can be made.
Your mesothelioma doctor will review your detailed personal pathology report that describes the types of mesothelioma cells found. You and your doctor will discuss the types of treatments that typically work best for epithelioid mesothelioma, your overall health and goals to determine which therapy options may be best for you.
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Diagnosing Epithelial Mesothelioma With Immunohistochemistry
The tool or technique for studying cancer tissues is called immunohistochemistry. Pathologists look at stained samples, testing for certain proteins linked to epithelial cells. If pathologists find proteins from other cancers, they’ll rule out epithelioid mesothelioma. An official diagnosis depends on more than just immunohistochemistry. It also considers the tumor’s appearance, location and cell traits.
Immunohistochemistry Markers
| Marker | What It Helps Confirm |
|---|---|
| Calretinin | Present in mesothelioma cells, especially sarcomatoid cells |
| Cytokeratin 5/6 | Found in more than 75% of mesothelioma cases |
| Podoplanin (D2-40) | Distinguishes mesothelioma from adenocarcinoma |
| WT-1 protein | Helps confirm pleural mesothelioma |
Subtypes of Epithelial Mesothelioma Cells
While epithelioid is a subtype of mesothelioma, there are further subtypes of the epithelioid type. Pathologists can identify these cell subtypes with immunohistochemistry.
Epithelioid mesothelioma has a better prognosis than other subtypes, but some epithelioid cell subtypes also have better prognoses than others. For example, adenomatoid cells are associated with a better mesothelioma survival rate.
Patient Advocate Danielle DiPietro explains why it’s so important to diagnose your cell subtypes. Danielle tells us, “When I speak with a patient who is hesitant to have a biopsy, which is rare, I explain that diagnosing the cell type is imperative for assessing treatment options.”
Epithelioid Cell Subtypes
| Subtype | Key Trait | Prognosis Note |
|---|---|---|
| Adenomatoid | Also called the microglandular type; makes up only 6% of pleural cases | The peritoneal form behaves like benign lesions and responds well to treatment |
| Deciduoid | Very rare, with fewer than 50 diagnosed cases; most often affects young women; more common in the abdomen than the pleura | Can be mistaken for other cancers, including a lung cancer called squamous cell |
| Glandular | Often develops in the pleura, with patterns that resemble glands | Behaves like adenocarcinoma that has spread to the pleura |
| Small Cell | Doesn’t show the stream, ribbon or rosette patterns found in small cell lung cancer; occurs more often in the abdomen | Median survival rate is around 8 months |
| Solid | Well-differentiated cells group in nests, cords or sheets and resemble noncancerous growth | Poorly differentiated cells may look like large cell carcinoma or lymphoma |
| Tubulopapillary | A common subtype that can resemble adenocarcinoma of the pleura | Distinct from benign well-differentiated papillary mesothelioma |
| Well-Differentiated Papillary Mesothelioma | Rare subtype often found in young women with no history of asbestos exposure | Less likely to spread or cause serious harm than other mesothelioma types |
Doctors often use a mix of treatment options like chemotherapy, immunotherapy and surgery to treat epithelioid mesothelioma. Using different therapies together can help patients live longer.
People diagnosed in early stages usually undergo aggressive treatment, while those with late-stage cancer often opt for palliative care, which may include immunotherapy, chemo and Tumor Treating Fields. However, palliative care can be helpful at any stage to manage symptoms and improve quality of life.
Common Epithelioid Mesothelioma Treatments
The epithelioid cell type responds better to surgery and chemo than sarcomatoid or biphasic mesothelioma, affording mesothelioma patients more multimodal therapy options. As Dr. Jacques Fontaine, thoracic surgeon and director of the Mesothelioma Treatment and Research Institute at Moffitt Cancer Center, tells us: “Usually epithelial type is a slightly less aggressive type of tumor. And usually it responds fairly well to chemotherapy. It may even respond to immune therapy. Surgery may be an option in epithelial type mesothelioma in specific circumstances.”
Patient Advocates can connect you to experienced mesothelioma specialists at top cancer centers who can provide additional insights or offer different treatment choices. Patient Advocates or your healthcare team can also help you find clinical trials that test new therapies or improvements to standard treatments.
Get answers about treatment, top doctors, and financial support from the nation’s most trusted mesothelioma resource.
Get Your Free GuideEpithelioid mesothelioma has the most favorable prognosis of the three mesothelioma cell types. This is because epithelioid cells respond better to treatment and spread more slowly than sarcomatoid or biphasic cells.
Life expectancy reflects that outlook. Patients typically survive between 1.5 and 6.5 years, depending on where the tumor develops, the stage at diagnosis and how well treatment works.
People with pleural epithelioid mesothelioma who undergo surgery live an average of 18 months. People with peritoneal epithelioid mesothelioma have a median survival of nearly 5 years. Another study on peritoneal mesothelioma found that people with epithelioid cells lived a median of about 5 years.
| Measure | Epithelioid Figure | Population | Source |
|---|---|---|---|
| 5-year survival rate | 12% | Pleural mesothelioma, all cell types | National Cancer Institute |
| 5-year survival with surgery | 10% to 15% | Resectable epithelioid pleural mesothelioma | Cancer Medicine |
| 2-year survival with chemotherapy | Evidence suggests around 35% | Epithelioid patients | Cancer Medicine |
| Median survival, Imfinzi (durvalumab) plus chemotherapy | 24.3 months | Epithelioid patients (9.2 months for nonepithelioid) | PrE0505 trial |
| Median survival | About 5 years | Peritoneal epithelioid mesothelioma | Peer-reviewed peritoneal mesothelioma studies |
Look for mesothelioma specialists with years of experience treating peritoneal and pleural mesothelioma. Oncologists need training to treat epithelioid mesothelioma, and our Patient Advocates can help you find a top doctor.
Epithelioid mesothelioma has no cure, but patients with this cell subtype have the most treatment options and respond best to all forms of treatment.
Researchers are constantly looking for mesothelioma patients with the epithelioid cell type for clinical trials. As of May 2026, clinical trials are actively recruiting mesothelioma patients across the U.S. Studying epithelioid patients lets researchers learn how a drug or therapy affects most people diagnosed with mesothelioma. For example, a clinical trial completed in 2024 examined the effectiveness of Itraconazole and Rifampin on epithelioid mesothelioma patients. Final results haven’t been published.
Epithelioid mesothelioma differs from sarcomatoid mesothelioma in cell shape, growth pattern and treatment response. Epithelioid cells cluster together and spread more slowly, giving patients more treatment options and a more favorable prognosis. Sarcomatoid cells have a spindle shape, grow more aggressively and respond less well to chemotherapy. Doctors call a mix of both biphasic mesothelioma.
Epithelioid mesothelioma includes 7 recognized subtypes: adenomatoid, deciduoid, glandular, small cell, solid, tubulopapillary and well-differentiated papillary mesothelioma. Each subtype has a distinct cell appearance under a microscope. Some subtypes, like adenomatoid, have a more favorable survival rate. Well-differentiated papillary mesothelioma is rare and typically less aggressive.
No, epithelioid mesothelioma isn’t lung cancer. It’s a cancer of the mesothelium, the thin lining around the lungs, abdomen, heart or testes. Lung cancer starts in the lung tissue itself. Both cancers can be caused by asbestos exposure, which is why people sometimes confuse them.
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My family has only the highest compliment for the assistance and support that we received from The Mesothelioma Center. This is a staff of compassionate and knowledgeable individuals who respect what your family is experiencing and who go the extra mile to make an unfortunate diagnosis less stressful. Information and assistance were provided by The Mesothelioma Center at no cost to our family.LashawnMesothelioma patient’s daughter
Asbestos.com. (2026, September 3). Epithelioid Mesothelioma. Retrieved September 3, 2026, from https://www.asbestos.com/mesothelioma/malignant/epithelial/
"Epithelioid Mesothelioma." Asbestos.com, 3 Sep 2026, https://www.asbestos.com/mesothelioma/malignant/epithelial/.
Asbestos.com. "Epithelioid Mesothelioma." Last modified September 3, 2026. https://www.asbestos.com/mesothelioma/malignant/epithelial/.
Dr. Jacques Fontaine is a thoracic surgeon at Moffitt Cancer Center in Tampa, Florida, where he heads up the Mesothelioma Research and Treatment Center. He specializes in minimally invasive robotic surgery and aggressive surgeries for mesothelioma.
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