Pericardial Mesothelioma

What Is Pericardial Mesothelioma?

Pericardial mesothelioma is a rare cancer that affects the heart’s lining, the pericardium. Fewer than 1% of all types of mesothelioma are pericardial. In fact, fewer than 150 cases of pericardial mesothelioma exist in medical literature.

For most people with mesothelioma, asbestos exposure is the cause. But the link between asbestos and pericardial mesothelioma is still being studied. Researchers are working to understand how asbestos fibers reach the heart. 

This cancer usually affects people between 50 and 70 years of age. It’s more common in men than in women. Symptoms appear at a later stage and can mimic other heart disorders.

Key Facts

• Incidence: About 1% of all mesothelioma cases
• Primary cause: Most cases are linked to past asbestos exposure
• Who it affects: Commonly in men over age 50
• Average survival: About 6 months to 10 months

Symptoms of Pericardial Mesothelioma

Pericardial mesothelioma symptoms are often vague and cardiac-related. Most commonly reported are chest pain, shortness of breath and irregular heartbeat because of tumors and fluid buildup in the pericardial sac, called pericardial effusion. This can also lead to heart palpitations or heart failure. 

Common Symptoms of Pericardial Mesothelioma

• Chest pain
• Cough
• Difficulty breathing, when lying flat (orthopnea) but even when at rest (dyspnea)
• Difficulty swallowing (dysphagia)
• Fatigue
• Fever
• Heart palpitations or irregular heartbeat (arrhythmia)
• Murmurs
• Night sweats
• Shortness of breath when lying flat

If you’re experiencing symptoms, schedule an appointment with your doctor immediately. Often, simple screening tests can lead to further imaging, including a chest X-ray, CT scan or echocardiogram (heart ultrasound), which can detect fluid in the pericardial sac, thickening or abnormal masses. 

Worsening Pericardial Mesothelioma Symptoms

Worsening symptoms occur as tumors grow and put more pressure on the heart and surrounding structures. These advanced signs indicate the disease has progressed, affecting both cardiovascular function and overall quality of life.

Advanced Symptoms of Pericardial Mesothelioma

• Chest pain, pressure or heaviness
• Extreme fatigue
• Fainting or dizziness
• Leg, ankle or abdominal swelling
• Worsening shortness of breath at rest

One documented case reported in JACC Journals in October 2025 involved a 73-year-old man who experienced recurring fevers, chills, night sweats and chest pain for 9 months before doctors diagnosed pericardial mesothelioma. His symptoms worsened over time, eventually affecting his heart’s ability to pump blood effectively and causing pericardial effusions. This case demonstrates how pericardial mesothelioma symptoms can intensify gradually and may initially resemble other heart or inflammatory conditions, making early diagnosis challenging.

How Pericardial Mesothelioma Is Diagnosed

An accurate pericardial mesothelioma diagnosis requires imaging and a tissue biopsy of the pericardium or pericardial fluid. Cardiologists and mesothelioma specialists work together to confirm the disease, often after other heart disorders have been ruled out. 

Steps in Diagnosing Pericardial Mesothelioma

1. Physical exams: Findings during this exam will likely lead to imaging tests. 
2. Echocardiogram: One of the first diagnostic tests you’ll receive, this test is an ultrasound of your heart that can reveal excess fluid. It helps doctors see the size, shape and function of your heart. The scan is noninvasive and uses sound waves.
3. Imaging tests: CT and MRI scans help detect pericardial tumors. This makes them a preferred diagnostic tool for determining whether a biopsy is necessary.
4. Biopsy: Doctors surgically remove fluid or tissue from a tumor. A pathologist views the cells under a microscope and confirms whether you have mesothelioma and the specific subtype.
5. Expert review: A pathologist or mesothelioma specialist will review your biopsy results to identify which treatments will work best for you.

Pericardial tumors generally aren’t localized. They tend to cover most of the heart. This cancer type accounts for approximately 50% of all pericardial tumors.

Unfortunately, most pericardial mesothelioma cases are discovered during an autopsy. Doctors only diagnose about 10% to 20% of cases before a patient dies. This makes seeking medical advice as soon as you experience symptoms important, as well as discussing exposure to asbestos. Doctors will assess your symptoms and clinical findings to determine treatment.

Seek a Second Opinion to Avoid Misdiagnosis

Getting a second opinion is especially important to prevent receiving a misdiagnosis of a more common illness. Pericardial mesothelioma is very rare, but specialists who focus on mesothelioma can help you move forward with the right treatment as quickly as possible.

Common Pericardial Mesothelioma Misdiagnoses

• Cardiac tamponade
• Cardiomyopathy
• Constrictive pericarditis
• Coronary heart disease
• Heart failure
• Intra-atrial myxoma
• Other malignant tumors of the pericardium
• Tuberculosis pericarditis
• Valvular disease

If you have received a diagnosis of pericardial mesothelioma, meeting with a specialist gives you access to the latest knowledge and treatment options. Mesothelioma oncologists and cardiothoracic surgeons not only confirm the diagnosis, but they also design care plans tailored to your needs. These experts can connect you with innovative therapies and clinical trials that may improve outcomes.

Insight From a Mesothelioma Specialist

We speak with 1-3 pericardial mesothelioma patients or their loved ones each year. This is an extremely rare diagnosis that most doctors have not seen in their careers. With the help of our Doctor Match program, we are able to connect these patients to world-renowned experts to explore treating this rare diagnosis.

Danielle DiPietro, Patient Advocate at The Mesothelioma Center

Treatment Options for Pericardial Mesothelioma

Treatment for pericardial mesothelioma is most often surgery and chemotherapy, which can extend survival. Your doctor may also include palliative procedures to manage fluid buildup around the heart and improve quality of life. The heart lining rests close to the heart and limits treatment options.

Surgery is the most effective treatment for this cancer, but more than 50% of patients aren’t eligible. In rare cases of an early diagnosis, surgery may be able to remove most of the tumor. But often there is tumor left behind. It’s therefore important to follow up with chemo or immunotherapy to treat the residual tumor.

Palliative treatment, such as fine needle aspiration, which removes fluid around the heart, can ease symptoms. Radiation therapy is considered minimally beneficial for this rare cancer. It’s difficult to administer without harming the heart.

Surgery (Pericardiectomy or Tumor Removal)

The primary surgical treatment options for pericardial mesothelioma are pericardiectomy and tumor resection. These procedures aim to relieve pressure on the heart and reduce symptoms.

Treatment Details

• Goal: Remove tumor mass and affected tissue to relieve pressure on the heart and prevent further disease progression.
• Procedures: Pericardiectomy removes part or all of the pericardium to relieve pressure and prevent fluid buildup. Tumor resection removes visible growths to improve heart function and reduce symptoms.
• Medical insight: Research indicates patients who undergo tumor removal experience longer survival than those who have a pericardiectomy alone.

Surgery can relieve chest pain and shortness of breath caused by fluid buildup around the heart. Doctors often pair surgical resection with chemotherapy to help control disease recurrence.

Chemotherapy & Immunotherapy

Chemotherapy and immunotherapy are systemic therapies that can help shrink tumors and slow disease progression in pericardial mesothelioma. While benefits are limited compared to other mesothelioma types, some people have responded well to treatment.

Treatment Details

• Goal: Shrink or slow tumor growth using medications to extend survival and improve quality of life when surgery isn’t an option or would be less beneficial.
• Chemotherapy: Drugs including cisplatin, pemetrexed, gemcitabine and vinorelbine can help shrink tumors, reduce fluid buildup and relieve chest pain or breathing difficulty.
• Immunotherapy: Drugs like Opdivo (nivolumab) and Keytruda (pembrolizumab) help the immune system recognize and attack mesothelioma cells, although research is limited for pericardial cases.
• Medical insight: A handful of cases have responded well to chemo. One woman lived longer than 2 years thanks to treatment with cisplatin, gemcitabine and vinorelbine.

Chemo cycles last several weeks, your oncology team will closely monitor side effects such as fatigue, nausea and lowered immunity. Combining chemo with surgery or immunotherapy may lead to better symptom control and improved outcomes for eligible patients.

Palliative & Supportive Procedures

Fluid buildup in the pericardium is the primary cause of symptoms. The aim of palliative treatment options is to minimize pain and reduce symptoms.

Treatment Details

• Goal: Reduce symptoms such as chest pain and difficulty breathing from fluid buildup in the pericardium to improve quality of life.
• Pericardiocentesis: Doctors insert a thin needle or catheter through the chest wall to drain excess fluid from the pericardium and reduce pressure on the heart.
• Pericardial window surgery: A small, permanent opening in the pericardium reduces fluid buildup and prevents pericardial effusions from recurring.
• Medication and cardiac support: Pain relievers, anti-inflammatory drugs and other medications help control symptoms such as irregular heart rate, fluid imbalance, fatigue and anxiety.

Palliative procedures can greatly improve day-to-day function and comfort for patients with pericardial mesothelioma. Doctors often use palliative care alongside chemotherapy or immunotherapy to manage symptoms and slow disease progression.

Studies also show combining therapies, or multimodal treatment, offers the best outcomes for eligible patients. A 2024 Memorial Sloan Kettering trial on pericardial mesothelioma found that multimodal therapy of surgery, chemo and radiation yielded a median survival of 70.3 months versus 8.2 months without the therapy.

Prognosis & Life Expectancy of Pericardial Mesothelioma

Pericardial mesothelioma prognosis is generally poor compared to peritoneal or pleural mesothelioma, with a median survival of about 6 to 10 months, though a minority of patients live a year or longer with treatment.A recent study in Seminars in Thoracic and Cardiovascular Surgery notes 22% of pericardial mesothelioma patients live for 1 year or more, and the 5-year survival rate is 9%. Research shows positive results from combined therapy and surgery for improved mesothelioma life expectancy.

These averages and statistics can’t predict your pericardial mesothelioma prognosis. Your specialist will evaluate your cancer stage, overall health and access to treatment for the best outcome. Palliative care can help control symptoms and clinical trials offer promising new therapeutic options. 

Coping & Support for Pericardial Mesothelioma

Practical strategies and a strong support network can reduce stress, ease symptoms and help you feel more in control during treatment. These options can help you cope with pericardial mesothelioma, providing practical help and emotional relief during treatment.

Resources for Survivors and Loved Ones

• Community organizations: Many community groups provide assistance to cancer patients. They may offer support groups, educational materials and even financial aid.
• Counseling: Professional counseling can help both patients and their families. Counselors offer emotional support and guidance for managing stress, anxiety and coping with the challenges of the disease.
• Hospital services: Many hospitals have oncology departments with specialized support. These services may include pain management, nutrition counseling and physical therapy.

• Practice self-care: Regular exercise, a balanced diet and quality sleep can help ease symptoms. Self-care also boosts overall well-being and may improve tolerance for treatments.
• Seek emotional support: It’s important to reach out to loved ones, close friends or professional counselors. Joining a mesothelioma support group can connect you with others who understand the challenges of this cancer.
• Stay organized: Tracking appointments, medications and symptoms can create a greater sense of control. Using a journal or planner may make it easier to stay consistent and reduce stress.

Our Patient Advocates can connect you to vital resources, offer support and help you understand your diagnosis and treatment options. Pericardial mesothelioma is a difficult diagnosis, but you’re not alone. Taking care of your physical and mental health needs can ease the impacts of the disease.

Common Questions About Pericardial Mesothelioma

Can pericardial mesothelioma run in families or be inherited?

Most cases aren’t hereditary. Certain rare genetic mutations such as BAP1 can increase the likelihood of risk in certain families. When multiple family members have mesothelioma or other cancers, it may be worthwhile to speak to a genetic counselor to see if testing is appropriate for you.

Who should be on my core care team?

Seek a pericardial mesothelioma expert and a cardiologist who specializes in pericardial disease. Your treatment team should generally include a cardiothoracic surgeon, medical oncologist and radiation oncologist, in addition to palliative care for symptom support and a nurse navigator for logistical support.

How do I get my pathology slides re-reviewed for a second opinion?

Contact your hospital’s pathology department or medical records and request that your pathology slides and blocks be sent to a mesothelioma center for review. The receiving physician’s office will provide shipping instructions and necessary documentation; your hospital will need to package and send out the appropriate materials. In the meantime, keep copies of your pathology report and any imaging so the second opinion team has everything they need.

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