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.

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What Are the Symptoms of Pericardial Mesothelioma?

Common symptoms of pericardial mesothelioma include chest pain, shortness of breath, heart palpitations and heart failure. Pericardial effusion, a buildup of fluid in the pericardial sac, causes these symptoms. 

Most patients don’t experience symptoms at first. When symptoms do appear, they may mimic heart failure, coronary artery disease or benign pericardial diseases. This makes diagnosing pericardial mesothelioma difficult.

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. 

“I had been having really bad coughs and wheezing, and it had been going on for a while,” pericardial mesothelioma survivor Dr. Berlinda Love tells us. “My relatives said to me, you need to dig a little deeper because that cough is getting pretty bad.” She says a persistent cough kept nagging her for quite some time before doctors performed a biopsy and diagnosed her with pericardial mesothelioma.

How Is Pericardial Mesothelioma Diagnosed?

Testing of the pericardial fluid for cancer cells or a biopsy of the pericardium can confirm the diagnosis. Many other conditions affecting the pericardium including fluid collection, infection, fibrosis or other tumors can mimic pericardial mesothelioma. Therefore, a biopsy is necessary to establish the diagnosis and guide appropriate treatment for mesothelioma.

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.

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 with pericardial mesothelioma, a rare cancer that often resembles other heart or lung conditions. Specialists who focus on mesothelioma can recognize these differences and confirm the diagnosis. A second opinion not only ensures accuracy but also helps 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.

What Are the Treatment Options for Pericardial Mesothelioma?

Mesothelioma treatment for pericardial mesothelioma includes surgery and chemotherapy. 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.

Pericardiectomy or Tumor Removal

The primary surgical treatment options for pericardial mesothelioma are pericardiectomy and tumor removal. A pericardiectomy removes part or all of the pericardium. This surgery relieves pressure and minimizes fluid buildup.

Tumor removal, or tumor resection, removes cancer without removing the pericardium. Research indicates more prolonged survival with tumor removal than a pericardiectomy.

Chemotherapy

The benefits of chemo are limited in pericardial mesothelioma. The chemo drugs pemetrexed and cisplatin or gemcitabine and vinorelbine are used for treating this condition, depending on the patient.

A handful of cases have responded well to chemo. One woman lived longer than 2 years thanks to the chemo drugs cisplatin, gemcitabine and vinorelbine.

Palliative Treatment

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

Removing the fluid with fine needle (pericardiocentesis) can improve the quality of life and make patients more comfortable. Pain medication can also reduce symptoms and improve comfort. 

What Is the Average Prognosis?

 A 2023 research report notes that median survival is about 2 to 6 months. Survival rates are poor compared to peritoneal or pleural mesothelioma. But some patients can live years after surgery or chemotherapy.

A 2024 case report says survival time is around 2.5 years. The 5-year survival rate for pericardial mesothelioma is 9%. 

Research shows positive results from surgery, offering hope for improved mesothelioma life expectancy. While data indicates fewer benefits from chemo, one case study reports on a 47-year-old woman who lived 2 years after chemo with cisplatin, gemcitabine and vinorelbine.

There have also been historic cases of people who’ve lived considerably longer. For example, a 1995 case report of a 27-year-old woman who underwent surgery and radiation therapy for pericardial mesothelioma states that she had no evidence of recurrence during 28 years of follow-up.

How You Can Cope With Pericardial Mesothelioma

Patients diagnosed with pericardial mesothelioma can access a variety of resources for support. These options can provide practical help and emotional relief during treatment.

• 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.

These resources can help patients better understand their diagnosis and treatment options. They also provide support for managing the physical and emotional challenges of pericardial mesothelioma.

Pericardial Mesothelioma Coping Strategies

Coping with pericardial mesothelioma can feel overwhelming, but effective strategies can help manage symptoms and improve quality of life. Patients and families can use practical daily habits to feel more supported and in control.

• 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 support group can also help by connecting you with others who understand the challenges of mesothelioma.
• 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.

Pericardial mesothelioma is a difficult diagnosis, but many resources are available to provide support. Practicing self-care, staying organized and seeking emotional support can ease the physical and emotional impacts of the disease.

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