Types of Mesothelioma

The four types of mesothelioma are defined by tumor location: Pleural (lung lining), peritoneal (abdominal lining), pericardial (heart sac) and testicular. Mesothelioma is also identified by three tumor cell types: Epithelioid, sarcomatoid and biphasic.

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This page features: 11 cited research articles

When people refer to the different types of mesothelioma, they are usually talking about the different places in the body where mesothelioma develops. But things can get a little confusing because there are different cell types of mesothelioma which may arise in each location too.

These factors affect your prognosis. Your oncologist considers them when creating your treatment plan.

Key Facts about the Types of Mesothelioma

  • Mesothelioma is most likely to develop in the lining surrounding the lungs or abdomen
  • The most common cell type, epithelioid, is also the most responsive to treatment
  • Treatment is tailored to your specific type of mesothelioma, right down to the microscopic cells that make up the cancer
  • Clinical trials may recruit participants based on their type of mesothelioma

The cell type of your cancer is identified during biopsy testing. This step is important to accurately identify and treat malignant mesothelioma.

The treatment plan your doctor recommends will depend mostly on the location of your cancer. Your cell type, age, overall health and cancer stage will play a role.

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Four Types of Mesothelioma Identified by Location

The type of mesothelioma you are diagnosed with is named after the place it developed. For example, when the cancer forms in the pleural lining around the lungs, it is called pleural mesothelioma.

  • Pleural: Lining of the lungs
  • Peritoneal: Lining around the abdomen
  • Pericardial: Heart sac
  • Testicular: Lining of the testes
Percentage of each type of mesothelioma diagram

  • Pleural Mesothelioma 75% of all cases
  • Peritoneal Mesothelioma 10-20% of all cases
  • Pericardial Mesothelioma 1% of all cases
  • Testicular Mesothelioma < 1% of all cases

Between 2,000 and 3,000 cases of mesothelioma are diagnosed each year in the U.S. Pleural mesothelioma accounts for approximately 75 percent of cases. Peritoneal accounts for 10 to 20 percent. Only 1 percent of cases arise from the pericardial lining around the heart or the lining covering the testicles.

But, incidence varies from year to year. A 2015 study looked at mesothelioma incidences from 2003 to 2008 and found that 85 percent of cases were pleural and 7 percent were peritoneal.

Each type of mesothelioma causes different symptoms. Treatment is tailored by type, and the prognosis varies as well.

Pleural Mesothelioma

  • Location: Pleural lining
  • Symptoms: Breathlessness, chest pain, fever and fatigue
  • Prognosis: 3+ years at stage 1 vs. 12 months at stage 4

Pleural is the most common type of mesothelioma. More research has been conducted on this type than the other types. Most patients qualify for chemotherapy, radiation therapy and immunotherapy. These therapies can add months or years to life expectancy.

Learn more about Pleural Mesothelioma

Peritoneal Mesothelioma

  • Location: Lining of the abdomen
  • Symptoms: Abdominal pain and swelling, bloating and bowel changes
  • Prognosis: 52 percent live at least five years after surgery with HIPEC

Even though less research has been conducted on this type compared to pleural, the prognosis for peritoneal is better. Studies show around half of patients who have surgery and heated chemotherapy (HIPEC) live longer than five years.

Learn more about Peritoneal Mesothelioma

Pericardial Mesothelioma

  • Location: Lining of heart
  • Symptoms: Irregular heartbeat, chest pain, difficulty breathing and cough
  • Prognosis: Typically ranges from six weeks to 15 months

The pericardial type is extremely rare. Around 200 cases are reported in medical literature. Surgery helps some patients live for years beyond the average six-month survival rate.

Learn more about Pericardial Mesothelioma

Testicular Mesothelioma

  • Location: Forms in the tunica vaginalis, which is the lining covering a testicle
  • Symptoms: Scrotal swelling, painless testicular lumps
  • Prognosis: 2 years

Testicular mesothelioma develops in the tunica vaginalis, which is the lining of the testes. Less than 100 cases are reported in medical literature. Treatment involves surgery and chemotherapy, which helps people live more than two years on average.

Learn more about testicular mesothelioma

Three Types of Mesothelioma Cells

There are three types of cells that compose mesothelioma tumors:

Epithelioid and sarcomatoid cells respond differently to treatment. Epithelial cells respond the best, and sarcomatoid cells are more resistant to treatment. This difference is why doctors consider your cell type when recommending a treatment plan. Incidence of these cell types varies depending upon location.

Pleural Mesothelioma Cells Broken Down by Type
Cell Type Percent
Epithelioid 50%
Biphasic 30%
Sarcomatoid 20%
Peritoneal Mesothelioma Cells Broken Down by Type
Cell Type Percent
Epithelioid 75%
Biphasic 24%
Sarcomatoid 1%

Pericardial mesothelioma appears to have a roughly equal distribution of the three cell types. Approximately two-thirds of testicular mesothelioma cases involve epithelioid cells. The rest of testicular cases are biphasic. Only one case of purely sarcomatoid cells is reported in testicular mesothelioma.

Certain subtypes of these cells are correlated with different types of mesothelioma. For example:

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Treatment Tailored to Your Type of Mesothelioma

The type of mesothelioma you are diagnosed with will influence your treatment options. Different treatments are used depending upon the location of your cancer.

Surgery

Surgery to remove tumors is different for each type of mesothelioma. Extrapleural pneumonectomy and pleurectomy and decortication are used to remove pleural tumors. Peritoneal tumors are removed with a peritonectomy. Pericardial tumors are removed with a pericardiectomy. Testicular tumors are removed with an inguinal orchiectomy.

Learn more about Mesothelioma Surgery

Chemotherapy Drugs

Different chemotherapy drugs are used to treat pleural and peritoneal mesothelioma. Cisplatin and pemetrexed is the most effective treatment against pleural mesothelioma. Combinations of gemcitabine, pemetrexed, mitomycin and carboplatin are most effective against peritoneal mesothelioma. No particular chemotherapy regimen is consistently effective for pericardial or testicular mesothelioma. The two latter types of mesothelioma are so rare that they have not been available for studies.

Learn more about Chemotherapy

Radiation Therapy

Different approaches to radiation therapy are used for all types of mesothelioma. In pleural mesothelioma, radiation therapy is used when surgery is an option or when tumors have invaded the chest wall. Radiation therapy hasn’t proven successful or very safe for peritoneal mesothelioma. But it has been used successfully to treat pericardial and testicular mesothelioma.

Learn more about Radiation Therapy

Palliative Treatment

Different procedures are used to drain fluid buildup from around the lungs and abdomen. Fluid around the lungs is drained with a thoracentesis. A paracentesis is used to drain fluid from the abdomen.

Learn more about Palliative Treatment

Your cancer’s cell type influences treatment in a less direct way than the location. Instead, oncologists consider your cell type when deciding how aggressively they can treat your cancer.

Patients with epithelial mesothelioma are more often considered for aggressive treatment plans because their cell type responds the best. Patients with sarcomatoid cells are less often considered for aggressive treatment.

Other factors, such as the stage of your cancer, your age and overall health, play a role in which treatments are recommended. Surgery is recommended to early-stage patients who are younger and in good health. Chemotherapy, radiation therapy and immunotherapy are available to every patient regardless of stage or age.

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Last Modified September 17, 2018

Registered Nurse and Patient Advocate

Karen Selby joined Asbestos.com in 2009. She is a registered nurse with a background in oncology and thoracic surgery and was the director of a tissue bank before becoming a Patient Advocate at The Mesothelioma Center. Karen has assisted surgeons with thoracic surgeries such as lung resections, lung transplants, pneumonectomies, pleurectomies and wedge resections. She is also a member of the Academy of Oncology Nurse & Patient Navigators.

Walter Pacheco, Managing Editor at Asbestos.com
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15 Cited Article Sources

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  2. Castleman, B. Asbestos: Medical and Legal Aspects. Aspen Publishers: New York. 2005.
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  4. Klebe, S. et al. (2010). Sarcomatoid Mesothelioma: A Clinical-Pathologic Correlation of 326 Cases.
    Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/20081811
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  6. Aber, A. et al. (2012). Benign Cystic Mesothelioma: A Rare Cause for Scrotal Swelling.
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  7. American Cancer Society. (2017, February 17). How is Malignant Mesothelioma Diagnosed?
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  8. Chekol, S., & Sun, C. (2012). Malignant mesothelioma of the tunica vaginalis testis. Arch Pathol Lab Med., 136:113-117. doi: 10.5858/arpa.2010-0550-RS
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    Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4406225/
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  12. Beebe-Dimmer, J. et al. (2016). Mesothelioma in the United States: a Surveillance, Epidemiology, and End Results (SEER)–Medicare investigation of treatment patterns and overall survival. Clin Epidemiol, 8:743–750. doi: 10.2147/CLEP.S105396
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