Mesothelioma: Pleural, Peritoneal and Other Subtypes
The specific type of mesothelioma you’re diagnosed with will guide your personalized treatment plan. The pleural (the lining around the lungs) and peritoneal (abdominal lining) types are the most common. Pericardial and testicular mesothelioma are very rare and have different treatment options.
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Mr. Wasserberg is proud to call himself a Trial Lawyer. He is often a featured speaker at industry summits and gatherings of the nation’s leading attorneys, from both sides of the bar. He is recognized by both his peers and his adversaries and is considered one of the nation’s premier mesothelioma and negligence attorneys
Content written by Dan Wasserberg
- Expertise
Mr. Wasserberg is proud to call himself a Trial Lawyer. He is often a featured speaker at industry summits and gatherings of the nation’s leading attorneys, from both sides of the bar. He is recognized by both his peers and his adversaries and is considered one of the nation’s premier mesothelioma and negligence attorneys
Experienced Mesothelioma Attorney
The Four Main Types of Mesothelioma
Mesothelioma is grouped into four main types. The type is based on where the tumor first grows in the body. Pleural mesothelioma is the most common type, making up most cases. Peritoneal mesothelioma is the second most common. Pericardial and testicular are very rare.
Diagnosing the correct type helps your care team choose the best path forward for treatment. Identifying the type is a key first step that shapes your entire treatment plan.
Pleural Mesothelioma
This cancer type starts in the pleura, which is the thin lining layer around the lungs. It accounts for approximately 80% to 90% of all mesothelioma cases.
Quick Facts About Pleural Mesothelioma
- Commonality: The most common type, making up the majority of all mesothelioma diagnoses.
- Development: It develops after asbestos fibers are inhaled and get trapped in the lung lining.
- Diagnosis: Doctors first use imaging scans (CT or PET scans) and then a tumor biopsy to confirm the diagnosis.
- Key symptoms: Shortness of breath, a dry cough, chest pain and fluid buildup around the lungs are the most common symptoms.
- Primary treatments: Surgery, chemotherapy, immunotherapy and radiation are common. Some patients also qualify for emerging treatments like targeted therapy and cancer vaccines.
- Prognosis or outlook: This type of cancer is aggressive, but treatment options like surgery and chemotherapy can help manage it.
Pleural mesothelioma is the only type with a formal staging system, called the TNM system, which classifies the cancer based on tumor size, lymph node involvement and how far it has spread. Your stage, from one to four, directly shapes which treatment options are available and how aggressively your care team can approach them.
An early-stage diagnosis typically opens the door to more treatment options, including surgery, while later stages shift the focus toward treatments that manage the disease and quality of life. Pleural mesothelioma has the most data and research for treatment options. A specialist in this specific type can help navigate the many choices available.
Peritoneal Mesothelioma
This type of mesothelioma develops in the peritoneum, which is the lining of the abdomen. It’s the second most common type of mesothelioma.
Quick Facts About Peritoneal Mesothelioma
- Commonality: The second most common type, accounting for about 10% to 20% of cases.
- Development: It develops when asbestos fibers are inhaled or swallowed and then travel to the abdominal lining where they become stuck in tissue.
- Diagnosis: The diagnostic process starts with imaging of the abdomen using CT or PET scans. Then a tumor biopsy is collected and analyzed to look for mesothelioma cells.
- Key symptoms: Swelling or pain in the abdomen, nausea, weight loss and fluid buildup are among the most common symptoms.
- Primary treatments: A specialized combination of tumor-removing surgery and heated intraperitoneal chemotherapy, or HIPEC, is a leading treatment. Post-surgery, the addition of traditional chemo treats any remaining cancer cells.
- Prognosis outlook: Some treatment approaches have shown promising results, leading to better outcomes for some patients.
Peritoneal mesothelioma has seen major treatment advances in recent years. Because peritoneal mesothelioma requires specialized treatment not available at every cancer center, finding a doctor who has experience with this specific type is one of the most important steps after diagnosis.
Pericardial Mesothelioma
This is an extremely rare type that forms in the pericardium, which is the lining around the heart. It accounts for fewer than 1% of all mesothelioma cases, with fewer than 150 cases documented in all of medical literature. That scarcity means most physicians have never encountered it, making it especially important to seek out a specialist with experience in this diagnosis.
Quick Facts About Pericardial Mesothelioma
- Development: It develops from asbestos fibers that travel through the bloodstream or lymph system to the heart lining.
- Commonality: Extremely rare, making up less than 1 percent of mesothelioma diagnoses.
- Diagnosis: Diagnosis is difficult and happens during surgery or after other heart conditions are ruled out.
- Key Symptoms: Chest pain, heart palpitations, trouble breathing, and fluid buildup around the heart.
- Primary Treatments: Treatment focuses on managing symptoms with surgery, removal of fluid or the tumor, along with chemotherapy.
- Prognosis Outlook: Because it is so rare and found late in the disease state, the prognosis is generally less favorable than for other types.
Diagnosing pericardial mesothelioma is challenging because its symptoms closely resemble those of more common heart conditions. Patients are frequently evaluated for problems such as constrictive pericarditis, cardiac tamponade or heart failure before the true cause is identified. It’s also sometimes mistaken for pleural mesothelioma, which is found more regularly. Because of this diagnostic complexity, a second opinion from a mesothelioma specialist is strongly recommended.
Testicular Mesothelioma
This is the rarest type of mesothelioma. It starts in the tunica vaginalis, which is the lining around the testes. Only a few hundred cases have been documented worldwide. Its symptoms closely resemble more common conditions such as hernias, infections or benign cysts, which can lead to misdiagnosis. A biopsy is needed to confirm a diagnosis.
Quick Facts About Testicular Mesothelioma
- Development: The exact cause is not fully understood. It is linked to asbestos exposure through the lymphatic system.
- Commonality: The rarest type, making up less than 1 percent of all mesothelioma cases.
- Diagnosis: It is found during surgery for a hernia or a lump in the scrotum.
- Key Symptoms: A painless lump or swelling in the scrotum is most common.
- Primary Treatments: Surgery to remove the tumor and the affected testicle is the main treatment.
- Prognosis Outlook: This type has a more favorable outlook compared to other mesotheliomas, especially when caught early.
While tumors removed with surgery can recur, testicular mesothelioma tends to have a more favorable outlook than other types. Data is limited given how few cases exist, but one study found the 5-year survival rate was 49%.
Mesothelioma Subtypes by Cell Type
Beyond the tumor location, doctors also look at the cell type under a microscope. This is another way to classify the disease. The cell type plays a major role in planning treatment and understanding what to expect in terms of prognosis.
The Three Main Cell Types
- Epithelioid: This is the most common cell type. It tends to grow more slowly and often responds better to treatment.
- Sarcomatoid: This type is less common and can be more aggressive. It may not respond to treatment as well as epithelioid cells.
- Biphasic: This is a mix of both epithelioid and sarcomatoid cells. Outcomes can depend on how much of each cell type is present.
Knowing your cell type helps your doctor create a more targeted treatment plan for you. It’s a key piece of information, along with tumor location, that helps determine which treatments will likely work best for you and predict how the disease will respond to these treatments.
Benign vs. Malignant Mesothelioma
Almost all mesothelioma diagnoses are malignant or cancerous. Malignant mesothelioma is aggressive and can spread to other parts of the body (metastasis). It requires a complex treatment plan often involving surgery, chemo and other therapies.
Benign mesothelioma is extremely rare. A benign or non-cancerous tumor doesn’t spread to other tissues. Surgery is usually the main treatment and it’s very effective. While any mesothelioma diagnosis is serious, the difference between benign and malignant shapes the entire treatment approach.
How Does Mesothelioma Type Affect Treatment Options?
Your mesothelioma type determines which treatments your doctor will consider. Tumor location, accessibility and the volume of clinical research all influence which options are available for each type. Pleural mesothelioma has the most established protocols, with decades of research behind surgery, chemotherapy and immunotherapy. The rarer types have fewer studied options simply because doctors have treated and studied far fewer cases, making it especially important to seek out a specialist with experience in your specific type.
Cell type also matters. Epithelioid cells tend to be less aggressive, so they often respond better to treatments like chemo, immunotherapy and surgery. Sarcomatoid cells are harder to treat because they respond poorly to chemo, though recent research suggests some patients see meaningful benefit from immunotherapy. Biphasic tumors contain both cell types, and treatment response generally depends on which type is more dominant.
Will My Mesothelioma Type Determine My Outcome?
Your mesothelioma type is an important factor in your overall outlook. Some types, like peritoneal and testicular mesothelioma, have more favorable outcomes. This is partly because newer treatments have been very effective for these types. However, many people with mesothelioma have survived significantly past their initial prognosis.
Overall health, your cancer stage and your cell type also play a big role. Access to a specialist who treats your specific type and finding the right treatment plan for you can have an impact on your results.
Mesothelioma Types FAQs
Can someone have more than one type of mesothelioma at the same time?
It’s very rare to have more than one type at the same time. Most people are diagnosed with mesothelioma in one specific location. In very rare cases, the disease might spread (metastasize) from its original spot to another lining, but it’s still considered the same type.
Does where I live or work affect which type of mesothelioma I might develop?
While there are hypothesis that breathing in asbestos vs ingesting it might account for the difference in where tumors initially develop in the body, currently there isn’t enough evidence to draw a conclusion. Most people are exposed to asbestos fibers that become airborne at work. Inhalation is likely the most common way asbestos enters the body. The effects of ingesting asbestos are still being studied.
What tests do doctors use to identify mesothelioma type?
Doctors use imaging tests (CT and PET scans) to find the tumor location. To confirm the type, they perform a tumor biopsy to identify the type under a microscope. This helps them see both the location and the cell type.
Are some mesothelioma types more common in certain people?
Pleural mesothelioma is the most common type. However, some studies suggest peritoneal mesothelioma may be slightly more common in women. Testicular mesothelioma is the only type that occurs exclusively in men.
Is mesothelioma type hereditary?
The type of mesothelioma you develop isn’t directly hereditary. The disease itself is the direct result of asbestos exposure. However, some research suggests that genetics might play a role in how a person’s body reacts to asbestos, which could potentially influence the type that develops. But more research is needed.
Can mesothelioma type change over time?
The location of where tumors first developed is set. However, the cell type can sometimes change or become more mixed after treatment. For example, a biphasic tumor might later show more of one cell type than the other.
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