Sarcomatoid malignant mesothelioma is a rare asbestos-related cancer that primarily develops in the lining of the lungs. The sarcomatoid cells that make up these mesothelioma tumors are resistant to treatment, but evidence shows the condition responds best to immunotherapy.
Learn more about mesothelioma, asbestos and the steps you can take to fight this disease.
Sarcomatoid mesothelioma is a rare cancer caused by asbestos. This cancer can affect the lining of the lungs, heart, abdomen or testes. “Sarcomatoid” refers to the tumor cell type. These cells make up most of the tumors for this type of mesothelioma.
Key Facts About Sarcomatoid Mesothelioma
Sarcomatoid mesothelioma, or spindle cell mesothelioma, is 10% to 20% of all cases.
The fibrous nature of sarcomatoid cells makes them resistant to treatment. This makes for a poor prognosis
Advances in immunotherapy have demonstrated double survival rates for some sarcomatoid malignant mesothelioma patients.
Sarcomatoid cells grow in connective tissues, such as bones, nerves and tendons. The sarcomatoid type is the rarest of the 3 primary cell types of mesothelioma. For comparison, about 60% of patients have the epithelial type, and 20% have the biphasic type. Sarcomatoid tumors spread easily and are tough to treat. This leads to a worse outlook for this type of mesothelioma. However, new immunotherapy treatments have helped some patients beat the odds.
What Causes Sarcomatoid Mesothelioma?
Diagram shows how inhaled asbestos fibers lead to tumor development.
Asbestos is the main cause of sarcomatoid mesothelioma. When people breathe in asbestos fibers, these fibers build up in the body. This buildup causes irritation and inflammation. Over time, this can turn mesothelial cells into cancer cells.
Mesothelioma risk factors include asbestos exposure at work, in the military, and from the environment. Mainly, industrial workers faced exposure. Veterans were at risk in shipyards and military bases. Also, some were unknowingly exposed when workers took home asbestos fibers on their clothes or body.
Sarcomatoid mesothelioma survivor Gene Hartline worked as a sheet metal contractor, where he believes he was exposed to asbestos. “The diagnosis was tough, especially when they said 4-6 months to live,” Hartline said. “But now, with this immunotherapy, I’m not going downhill anymore. I’m on the climb back up. And that feels good.”
Sarcomatoid Mesothelioma Symptoms
Sarcomatoid mesothelioma has symptoms of shortness of breath, chest pain and coughing. Severe cases can lead to breathing difficulties and a lasting cough. Symptoms may take 20 to 60 years to develop.
Symptoms depend on tumor location. Sarcomatoid cells are mainly in the lung lining. But in sarcomatoid peritoneal cancer, symptoms are different. Patients may face bowel issues, pain, and swelling in the abdomen.
Symptoms of Sarcomatoid Mesothelioma
Anemia (low iron)
Chest pain or abdominal fullness
Coughing up blood
Fatigue and extreme tiredness
Lack of appetite, anorexia and nausea
Low blood oxygen levels
Persistent cough
Prolonged hoarseness
Shortness of breath
Weight loss and weakness
A 2023 review published in the journal Thoracic Cancer found that sarcomatoid mesothelioma symptoms are often vague. This makes early diagnosis tough, as patients might not mention key symptoms. These symptoms are often like those of common illnesses, such as bronchitis.
If you have any mesothelioma signs or a history of asbestos exposure, speak with a specialist as soon as possible. If you have a history of asbestos exposure, speak with your doctor about early screening. An early diagnosis may mean more treatment options.
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A pathology stain showing sarcomatoid mesothelioma cells under a microscope.
When patients go to the doctor with mesothelioma symptoms, doctors order imaging tests such as X-rays or CT scans. If X-rays reveal abnormalities, they’ll collect a tissue sample for a biopsy. Another doctor reviews the sample under a microscope and creates a pathology report.
Doctors diagnose sarcomatoid mesothelioma through biopsies. A biopsy is the only test that reveals specific details, such as cell type.
Pathology stains are tests that make cell features visible under a microscope. Sarcomatoid cells are long, narrow, and shaped like spindles.
Sarcomatoid mesothelioma is a rare subtype in contrast to epithelial. Sarcomatoid tends to be a little more locally progressive.
Understanding Your Pathology Report
Your pathology report describes the tumor cell type, biomarkers and cancer stage. Your doctor uses the findings to complete your diagnosis. Ask your doctor about your report and how it affects your treatment options.
“Most patients don’t know their cell type when I initially speak with them,” said Dr. Snehal Smart, a medical doctor and Patient Advocate at The Mesothelioma Center. “I help them review their pathology report and explain what sarcomatoid cell types are and what this means for them.”
Patient Advocates can walk you through each section of the report to make sure you have a good understanding of what it says. They can answer questions about how a diagnosis may impact treatment and prognosis.Immunohistochemical markers, or biomarkers, are key in cancer treatment. They help doctors pick the best drugs. For instance, if sarcomatoid cells in your tumor show high PD-L1 levels, this is seen after staining. Here, the best choices are checkpoint inhibitors like Opdivo and Yervoy.
Rare Sarcomatoid Cell Types
Rare sarcomatoid mesothelioma cell subtypes can provide information about your prognosis. These types come in three categories. Some may provide a better prognosis. Others can point to a higher chance of metastasis.
Rare Sarcomatoid Cells
Desmoplastic Mesothelioma. This sarcomatoid subtype is one of the most difficult to diagnose. With this cell type, doctors may be unable to track if your tumor is growing.
Lymphohistiocytoid Mesothelioma. These tumors contain inflammatory and immune cells. This can translate to more symptoms but also a better life expectancy.
Transitional Mesothelioma. This type grows and spreads like other subtypes. It consists of large, spindle-shaped cells that make the disease easier to diagnose.
These sarcomatoid mesothelioma subtypes are generally rare. They most often develop in the pleura of the lungs. Ask your physician whether there are any abnormalities in your pathology report. They can offer more information on your prognosis.
What Is the Survival Rate of Sarcomatoid Mesothelioma?
A recent study showed the median overall survival for sarcomatoid mesothelioma was 15 months with immunotherapy and 10.7 months with chemotherapy. Each patient’s prognosis differs based on health, tumor location and metastasis. Doctors use data from the recent past to make prognosis estimates for sarcomatoid mesothelioma life expectancy.
Patients with pleural sarcomatoid mesothelioma have a life expectancy of about five months. For peritoneal mesothelioma, the average is 10 to 11 months after diagnosis. Women with the sarcomatoid type often outlive men.
The most impressive advancement for checkpoint blockade has been the demonstration that for people with sarcomatoid and biphasic mesothelioma, we can double survival with the combination of ipilimumab and nivolumab.
These cells play a key role in the prognosis of sarcomatoid mesothelioma. Their shape makes them prone to breaking apart. This facilitates the spread of cancer cells to new areas. Furthermore, sarcomatoid cells often return quickly after treatment.
These factors make cancer more likely to come back or spread after treatment. Still, some patients with sarcomatoid tumors have lived for years due to advances in immunotherapy. New treatments in clinical trials might work better for some patients.
Wally Rogers
Verified Asbestos.com Survivor
Immunotherapy Works Wonders for Sarcomatoid Mesothelioma Survivor
Following rounds of chemotherapy, Wally Rogers’ tumors began growing again. Diagnosed with sarcomatoid mesothelioma, his tumors were particularly difficult to treat. After connecting with a specialist who recommended immunotherapy, he began Keytruda. Follow-up tests showed an almost immediate effect on the hard-to-treat cancer. CT scans showed no sign of remaining tumor cells.
Treatment Options for Sarcomatoid Mesothelioma
Sarcomatoid mesothelioma can be treated with chemo, immunotherapy, palliative care and other treatment options. Treatment varies by patient, depending on cancer stage, tumor size, and health. Surgery is rarely advised due to the rapid recurrence of this type. However, it may be an option for peritoneal patients who respond well to immunotherapy.
Recent research shows immunotherapy can offer lasting benefits to some sarcomatoid patients. However, Tumor Treating Fields therapy hasn’t proven effective for sarcomatoid tumors. For the best options, it’s wise to consult a mesothelioma specialist at a top cancer center.
Sarcomatoid Mesothelioma Treatment
Chemotherapy: Patients with sarcomatoid mesothelioma who receive Alimta plus cisplatin or carboplatin chemotherapy have a median survival of 15 months.
Immunotherapy: Opdivo and Yervoy, two immunotherapy drugs, improve patient survival by an average of 4 months over chemotherapy alone.
Palliative Care: Less invasive chemotherapy and surgery can ease symptoms and slow tumor growth. They can also improve breathing, thanks to palliative care.
Radiation Therapy: Radiation is often used alongside other therapies. It may increase the 2-year life expectancy 30% for some mesothelioma patients.
“Sarcomatoid mesothelioma is a little less responsive to chemotherapy,” mesothelioma specialist Dr. Andrea Wolf of Mount Sinai Hospital told The Mesothelioma Center at Asbestos.com. “But from what we see from more recent data, it may be more responsive to immunotherapy. And we have additional treatment options for those patients.”
Sarcomatoid patients may seek palliative care for symptom relief and better quality of life. Yet, only 48% of mesothelioma patients surveyed by The Mesothelioma Center in 2023 reported using it.
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Sarcomatoid mesothelioma is generally considered incurable. Surgery isn’t typically recommended for sarcomatoid mesothelioma. Other treatments including immunotherapy, chemotherapy and radiotherapy are unlikely to be curative. There may be occasional long-term survival in sarcomatoid mesothelioma treated with immunotherapies.
Answered By:Anna Nowak, internationally renowned asbestos researcher and mesothelioma advocate
Where can I get treatment for sarcomatoid cell mesothelioma?
You can get treatment for sarcomatoid mesothelioma from a specialist at a top center. This type is harder to treat and needs an expert. Specialists work at the best cancer centers, usually in major cities.
Can sarcomatoid mesothelioma be prevented?
You can prevent sarcomatoid mesothelioma by avoiding asbestos. This exposure often occurs at work or from damaged materials. First, check your home for asbestos. If you find any, hire a professional to remove it.
Is there any ongoing research on sarcomatoid mesothelioma?
Researchers are working on new treatments for sarcomatoid mesothelioma. Some patients have had success with new immunotherapy drugs in trials. You might qualify for a trial and receive the latest treatment for sarcomatoid cells. So ask your mesothelioma specialist about the best options for you.
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Selby, K. (2025, January 22). Sarcomatoid Mesothelioma. Asbestos.com. Retrieved April 1, 2025, from https://www.asbestos.com/mesothelioma/malignant-sarcomatoid/
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Selby, Karen. "Sarcomatoid Mesothelioma." Asbestos.com, 22 Jan 2025, https://www.asbestos.com/mesothelioma/malignant-sarcomatoid/.
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Selby, Karen. "Sarcomatoid Mesothelioma." Asbestos.com. Last modified January 22, 2025. https://www.asbestos.com/mesothelioma/malignant-sarcomatoid/.
Dr. Jacques Fontaine is a thoracic surgeon at Moffitt Cancer Center in Tampa, Florida, where he heads up the Mesothelioma Research and Treatment Center. He specializes in minimally invasive robotic surgery and aggressive surgeries for mesothelioma.
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