Pericardial Mesothelioma

 

Pericardial Mesothelioma

Pericardial mesothelioma affects the lining surrounding the heart (pericardium). It is a rare form of mesothelioma and only accounts for 1 percent of all diagnoses.

What is Pericardial Mesothelioma?

Pericardial mesothelioma is a cancer that affects the pericardium. It is currently unknown how the asbestos fibers get into the pericardium, and this type of mesothelioma is extremely hard to detect. Men are two times more likely to be diagnosed with pericardial mesothelioma than women. There have been cases of pericardial mesothelioma metastasizing to the lung or abdomen.

How Is Pericardial Mesothelioma Treated?

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  Pericardiectomy

  This surgery is rarely used in pericardial mesothelioma patients because the diagnosis is so rare that it is hard to catch early. If patients are eligible, doctors remove the affected part of the pericardium and any surrounding tumors.
• 

  Chemotherapy

  This is the most common treatment option for pericardial mesothelioma patients. There are various chemotherapy methods that can be used to improve a patient’s prognosis. Chemotherapy is most effective when used in conjunction with another treatment like radiation.
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  Radiation

  This is the least invasive treatment option for pericardial patients. Radiation is used for both palliative and curative purposes. Radiation works by shrinking the tumor, reducing the invasion on the heart.

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Symptoms

Patients may experience chest pain or other symptoms of pericardial mesothelioma. One of the most common reasons pericardial mesothelioma goes undetected is because it is highly uncommon for mesothelioma to originate in the pericardium. Patients have also reported symptoms that cause it to be mistaken for other heart ailments.

• Chest Pain
• Shortness of breath
• Swelling of face or arms
• Fatigue

• Cough
• Pericardial effusion
• Irregular heartbeat
• Murmurs

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Diagnosis

Physicians have a difficult time diagnosing pericardial mesothelioma because of the extreme rarity of the disease.

Pericardial mesothelioma has also been confused with constrictive pericarditis, cardiac tamponade (pressure from fluid buildup) and cardiac failure.

Pericardial mesothelioma can be diagnosed through fluid and tissue biopsies. Patients with pericardial mesothelioma commonly complain about chest pain. When mesothelioma is suspected, cardiac surgeons extract fluid or tissue and test the sample for mesothelioma.
Doctors use tests like the echocardiogram and CT scan to gather images that may tell if a patient has pericardial mesothelioma. An echocardiogram uses sound waves to diagnose or monitor heart ailments, including atrial fibrillation, heart disease and pericardial mesothelioma.
The echo allows a doctor to hear how a patient’s heart is beating and pumping blood. Many patients with pericardial mesothelioma experience chest pain because their heart is unable to pump blood at maximum capacity. Echocardiograms are also essential to determine the extent to which the heart has been affected by the mesothelioma.

Pericardial Mesothelioma

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Dr. David Sugarbaker

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Dr. Robert B. Cameron

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Treatment

Treatment options for pericardial mesothelioma are limited because of the proximity of the tumors to the heart itself. Unlike pleural or peritoneal mesothelioma, where the lung or abdominal lining can be removed, the pericardium presents further risks and can be difficult to remove.

Pericardiectomy Surgery

A pericardiectomy is the removal of some or all of the pericardium. If patients are deemed eligible, they may be able to have tumors surgically removed from the lining of their heart.
This procedure is often done to relieve the heart from constriction. It is a risky surgery because of the heart being so close and the risk of damage in the process. It’s also a very rare procedure in the case of mesothelioma because many diagnoses have already metastasized.
It is also seldom performed because only 1% of all diagnosed mesothelioma originates in the pericardium.

Chemotherapy

Many cases of pericardial mesothelioma are discovered post mortem. Due to its rarity, much is unknown about this type of cancer. However, as scientific advances are made, more is being discovered about the causes of pericardial mesothelioma and possible chemotherapy options.
One of the only effective chemotherapy treatments for patients with pericardial mesothelioma is the drug gemcitabine. Gemcitabine can shrink tumors and slow the progression of mesothelioma. More research is being done to find more treatment options for this rare type of mesothelioma.

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Prognosis

The prognosis for patients with pericardial mesothelioma is poorer than for pleural and peritoneal mesothelioma. The rarity of pericardial mesothelioma means it isn’t able to be studied as much as other types of mesothelioma, contributing to the poor prognosis.

There is also less information available about how the asbestos fibers lodge into the pericardium and which treatments are most effective. However, some patients show a positive outlook.

One patient who underwent a pericardiectomy survived five years after his initial surgery date. There has been research conducted through Johns Hopkins Hospital that shows pericardiectomies are performed with lower mortality rates as time goes on. Taking part in clinical trials also offers unique treatments and is one way many patients improve their prognosis.