Types of Mesothelioma: The Ultimate Guide

Types of Mesothelioma

Mesothelioma is a cancer of growth of cells in the mesothelium. The mesothelium is a thin layer of tissue that covers many internal organs.

Mesothelioma most often happens in the tissue around the lungs. This is called pleural mesothelioma. Mesothelioma also can happen in the tissues in the belly, around the heart and around the testicles.

Mesothelioma, which is sometimes called malignant mesothelioma, is a fast-growing and deadly form of cancer. There are mesothelioma treatments. But for many people with mesothelioma, there is no cure.

There are four main types of mesothelioma. They are as follows:

Pleural: Develops in the lining around the lung
Peritoneal: Develops in the lining of the abdomen
Pericardial: Develops in the lining around the heart
Testicular: Develops in the lining of the testicles

Mesothelioma also has three cell types: epithelioid, sarcomatoid and biphasic.

Mesothelioma has four main types based on where tumors grow in the body. Mesothelioma occurs in the linings around the lungs, abdomen, heart and testicles. Mesothelioma can be further classified by cell type. The three main mesothelioma cancer cell types are epithelioid, sarcomatoid and biphasic.

Causes

It’s not always clear what causes mesothelioma. Experts believe that being around asbestos causes many mesotheliomas. But not everyone with mesothelioma has been around asbestos. Exactly what causes the cancer may not be known.

Mesothelioma is a cancer that starts as a growth of cells in the mesothelium. The mesothelium is a thin layer of tissue that covers many internal organs.

Mesothelioma happens when cells in the mesothelium develop changes in their DNA. A cell’s DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time.

In cancer cells, the DNA changes give other instructions. The DNA changes tell the cancer cells to make more cells quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it’s called metastatic cancer.

Pleural Mesothelioma (Lungs)

Pleural mesothelioma forms in the lining around the lungs, also called the pleura. It accounts for 80% – 90% of cases, making it the most common type of mesothelioma. This rare cancer is caused by asbestos exposure. When a person inhales asbestos fibers, the fibers may end up in the pleura. Over time, irritation caused by these fibers may lead to tumor growth.

Pleural Mesothelioma Symptoms

Chest pain
Coughing up blood
Difficulty swallowing
Dry cough
Fatigue
Loss of appetite
Night sweats
Pleural effusion (fluid buildup in the pleura)
Pleural plaques
Shortness of breath
Unexplained weight loss

The median survival for pleural mesothelioma is about 18 months with treatment. Common pleural mesothelioma treatments include:

Chemotherapy
Extrapleural pneumonectomy (EPP) surgery
Immunotherapy
Pleurectomy decortication (P/D) surgery
Radiation therapy

Peritoneal Mesothelioma (Abdomen)

Peritoneal mesothelioma forms in the lining of the abdomen, also called the peritoneum. This mesothelioma type accounts for 10% – 15% of cases. It is caused by asbestos exposure. When inhaled or ingested, asbestos fibers end up in the peritoneum. These fibers can cause irritation and cellular damage that can lead to tumor growth.

Peritoneal Mesothelioma Symptoms

Abdominal pain
Abdominal swelling
Ascites/peritoneal effusion (fluid buildup in the peritoneum)
Blood clots
Fever
Inflammatory lesions
Intestinal obstruction
Night sweats
Weight loss

Median survival for peritoneal patients who receive treatment is about 2.5 years. Peritoneal mesothelioma patients have different treatment options, including:

Chemotherapy
Cytoreductive surgery (CRS)

Mesothelioma doctors may combine therapies for more effective treatment. For example, CRS plus heated intraperitoneal chemotherapy (HIPEC) are standard for qualified patients. HIPEC is a local chemotherapy applied to the abdominal cavity. Survival for patients who receive CRS and HIPEC may range from 2.5 to 7.5 years.

Pericardial Mesothelioma (Heart)

Pericardial mesothelioma forms in the lining of the heart, also called the pericardium. It is a rare type of mesothelioma, accounting for less than 1% of all cases. Pericardial mesothelioma has been linked to asbestos exposure. However, there is a lack of information about the exact way this mesothelioma type develops due to its rarity.

Pericardial Mesothelioma Symptoms

Cardiac tamponade (fluid or blood buildup between the heart and pericardium)
Chest pain
Difficulty swallowing
Dry cough
Pericardial effusion (fluid buildup in the pericardium)
Pericardial thickening
Shoulder pain
Swelling of the legs or lower extremities

Testicular Mesothelioma

Testicular mesothelioma forms in the lining around the testicle, called the tunica vaginalis. This lining covers the testes. This type is very rare, accounting for less than 1% of mesothelioma cases. This form of mesothelioma has been connected to asbestos exposure. But the exact way it develops is not fully understood.

Testicular Mesothelioma Symptoms

Hydrocele (fluid buildup in the scrotum)
Inguinal mass (a mass that may mimic a hernia in the groin)
Scrotal swelling
Solid scrotal mass
Spermatocele (a cyst near the top or behind the testicle)

With treatment, testicular mesothelioma has a median survival of 6 years. The most common treatment removes a testicle and its spermatic cord. Patients may also receive chemotherapy or radiation.

Mesothelioma Cell Types

Mesothelioma type can be defined by cell type and tumor location. Specialists identify different cell types by their unique shapes.

The three main mesothelioma cell types are:

Epithelioid
Sarcomatoid
Biphasic

Cancer cell type may affect how a patient responds to certain treatments.

Epithelioid Mesothelioma

Epithelioid mesothelioma is the most common cell type, making up about 70% of cases. Epithelioid cells have box or oval shapes. They tend to respond better to treatment than other cell types. The best outcomes are associated with patients who receive both surgery and chemotherapy. Epithelioid mesothelioma survival times range from 1.5 to 6.5 years.

Epithelioid mesothelioma is a form of malignant mesothelioma made up of epithelioid cells. It is a form of cancer caused by asbestos.

Epithelial cells make up one of four types of tissues naturally found in the body. Epithelial tissue is located on the skin’s surface, in the linings of hollow organs and blood vessels and along the lining of internal cavities.

Mesothelioma Treatment by Type

Mesothelioma treatment options vary based on location and cell type. A doctor can create an individualized treatment plan based on a patient’s unique mesothelioma diagnosis. Treatment options include surgery, chemotherapy and immunotherapy. Patients may receive two or more treatments as part of a multimodal therapy plan.
Surgery

Patients eligible for aggressive mesothelioma treatment may undergo surgery. Multimodal treatment involving surgery may be the best way of extending survival. The type of surgery a patient undergoes depends on the type and location of their mesothelioma. Surgery options for the main mesothelioma types include:

Pericardial mesothelioma: Pericardiectomy
Peritoneal mesothelioma: Cytoreductive surgery (CRS)
Pleural mesothelioma: Extrapleural pneumonectomy (EPP), pleurectomy decortication (P/D)
Testicular mesothelioma: Radical orchiectomy

Currently, doctors consider cell type as a factor affecting surgery options. For example, sarcomatoid patients may not be eligible for surgery. But some experts believe this could change. They want to reexamine cell-type-based surgery qualifications in light of new immunotherapy treatments.

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