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Mesothelioma types describe the location where the cancer first develops and the specific cell types involved. The 4 main types of mesothelioma based on tumor location are pleural, peritoneal, pericardial and testicular. Epithelioid, biphasic, and sarcomatoid are the main cell types.
Written by Karen Selby, RN | Medically Reviewed By Dr. Jacques Fontaine | Edited By Walter Pacheco | Last Update: October 21, 2024
The 4 main types of mesothelioma are pleural, peritoneal, pericardial and testicular. Doctors base the names of these types on the location where the tumor initially develops.
All 4 types of mesothelioma form in the tissue called the mesothelium that lines different organs and body cavities. This lining is made up of mesothelial cells that can turn cancerous following asbestos exposure.
Epithelioid cells are the most common type of cell found in mesothelioma tumors. Noncancerous or benign mesothelioma tumors are rare.
Pleural mesothelioma, which occurs in the pleural tissue that lines your lungs, makes up about 70% to 75% of all mesothelioma cases. Typical pleural mesothelioma symptoms include chest pain, shortness of breath, fatigue, fever and weight loss.
Aggressive surgery provides the best outcome for early-stage pleural mesothelioma. Patients can live for 3 or more years with stage 1 treatment versus roughly 12 months with stage 4 treatment. There are more clinical trial studies on pleural mesothelioma than any other type.
Peritoneal mesothelioma begins in the lining of your abdomen that surrounds the abdominal organs. This type of mesothelioma accounts for 10% to 20% of all cases. Symptoms of peritoneal mesothelioma include abdominal pain, swelling and bloating, loss of appetite and bowel changes.
About 50% of all peritoneal mesothelioma patients are eligible for surgery with heated chemotherapy, which helps many patients live 5 or more years after diagnosis. The prognosis for peritoneal mesothelioma is better than for the pleural type, but there is less available research.
Pericardial mesothelioma develops in the protective heart sac known as the pericardium. This tumor type is very uncommon: Medical literature only documents about 200 cases. Symptoms of pericardial mesothelioma include irregular heartbeat, chest pain, difficulty breathing and cough.
Treatment may include surgery, chemotherapy and radiation. A 2022 case series reported a median overall survival of 25.9 months, and trimodal treatment patients surviving a median of 70 months.
Testicular mesothelioma develops in the outer lining of the testes. Tumors form on tissue called the tunica vaginalis. This form of mesothelioma is extremely rare. Fewer than 300 cases exist in medical literature.
Symptoms include scrotal swelling and painless testicular lumps. Treatment options include surgery and chemotherapy, and clinical trials may be available as well. These therapies can help patients live more than 2 years, on average, after diagnosis.
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Epithelioid, sarcomatoid and biphasic are the 3 main types of mesothelioma cells. Biphasic is a mix of the first 2 mesothelioma cell types.
Asbestos exposure causes the malignant form of mesothelioma cancer. Tumors vary in response to treatment. Epithelial or epithelioid cells respond the best. Sarcomatoid cells are more resistant to treatment.
Cancer doctors take these differences into account, creating your treatment plan around your specific type of mesothelioma. The incidence and frequency of these cell types vary by cancer location.
Pericardial mesothelioma exhibits a roughly equal distribution of the 3 primary cancer cell types. The minority are biphasic. Most testicular cases contain only epithelial cells. There is only a single case of sarcomatoid cell disease for this type.
Epithelioid mesothelioma tends to be less aggressive and doesn’t spread as fast as other cell types. Patients with epithelioid cell tumors have the best prognosis.
This subtype occurs in 70% to 75% of cases. About 50% of pleural disease is epithelioid. Around 75% of peritoneal tumors are epithelioid.
Sarcomatoid mesothelioma is the most aggressive and challenging to treat. Sarcomatous, spindle or diffuse malignant fibrous mesothelioma refer to the same variant.
This cell type is the least common mesothelioma cell type. It accounts for around 10% to 20% of all mesothelioma diagnoses. About 20% of pleural tumors are sarcomatoid. Only about 1% of peritoneal cases are sarcomatous.
Biphasic mesothelioma refers to tumors that contain both epithelial and sarcomatoid cells. Life expectancy for this variant depends upon which of the 2 cell types appears most.
More epithelioid cells generally mean a better prognosis. If the tumor is high in sarcomatoid cells, it’s harder to treat and life expectancy is shorter. Around 30% of pleural and 25% of peritoneal tumors are biphasic.
The primary 3 mesothelioma cell types can be further classified into subtypes, each with distinct traits visible under a microscope. These subtypes have unique features that set them apart from the classic definitions of the primary types.
While benign mesothelioma falls into the epithelial category and typically responds better to treatment, other rare subtypes often present greater challenges in diagnosis and treatment. Understanding these subtypes is crucial for effective management and treatment planning.
Benign mesothelioma is a rare noncancerous tumor in the lining of the lungs or abdomen. These cells don’t spread to other parts of the body and grow more slowly, often forming one large mass instead of many small ones.
Examples of benign cell subtypes include benign multicystic, adenomatoid, localized fibrous, papillary and mesothelioma of uncertain malignant potential. Adenomatoid cells can occur in both malignant mesothelioma and benign mesothelioma.
Well-differentiated papillary cells primarily occur in cases of peritoneal mesothelioma. The literature documents some cases in other locations, including a 2024 case found in the pleura. Researchers dropped ”mesothelioma” from this condition’s name in 2022 and renamed it “well-differentiated papillary tumor” to limit confusion with the malignant disease.
This subtype is generally considered benign, but some cases have turned malignant. Treatment generally involves surgery and heated chemotherapy. In cases that return, doctors repeat these procedures to keep tumors under control.
Rare cell types are irregular and are more challenging to diagnose. They have subtle differences among them. They may also affect prognosis and life expectancy.
Certain subtypes are associated with pleural or peritoneal mesothelioma. Treatment for rare subtypes depends on the primary cell type.
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Get Help NowYour specific mesothelioma diagnosis will influence your treatment plan and various treatment options. These depend on tumor and cell type. Doctors must also consider your age and general health, as well as assess your wishes and needs going into treatment.
A proper mesothelioma treatment plan is often multimodal, involving many therapies. Surgery is an appropriate option for patients who are younger and in good health. Chemotherapy, radiation and immunotherapy are available to a broader range of patients.
Standard chemotherapy for mesothelioma involves 2 drugs. The most common combination for the pleural form of mesothelioma is cisplatin and pemetrexed (Alimta). Gemcitabine, carboplatin and other drugs are more effective against the peritoneal variant.
No chemo drug is particularly effective for the pericardial or testicular forms. These types are so rare that there is no standard chemotherapy plan. A specialist can devise the best plan for you based on your treatment history, cancer type and health.
The FDA granted approval for the combined use of immunotherapy medications nivolumab (Opdivo) and ipilimumab (Yervoy) as a frontline treatment for pleural mesothelioma in 2020. This treatment has a median overall survival of approximately 18 months, surpassing the survival range of 12-14 months seen with traditional chemotherapy.
While immunotherapy is proven to work for many pleural patients, studies show mixed results for peritoneal patients. Because of the rarity of peritoneal mesothelioma, limited clinical trial data exists. Certain studies suggest that immunotherapy may offer benefits in select cases of peritoneal mesothelioma. Research continues in clinical trials, which is where some peritoneal patients access this treatment.
My mesothelioma journey has been difficult at times, but I try to remain positive. I returned home from extrapleural pneumonectomy surgery a week or so after getting out of the ICU. I started chemotherapy about 3 months later with rounds of cisplatin and Alimta. After recurrence, I began targeted radiation therapy coupled with immunotherapy. My mesothelioma is currently under control.
Surgeries for mesothelioma vary greatly because they involve operating on different parts of the body. Surgery is generally an option for patients who are younger, in good health and diagnosed with an earlier stage of cancer.
Recovery from surgery depends on how intensive the operation is and whether it involves the delivery of other therapies, such as heated chemotherapy. Your treatment team will discuss the recovery process with you beforehand to make sure your family is prepared at home.
Doctors use radiation alongside surgery to slow tumor growth in pleural mesothelioma. Used alone, it can shrink tumors and help relieve symptoms.
Radiation therapy isn’t typical for peritoneal patients. It may harm some organs, such as the kidneys or liver. Radiation can benefit pericardial and testicular patients.
The goal of palliative therapy is to manage pain and other cancer symptoms. Palliative care may be part of a multimodal treatment plan, and it can improve your quality of life and well-being.
One example of a palliative treatment for mesothelioma is thoracentesis. This procedure drains fluid from around your lungs. Paracentesis removes fluid from your abdomen. These procedures can ease your pain and pressure and make breathing and eating easier.
Cell type refers to the type of cells that make up the tumors. Tumor location refers to where the cancer first began growing, such as the lining of the lungs or abdomen.
The type of mesothelioma a patient has impacts their overall prognosis and recommended treatments. Mesothelioma treatment is complex, and many other factors influence treatment options and prognosis, such as the stage of the cancer.
You can speak with a Patient Advocate to find a mesothelioma specialist who has experience treating your type of mesothelioma.
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Selby, K. (2024, October 21). Types of Mesothelioma. Asbestos.com. Retrieved October 28, 2024, from https://www.asbestos.com/mesothelioma/types/
Selby, Karen. "Types of Mesothelioma." Asbestos.com, 21 Oct 2024, https://www.asbestos.com/mesothelioma/types/.
Selby, Karen. "Types of Mesothelioma." Asbestos.com. Last modified October 21, 2024. https://www.asbestos.com/mesothelioma/types/.
A medical doctor who specializes in mesothelioma or cancer treatment reviewed the content on this page to ensure it meets current medical standards and accuracy.
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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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