Pericardial Mesothelioma

Pericardial mesothelioma is an extremely rare type of mesothelioma, the cancer that originates in the linings around certain organs. Pericardial mesothelioma originates in the lining of the heart, and is one of the rarest forms of mesothelioma, occurring in only about one to 10 percent of all patients.

The only known, or even suspected, cause of all forms of mesothelioma, including pericardial mesothelioma, is exposure to asbestos. Somewhere between 70 and 80 percent of all mesothelioma patients have documented histories of asbestos exposure, although it is thought that the remaining 20 to 30 percent of patients may have been exposed to asbestos, but simply not have been aware of the exposure.

Asbestos is a carcinogenic mineral material that was at one point very commonly used as insulation. It could be found in automotive brakes, residential insulation, and many construction materials. The asbestos dust is easily inhaled, and can also be ingested when it settles on food or in drinking water.

Although the link between pericardial mesothelioma and asbestos exposure is not yet completely understood, the most credible theory to date is that when asbestos is inhaled, these fibers travel into the bloodstream and then make their way into the heart. The fibers, which can be sharp and spiny, become embedded in the pericardial mesothelium, or lining of the heart, and cannot be removed. Because the body has no way of ridding itself of asbestos, and because it views asbestos as a foreign object, the asbestos fibers are treated as an infection by the body. While the asbestos is trapped in the lining of the heart, it mutates surrounding cells, leading to cancerous tumors.

Mesothelioma can result from minimal or infrequent contact with asbestos, as well as from ongoing and repeated exposure. There is no “safe” level of asbestos exposure, as even one instance of exposure can result in a diagnosis, down the line, of an asbestos-related disease. The time between the exposure itself and the actual development of mesothelioma cancer is usually several decades, with most people diagnosed between 30 and 45 years after their contact with asbestos.

Symptoms and Diagnosis

Many patients do not consult their doctor right away, as the initial symptoms of pericardial mesothelioma are somewhat vague and nonspecific. The symptoms of pericardial mesothelioma include coughing, heart palpitations, extreme fatigue after only mild activity, difficulty breathing, and chest pain. Many of these symptoms are passed off by both patients and physicians as being caused by other, more common conditions, such as asthma, lupus, or other types of heart disease. Sometimes they are even written off as an unfortunate part of the aging process. When a patient presents with these symptoms, further examination might indicate pericarditis, or swelling of the heart; or cardiac tamponade, a condition in which blood or other fluid accumulates in the pericardium (the lining of the heart). However, particularly when combined with a history of occupational or secondhand asbestos exposure, these symptoms may lead a physician to suspect pericardial mesothelioma.

Moreover, many of the symptoms of pericardial mesothelioma do not become apparent until more advanced stages of the disease, which further complicates both diagnosis and prognosis.

If pericardial mesothelioma is suspected, body image scans such as x-rays, MRI, and CT scans will be performed, in order to make a conclusive diagnosis. These diagnostic methods will also identify locations of possible growths; if growths are found, the physician will order a biopsy, or tissue sample, which will be analyzed by a pathologist. Once a definitive diagnosis of pericardial mesothelioma has been given, the doctor will stage the disease, or determine how advanced it has become, and will work with the patient to develop a treatment plan.

Treatment

Surgery to remove the tumor is only possible if the mesothelioma has been caught during Stage I, and if it has not metastasized, or spread, to other parts of the body. Even if these conditions are met, however, surgery is a risky procedure, primarily because of the tumor’s proximity to the heart and lungs.

Palliative surgery, which is not intended to cure the cancer but merely to relieve its symptoms, may be a more viable option. Frequently, in pericardial mesothelioma, fluid builds up in the space between the visceral mesothelium, or the outer lining of the heart itself, and the parietal mesothelium, which is the inner lining of the chest cavity. Physicians may advise a certain type of surgery called pericardiocentesis to drain this fluid, which will alleviate pain and other symptoms, and which may prolong life.

Radiation can also be used to shrink the tumors, although this carries with it the risk of damaging nearby organs, such as the heart and the lungs. Internal radiation, in which the radioactive material is introduced directly into the body via a capsule or seed, can be applied directly to the tumor; this procedure can minimize damage to these important organs. Although research has not indicated a clear benefit for chemotherapy in the treatment of pericardial mesothelioma, some anecdotal studies have found evidence that this treatment can also be helpful.

A treatment that is used purely for improvement of symptoms is called fine needle aspiration. This is a procedure where a thin needle is placed into the pericardial lining of the heart for the purposes of removing the fluid surrounding the heart. This procedure is less invasive than pericardiocentesis, and can be performed several times to reduce pressure, pain, and other symptoms associated with this fluid build-up.

Some alternative approaches have also been used in the treatment of pericardial mesothelioma. These treatments include massage therapy, hypnosis, yoga, nutritional supplements and acupuncture. Patients may turn to such holistic methods to increase their quality of life, or to help mitigate the side effects of traditional treatments. Additionally, some experimental treatments which have shown promise in early testing are gene therapy and immunotherapy. Both of these therapies are conducted to promote the creation of healthy cells in the body, while eliminating the cancerous cells. There remains a great deal of research, however, before conclusive results of these experimental treatments can be quantified. Nevertheless, pericardial mesothelioma patients may opt to enter clinical trials for these and other forms of cancer treatment.

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Prognosis

Because of the location of pericardial mesothelioma in conjunction with a lack of symptoms until the more advanced stages of the disease, the prognosis for this disease is quite poor. Average life span after initial diagnosis is only six months. Death is frequently a result of congestive heart failure or the blockage of the superior vena cava. If, however, pericardial mesothelioma is identified in its early stages (as most often occurs during screening for other health issues), then the prognosis for pericardial mesothelioma can be similar to that of other cancers that are identified early on, especially if the patient is young and in good health, and therefore more able to tolerate surgery and radiation.

Mesothelioma Clinical Trials