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Pericardial Mesothelioma
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Pericardial mesothelioma is a cancer that forms in the sac around the heart. Occupational asbestos exposure is linked to this type of cancer. Treatment aims to control tumor growth with surgery and chemotherapy. The 1-year survival rate is around 26%.
Written by Sean Marchese, MS, RN | Edited By Walter Pacheco | Last Update: October 18, 2024
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Written by Sean Marchese, MS, RN | Edited By Walter Pacheco | Last Update: October 18, 2024
What Is Pericardial Mesothelioma?
Pericardial mesothelioma is a rare cancer that affects the heart’s lining, the pericardium. Less than 1% of all types of mesothelioma are pericardial.
Asbestos exposure causes pericardial mesothelioma. It’s not known how asbestos fibers reach the heart. However, researchers are studying the cancer’s development.
Key Facts About Pericardial Mesothelioma
- This cancer type makes up about half of all primary pericardial tumors.
- It usually affects people between 50 and 70 years of age. It occurs in men more often than women.
- At least 75% of men with pericardial mesothelioma have a history of asbestos exposure.
- About 200 cases of pericardial mesothelioma exist in medical literature.
People with pericardial mesothelioma may show symptoms at a later stage. Symptoms can include chest pain, fatigue and shortness of breath. These sign are like those of other heart disorders. So diagnosing pericardial mesothelioma is challenging.
Pericardial treatment options primarily include surgery and chemotherapy. A 2023 report in BMC Cardiovascular Disorders says most patients live for 3 to 10 months. Survival rates are low, but some patients can live years after surgery or chemotherapy.
Diagram shows pericardial mesothelioma tumors forming on the smooth lining around the heart.
What Are the Causes of Pericardial Mesothelioma?
Pericardial mesothelioma is caused by asbestos exposure. Researchers suspect asbestos fibers travel through the bloodstream to the heart lining. Over time, these fibers cause inflammation and genetic mutations. This damage can lead to mesothelioma tumor development.
A 2020 study in the Scandinavian Journal of Work, Environment & Health confirmed the connection. It found that occupational asbestos exposure is significantly associated with pericardial mesothelioma.
Researchers reported cases linked with occupational asbestos exposure by gender. About 24% of women and 75% of men with pericardial mesothelioma worked around asbestos. Industries at high risk of asbestos exposure included construction, metal works, textiles and agriculture.
Other risk factors are similar to those of other types of mesothelioma. These factors include exposure to radiation, SV40 virus, tuberculosis and erionite.
What Are the Symptoms of Pericardial Mesothelioma?
Common pericardial mesothelioma symptoms include difficulty breathing, chest pain and heart palpitations. Fluid buildup around the heart and thickening of the pericardial layers also cause symptoms.
Most pericardial mesothelioma patients have no symptoms at first. This fact contributes to a late-stage diagnosis. The signs of pericardial mesothelioma can also resemble those of other heart conditions. This similarity makes it difficult to diagnose.
Symptoms of Pericardial Mesothelioma
- Chest pain
- Cough
- Difficulty breathing, even when at rest (dyspnea)
- Fatigue
- Fever
- Heart palpitations or irregular heartbeat (arrhythmia)
- Murmurs
- Night sweats
- Pericardial effusion
- Shortness of breath when lying flat
A 2024 case report listed cough, difficulty breathing and abdominal pain as a patient’s symptoms. The report appeared in the Journal of Surgical Case Reports. If you have symptoms, see your doctor right away. Screening tests can find the cause of these health problems.
“Pericardial mesothelioma can present with heart failure initially,” says Dr. Wickii Vigneswaran, a thoracic surgeon at the Loyola University Medical Center. “You’re not suspecting mesothelioma. You are going to find pericardial effusion or heart failure. Or the other way it presents is what we call constrictive pericarditis.”
How Is Pericardial Mesothelioma Diagnosed?
A physical exam and imaging tests can find pericardial mesothelioma tumors. A biopsy can confirm whether they are cancerous. Pericardial mesothelioma is often diagnosed after surgery or during an autopsy.
- A biopsy will test the makeup of abnormal growths. Most pericardial biopsies are obtained through surgery. A pathologist checks biopsies to confirm if you have mesothelioma and its cell type.
- A pericardiocentesis extracts fluid samples that can reveal cancer cells. A pathologist uses cytology tests to detect cancer in fluid samples. An echocardiogram or CT scan can help guide the procedure.
- An echocardiogram is one of the first diagnostic tests patients receive. This test is an ultrasound of the heart that can reveal excess fluid. It helps doctors see the size, shape and function of the heart. The scan is noninvasive and uses sound waves.
- Imaging tests scans help detect pericardial tumors. They include such as computed tomography and magnetic resonance imaging. This makes them a preferred diagnostic tool for determining whether a biopsy or cytology is necessary.
- Physical exams can uncover signs and symptoms of pericardial mesothelioma. Findings during this exam will lead to imaging tests.
Doctors will also assess your symptoms, medical history and current medical condition. Experts diagnose about 25% of cases before a patient dies. Cytology tests of pericardial fluid can sometimes show cancer cells. But a biopsy obtained through surgery is more reliable. Other methods may lead to a misdiagnosis.
Seek a Second Opinion to Avoid Misdiagnosis
It’s vital to meet with a specialist. They must confirm a pericardial mesothelioma diagnosis. A mesothelioma expert will know more about this rare cancer. They can ensure an accurate diagnosis and prompt treatment.
Common Pericardial Mesothelioma Misdiagnoses
- Cardiac tamponade
- Cardiomyopathy
- Constrictive pericarditis
- Coronary heart disease
- Heart failure
- Intra-atrial myxoma
- Tuberculosis pericarditis
If you have been diagnosed with any of these conditions, always seek a specialist. Mesothelioma oncologists and cardiothoracic surgeons can diagnose and treat pericardial mesothelioma. These experts can recommend new therapies and clinical trials that may improve survival.
What Are the Treatment Options for Pericardial Mesothelioma?
Mesothelioma treatment for pericardial mesothelioma includes surgery and chemotherapy. The heart lining rests close to the heart and limits treatment options.
Surgery is the most effective treatment for this cancer, but more than half of patients are not eligible. In rare cases of an early diagnosis, surgery may be able to remove tumors. The primary surgical treatment option for pericardial mesothelioma are pericardiectomy and tumor removal. It is also called a pericardial window.
Chemotherapy and radiation can slow tumor growth. Palliative treatment can ease symptoms. Immunotherapy has been tried in some patients with heart failure. It had limited success.
Surgery
Pericardial mesothelioma patients who are good candidates for surgery may undergo a pericardiectomy. This is also called a pericardial window. A pericardiectomy removes part or all of the pericardium along with tumors. This surgery relieves pressure and minimizes fluid buildup.
In 2024, Translational Cancer Research reported a patient survival of 2.5 years following a pericardiectomy. According to a 2018 report in The Annals of Thoracic Surgery, another patient was alive four years after a pericardiectomy. The patient experienced a recurrence that was successfully treated with another surgery.
Chemotherapy
The benefits of chemotherapy are minimal for most patients with pericardial mesothelioma. The chemotherapy drugs pemetrexed and cisplatin may improve survival. Gemcitabine has produced mixed results. Recent case reports show the addition of bevacizumab to chemotherapy for certain patients. A handful of cases have responded well to chemotherapy.
Radiation Therapy
Radiation therapy has been used to control pericardial mesothelioma growth and improve pain. This treatment carries a higher risk near the heart. For this reason, radiologists use advanced techniques for delivering radiation.
For example, doctors can use volumetric modulated arc therapy to treat a tumor recurrence. They can also apply radiation after surgeons remove tumors. A patient received this treatment in a 2021 case report in Advances in Radiation Oncology.
Palliative Treatment
Palliative treatment options aim to minimize pain and reduce symptoms for people with pericardial mesothelioma. This care can improve the quality of life and make patients more comfortable. Radiation and chemotherapy may be used in palliative care. They can shrink tumors, prevent recurrence and improve symptoms.
Diagram shows the area of the pericardium where excess fluid builds up.
Pericardial mesothelioma is thought to occur when asbestos lodges itself around the heart.
Fluid buildup in the pericardium is the primary cause of symptoms. This condition is called pericardial effusion. A pericardiocentesis removes excess fluid to relieve pain and pressure around the heart. Pain medication can also reduce symptoms and improve comfort.
Prognosis and Survival Rates for Pericardial Mesothelioma
The prognosis for pericardial mesothelioma is poor compared to peritoneal or pleural mesothelioma. Nearly 50% to 60% of pericardial patients die within six months of diagnosis. However, this is not the case for everyone. About 26% of patients live for one year or more. A 2024 case report says survival time is around 2.5 years. The 5-year survival rate for pericardial mesothelioma is 9%.
Research shows minor benefits from chemotherapy, except for one case. A 47-year-old woman lived two years after chemotherapy with cisplatin, gemcitabine and vinorelbine. In 2024, Frontiers in Cardiovascular Medicine described a patient who refused surgery. They opted for chemotherapy with bevacizumab. He lived for about one year.
Hope for a better life expectancy exists for some patients because of positive results from surgery. Surgery combined with other therapies has helped some patients live for years. A 1995 case report described a 27-year-old woman who underwent surgery and radiation therapy. She had no evidence of recurrence during 28 years of follow-up.
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Connect NowAdditional Resources for Pericardial Mesothelioma Patients
Helpful resources and coping strategies are available for patients and their loved ones. Coping with pericardial mesothelioma can be challenging. Effective coping strategies can manage symptoms and improve quality of life.
- Community Organizations. Many community organizations offer support and resources to patients with cancer. These associations may provide support groups, educational resources and financial help.
- Counseling. Counseling can be helpful for patients with pericardial mesothelioma and their families. Professional counselors can provide emotional support. They can also offer guidance on how to manage stress and anxiety.
- Hospital Services. Many hospitals have specialized oncology departments. These units offer pain management, nutrition counseling and physical therapy.
- Practice self-care. Exercise, healthy eating and quality sleep can help manage symptoms. They’ll also improve general well-being and allow you to tolerate more treatments.
- Stay organized. Keep track of appointments, medications and symptoms. This can help you feel more in control of your condition. Use a journal or planner to stay organized.
- Seek emotional support. It’s vital to ask for help from loved ones, friends or professional counselors. Joining a support group can also be helpful. You can connect with others who are going through similar experiences.
These resources can help patients better understand their condition and treatment options. They can also help them cope with the disease’s physical and emotional challenges.
Common Questions About Pericardial Mesothelioma
- How does pericardial mesothelioma affect heart function?
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Pericardial mesothelioma tumors cause thickening of the heart lining and fluid buildup. The fluid pressure restricts the heart’s ability to pump effectively, leading to symptoms like chest pain and arrhythmias.
- Is pericardial mesothelioma linked to other asbestos-related diseases?
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Pericardial mesothelioma is linked to asbestos exposure like other types of mesothelioma. People with pleural, peritoneal and testicular types also have a history of asbestos exposure.
- What are the early warning signs of pericardial mesothelioma?
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The initial signs include chest pain, shortness of breath, and irregular heartbeat. These symptoms develop as the cancer grows and leads to fluid buildup around the heart. Because these signs mimic other heart conditions, diagnosis is often delayed until the disease is more advanced.
- Are there any clinical trials for pericardial mesothelioma treatment?
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Few trials focus only on recruiting patients with pericardial mesothelioma. That’s because it is rare. But these patients may qualify for trials that compare heart procedures or test new cancer drugs. Participation may provide access to cutting-edge treatments.
- How is asbestos exposure proven in pericardial mesothelioma cases?
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Asbestos exposure is proven through work history and medical documents. Exposure evidence may include working at or living near asbestos job sites. A mesothelioma biopsy can show asbestos fibers. This may be submitted as medical evidence.
- Can lifestyle factors influence pericardial mesothelioma prognosis?
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Maintaining a healthy lifestyle can help patients get through aggressive cancer treatment. Electing treatment for pericardial mesothelioma has the biggest impact on your prognosis. Proper nutrition, regular exercise and avoiding smoking may improve your response to treatment.
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