Pericardial Mesothelioma

Pericardial mesothelioma is a cancer that develops in a thin membrane surrounding the heart, known as the pericardium. The membrane has two layers: an outer layer called the parietal layer, heart sac or theca cordis, and an inner layer known as the visceral layer or epicardium.

There are four common forms of mesothelioma, and pericardial and testicular mesotheliomas are the rarest. To date, approximately 200 cases of pericardial mesothelioma are presented in medical literature. That represents around 1 percent of all known diagnosed mesotheliomas.

Almost all mesothelioma cancers can be traced to an exposure to asbestos, but medical researchers continue to study the link between asbestos and pericardial mesothelioma. Studies are clear on how inhaled microscopic fibers reach the lungs to cause pleural mesothelioma, but less clear on how the fibers reach the pericardium.

This form of cancer strikes twice as many men as women, and is most often diagnosed in people between the ages of 50 and 70. Like the other forms of mesothelioma, the disease develops over a long period of time — one to five decades — and is typically discovered in a later stage. Symptoms include chest pain, fatigue and shortness of breath, among others, and they mimic those of other disorders to make diagnosing pericardial mesothelioma difficult.

Treatment options follow that of most other cancers: surgery (if a patient is deemed healthy enough), chemotherapy, radiation therapy and/or a combination of all three modalities. About half of the people who contract pericardial mesothelioma survive longer than six months.

Pericardial Mesothelioma Symptoms

Symptoms for pericardial mesothelioma can be very similar to other heart conditions, making it difficult to diagnose.

The clinical presentation of symptoms isn't always apparent when the cancer initially develops, a fact that contributes to a late-stage diagnosis. The fact that symptoms resemble those of other heart conditions also makes the cancer difficult to accurately diagnose. Most symptoms are caused by the buildup of fluid and the thickening of pericardial layers.

The following symptoms may indicate pericardial mesothelioma:

• Heart palpitations or irregular heartbeat (arrhythmia)
• Chest pain
• Murmurs
• Cough
• Difficulty breathing, even when at rest (dyspnea)
• Orthopnea (dyspnea which occurs when lying down)
• Fatigue
• Fever or night sweats

The presence of any of these symptoms should be followed with a visit to the doctor with recommended screenings such as an X-ray or CT scan.

How Does Asbestos Cause Pericardial Mesothelioma?

Pericardial Mesothelioma occurs when asbestos lodges itself in and around the heart.

The causal relationship between asbestos exposure and pericardial mesothelioma is not fully understood. Researchers confirm that pleural and peritoneal mesotheliomas are primarily caused by exposure to asbestos, yet the etiology of pericardial mesothelioma is less definitive. Some patients with pericardial mesothelioma do have a history of exposure, but the limited number of reported cases prohibits researchers from effectively analyzing the relationship between the two. One 1982 study found a history of asbestos exposure in three of 15 cases and another 1994 study reported asbestos exposure among four of 15 cases.

Asbestos fibers can become lodged in the pericardial membranes that surround the heart. When this occurs — just as it does in the lining of the lungs and the lining of the abdomen — the body experiences extreme difficulty in eliminating the fibers. They can remain stuck in the membranes, and over a long period of time — sometimes up to 50 years — the asbestos fibers cause the cells of the pericardium to undergo changes that may result in cancer.

Once cells become cancerous they begin to divide more rapidly, without the restraint that regulates the growth cycles of normal, healthy cells. As malignant pericardial mesothelioma cells continue to grow, they lead to the thickening of the pericardial membranes, and eventually cause tumors to develop. These changes in the pericardial membrane lead to the buildup of fluid between the pericardial layers, which, combined with the thickening of the layers, puts pressure on the heart.

Pericardial Mesothelioma Diagnosis

To diagnose pericardial mesothelioma, a patient's symptoms, medical history and current medical condition must be cumulatively assessed. Imaging tests can help determine specifically where it is located.

• Physical Examination
• Imaging Tests
• Biopsy

Computed tomography, or CT scans, provides sensitivity towards the detection of the pericardial tumor, making it a preferred diagnostic tool. Magnetic resonance imaging (MRI) can also yield extremely successful results in identifying and assessing the cancer. Pericardial tumors generally are not localized, and they tend to cover most of the heart. Furthermore, this mesothelioma type accounts for approximately half of all pericardial tumors.

Radionuclide imaging, an advanced detection method that involves the injection of radioactive material to help identify cancerous cells, was reportedly used to detect at least one case of pericardial mesothelioma. When using Radionuclide imaging to detect this cancer, the radioactive chemical radiogallium is required.

A biopsy can be more suitable in determining the cancer's point of origin. This procedure involves the removal of tissue or fluid from the pericardium, followed by laboratory tests of the tissue or fluid to confirm the presence of cancer.

Between 10 and 20 percent of pericardial mesothelioma cases involve a diagnosis that is made before a patient dies. Conversely, 80 to 90 percent of the diagnosed cases are made post-mortem. Some of the challenges with early and accurate diagnosing of pericardial mesothelioma include the minuscule number of people with the disease and the delayed presentation of symptoms.

Pericardial Mesothelioma Treatments

Treatment options for pericardial mesothelioma patients are limited because the heart lining rests so closely to the heart itself that treatment can easily damage the heart. Most of these cancer patients are not ideal candidates for surgery, which is often the most effective way to treat mesothelioma. However, there are rare cases where the cancer is diagnosed early and surgery can be carried out to remove small, localized tumors. Still, this surgery is extremely dangerous because of the close proximity to the heart, arguably the body's most critical organ.

If a patient is considered a good candidate for a surgery, they will be treated with a pericardiectomy, the surgical process of removing part of or the total pericardium. A pericardiectomy can relieve pressure and minimize fluid buildup, allowing the heart to continue functioning properly. A pericardiocentesis removes excess fluid from the pericardium to relieve pressure around the heart.

Get Help Now

Chemotherapy is an option that is normally considered for mesothelioma, but the clinical benefits seen in pericardial patients who received this treatment were minimal. Similarly, radiation therapy, which is considered one of the primary therapies for most peritoneal and pleural mesothelioma cases, is considered minimally effective for pericardial cancer.

Palliative treatment options are the most viable and common treatments, which aim to minimize pain and reduce the symptoms caused by the buildup of fluid in the pericardium. Essentially, palliative care can improve a patient's quality of life and make them more comfortable. Palliative treatments can include therapies that relieve pain and pressure around the heart, such as a pericardiocentesis or pain medication.

Another treatment that removes excess fluid from the pericardium is known as a fine needle aspiration. This palliative procedure is more commonly used as a diagnostic method for pleural mesothelioma patients, but can provide comfort for certain patients.

Pericardial Mesothelioma Prognosis

The common prognosis for pericardial mesothelioma is shorter than that of peritoneal or pleural mesothelioma. Nearly 50 to 60 percent of all pericardial patients pass away within six months of receiving a diagnosis. However, this is not the case for everyone.

Hope exists for some pericardial patients because researchers have cited positive results through surgical excision of localized tumors. Partial pericardial resection with radiation therapy improved survival in two patients; one patient lived a year after treatment and another was alive five years after treatment. Smaller, less impactful benefits were demonstrated from chemotherapy.

As with other types of mesothelioma, an early diagnosis can yield a more optimistic prognosis, often resulting in more treatment options. This is rare though because the onset of symptoms is often gradual and inconspicuous, and not accurately detected until the cancer has further developed.

Want to Talk to a Patient Advocate?

Would you like more information about mesothelioma? Please contact our Patient Advocates at (800) 615-2270 or fill out this form for a free informational packet filled with information about treatment options, doctors and legal options.