Skip to content
Mesothelioma.net
phone iconCall1-800-692-8608 chat icon Chat 24/7 Live Chat
Menu
  • Malignant Mesothelioma
    • About Mesothelioma
      • How to Survive Mesothelioma
      • 100 Questions & Answers about Mesothelioma (Free Book)
      • Symptoms
      • Diagnosis
      • Prognosis
      • Life Expectancy
    • Types
      • Pleural
      • Peritoneal
      • Epithelioid
      • Sarcomatoid
      • Biphasic
    • Stages
      • Stage 1
      • Stage 2
      • Stage 3
      • Stage 4
    • Additional Information
      • Causes
      • Asbestos and Its Dangers
      • Facts
      • Support
      • Financial Compensation
      • FREE Mesothelioma Packet
  • Treatment
    • Treatment Options
      • Surgery
      • Chemotherapy
      • Radiation Therapy
      • Multimodal Therapy
      • Medications
      • Palliative Treatment
    • Find Top Doctors
      • Doctors
      • Treatment Centers
      • Treatment & Doctors Near You
      • New Treatments
      • Care Providers
      • Clinical Trials
      • Costs
  • Asbestos Trusts
  • Compensation
  • Veteran Assistance
    • Mesothelioma and Veterans
      • VA Claims for Mesothelioma
      • Vietnam Veterans
    • Military Branches and Asbestos
      • Navy Veterans
      • Navy Ships
      • Marine Corps Veterans
      • Army Veterans
      • Air Force Veterans
      • U.S. Coast Guard
  • Surviving Mesothelioma
  • About Us / Contact
  • Home
  • ›
  • Malignant Mesothelioma
  • ›
  • Types
  • ›
  • Biphasic
Page Updated: June 22, 2022

Biphasic Mesothelioma

Pinar Kanlikilicer Page Medically Reviewed and Edited by Pinar Kanlikilicer, PhD

FREE Mesothelioma Packet

Fact Checked

This page has been fact checked by a PhD who specializes in cancer research. Sources of information are listed at the bottom of the article.

FREE Mesothelioma Packet

We make every attempt to keep our information accurate and up-to-date.

Please Contact Us with any questions or comments.

Biphasic mesothelioma is the second most common type of mesothelioma cancer as described by the cells in the tumors. Approximately 20% of diagnosed mesothelioma cases are biphasic. It includes a mix of two major cell types: epithelioid and sarcomatoid.[1]

FREE Mesothelioma Packet

How Is Mesothelioma Classified by Cell Type?

Histology is the study of microscopic cell structures. When a tumor is discovered through imaging scans, cells are removed for examination by a pathologist to determine whether they are benign or malignant and determine the cells’ origin. Mesothelioma cells may develop in the peritoneum, pleura, or pericardium.[2]

A pathologist will also look at biopsied cells to determine their histological classification, or cell type:[3]

  • Epithelioid
  • Sarcomatoid
  • Biphasic

Cell type describes the cells that mutated and became malignant to cause cancer. The distinction is important because it informs treatment and plays a role in prognosis and how the cancer progresses.

What Is the Definition of Biphasic Mesothelioma?

Biphasic mesothelioma is cancer with a mix of both epithelial cells and sarcomatoid cells. The biopsied sample must contain more than 10% of either epithelioid or sarcomatoid cells to be classified as biphasic.

For example, if a biopsy shows 88% epithelial cells and 12% sarcomatoid cells, the diagnosis is biphasic mesothelioma. If the sample contains 91% epithelial and 9% sarcomatoid cells, it is considered epithelioid mesothelioma.

Biphasic Mesothelioma Cells

Biphasic Mesothelioma Cells (by WebPathology)

What Are Sarcomatoid and Epithelioid Cells?

Biphasic mesotheliomas are tumors that include a mix of these two cell types. Epithelial cells make up tissue in the body that lines surfaces of organs, blood vessels, and the interiors of cavities. When these cells become cancerous, it is called a carcinoma.[4]

On the other hand, sarcoma develops from cells that make up bone, fat, muscle, vascular, and connective tissue. Sarcomas are rarer than carcinomas. [4]

The distinction between the cell types is important in the diagnosis and treatment of mesothelioma:

  • Epithelioid mesothelioma cells are easier to treat.
  • They are also less aggressive because they tend to stick together rather than spread.
  • Sarcomatoid cells are more likely to spread to other organs as they adhere less to one another.
  • Epithelioid cells appear as rounded, cube-like shapes.
  • Sarcomatoid cells are spindle shaped and arrange themselves in a disorganized manner.

How Common Is Biphasic Mesothelioma?

All types of mesothelioma are rare. In terms of cell type, epithelioid mesothelioma is the most common, and sarcomatoid is the rarest. Biphasic mesothelioma accounts for about 25% to 30% of diagnoses. The rate is similar in both pleural and peritoneal mesothelioma.

What Are the Symptoms of Biphasic Mesothelioma?

The symptoms of biphasic pleural mesothelioma are:

  • Shortness of breath
  • Difficulty breathing
  • Wheezing
  • Coughing
  • Chest pains
  • Lumps under the skin

Typical symptoms of biphasic peritoneal mesothelioma include:

  • Abdominal swelling
  • Abdominal pain
  • Gastrointentinal problems
  • Nausea
  • Vomiting
  • Anemia

As both of these types of mesothelioma progress, symptoms worsen. Patients in later stages may also experience extreme fatigue, fever, loss of appetite, and weight loss.

How Is Biphasic Mesothelioma Diagnosed?

All types of mesothelioma are difficult to diagnose and may lead to misdiagnoses. Pleural mesothelioma is often misdiagnosed as lung cancer, for instance.

Peritoneal biphasic mesothelioma can be misdiagnosed as liver cancer, carcinosarcomas, synovial sarcoma, and other cancers.[5][6]

  • Diagnosis of biphasic mesothelioma begins with a visit to the doctor and a physical examination.
  • This is usually followed by an X-ray, CT scan, MRI, or PET scan (or combination of these) to determine if there are tumors or other abnormal tissues.
  • Any abnormal tissues are then biopsied. In most cases this requires the insertion of a needle to draw fluid or tissue. If the tumor is particularly difficult to reach, surgery may be required.
  • A pathologist then examines the biopsied cells to determine if they are malignant or benign.
  • The pathologist will also determine if the cells are in the mesothelium or some other tissue. This histological diagnosis is not always accurate. It is often difficult to distinguish mesothelioma cells from other cancer types.[7]
  • If the pathologist makes a confident mesothelioma diagnosis, they will then examine the cells to determine what type they are. If there is a mix of epithelioid and sarcomatoid cells in the sample, the diagnosis will be biphasic mesothelioma.[7]

The pathology component of diagnosis is essential to a complete mesothelioma diagnosis. Knowing the cell types and their proportions helps doctors develop the right treatment plan. This distinction also informs an overall prognosis for the patient.

Misdiagnosis is common in all types of mesothelioma. Even when doctors determine a patient has mesothelioma, getting the cell type right can be challenging. Studies have found that biphasic mesothelioma is more likely to be misdiagnosed than epithelioid mesothelioma.[6]

The study found that thoracoscopy led to the highest rates of accurate diagnosis of biphasic mesothelioma. Thoracoscopy is a minimally invasive procedure. Doctors use a scope inserted into a patient’s chest to remove a piece of tissue for diagnosis.

How Is Biphasic Mesothelioma Treated?

Treatment for biphasic mesothelioma depends on many factors. One factor is the ratio of epithelial to sarcomatoid cells:

  • If more epithelial cells are present, the cancer is likely to spread slowly to areas near the original tumor.
  • If sarcomatoid cells dominate, the cancer is more likely to be fast-growing and aggressive. This heterogeneity is the major factor that limits treatment options for biphasic mesothelioma.

There are also individual factors to consider. These factors include the patient’s health, tumor location, and the extend of the metastasis.

Surgery is usually only performed for epithelioid mesothelioma; however, if the biphasic tumor is mostly epithelioid, surgical removal of all or part of the tumor may be part of the treatment. Surgery is typically followed by radiation and chemotherapy.

For mostly sarcomatoid biphasic tumors, chemotherapy and radiation are more likely choices for treatment. Sarcomatoid patients are generally not eligible for surgery.

What Is the Outlook for Patients with Biphasic Mesothelioma?

As with treatment, the prognosis for patients with biphasic mesothelioma varies by individual. Unfortunately, most patients have a poor prognosis, regardless of cell type. Mesothelioma is aggressive and difficult to treat.

Generally, the outcomes for biphasic patients are better than those for sarcomatoid patients. Outcomes are worse than for epithelioid mesothelioma.

Survival rates for biphasic mesothelioma are low but vary depending on the proportion of cell types. The greater the ratio of epithelial cells present in a biphasic tumor, the longer the life expectancy.

A study measured survival times for patients who underwent some type of surgical procedure. The median survival time varied depending on the patients’ cell types:[8]

  • Epithelial – 19 months
  • Biphasic – 12 months
  • Sarcomatoid – 4 months

Can I Improve My Prognosis?

Yes, patients can always take steps to improve the outcome, even if there is little to no hope of remission. Decisions you make following a diagnosis of biphasic mesothelioma can extend your life and improve the quality of life you experience:

  1. Start treatment right away.
  2. Work with specialists with experience treating mesothelioma patients.
  3. Choose the most aggressive treatments for which you qualify.
  4. Listen to your medical team and follow their instructions.
  5. Take care of your overall health, which includes eating a good diet and avoiding alcohol and smoking.
  6. Talk to your care team about palliative treatments that will help you feel better.

If you were exposed to asbestos and then received a diagnosis of biphasic mesothelioma, you may feel someone else is to blame. Either your employer or the maker of asbestos-containing materials could be at fault. File with an asbestos trust fund or start a lawsuit if you feel you have a strong case to make for compensation. This process can be complicated, but a lawyer with experience in asbestos and mesothelioma cases can help you navigate the process.

Get Your FREE Mesothelioma Packet

Page Medically Reviewed and Edited by Pinar Kanlikilicer, PhD

Pinar Kanlikilicer

Dr. Pinar Kanlikilicer has a PhD in Biomedical Engineering. She completed her 5-years of postdoctoral training in the Department of Experimental Therapeutics at MD Anderson Cancer Center. She is currently working in the field of cancer as a research scientist.

Learn more about Cancer Research Specialist Pinar Kanlikilicer, PhD
References
  1. American Cancer Society. (2018, November 16). What is Malignant Mesothelioma?
    Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/about/malignant-mesothelioma.html
  2. Mayo Clinic. (2019, January 15). Mesothelioma. Symptoms and Causes.
    Retrieved from: https://www.mayoclinic.org/diseases-conditions/mesothelioma/symptoms-causes/syc-20375022
  3. Husain, A.N., et al. (2018, January). Guidelines for Pathologic Diagnosis of Malignant Mesothelioma. Arch. Pathol. Lab. Bed. 142, 89-108.
    Retrieved from: https://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2017-0124-RA
  4. National Cancer Institute. (n.d.). Cancer Classification.
    Retrieved from: https://training.seer.cancer.gov/disease/categories/classification.html
  5. Hassan, D. and Ligato, S. (2019). Localized Biphasic Malignant Peritoneal Mesothelioma with Rhabdoid Features Involving the Liver: Case Report and Review of the Literature. Case Reports in Pathology. https://doi.org/10.1155/2019/2732674.
    Retrieved from: https://www.hindawi.com/journals/cripa/2019/2732674/
  6. Kao, S.C., Yan, T.D., Lee, K., Burn, J., Henderson, D.W., Klebe, S., Kennedy, C., Vardy, J., Clarke, S., van Zandwijk, N., and McCaughan, B.C. (2011, March). Accuracy of Diagnostic Biopsy for the Histological Subtype of Malignant Pleural Mesothelioma. J. Thorac. Oncol. 6(3), 602-5.
    Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/21266919
  7. Inai, K. (2008, March). Pathology of Mesothelioma. Environ. Health Prev. Med. 13(2), 60-64.
    Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2698271/
  8. Meyerhoff, R.R., Yang, C-F.J., Speicher, P.J., Gulack, B.C. Hartwig, M.G., D’Amico, T.A., Harpole, D.H., and Berry, M.F. (2015, June). Impact of Mesothelioma Histologic Subtype on Outcomes in Surveillance, Epidemiology, and End Results Database. J. Surg. Res. 196(1), 23-32.
    Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430361/
View All References

Jump To a Topic
  • How Is Mesothelioma Classified by Cell Type?
  • What is the Definition of Biphasic Mesothelioma?
  • What Are Sarcomatoid and Epithelioid Cells?
  • How Common is Biphasic Mesothelioma?
  • What Are the Symptoms of Biphasic Mesothelioma?
  • How Is Biphasic Mesothelioma Diagnosed?
  • How Is Biphasic Mesothelioma Treated?
  • What Is the Outlook for Patients with Biphasic Mesothelioma?
  • Can I Improve My Prognosis?
  • Where Can I Get Additional Help?

Site Navigation

Home
Malignant Mesothelioma
How to Survive Mesothelioma
100 Questions & Answers about Mesothelioma (Free Book)
Surviving Mesothelioma - Beating the Odds (Free Book)
FREE Mesothelioma Packet
Symptoms
Shortness of Breath
Cough
Night Sweats and Fever
Weight Loss
Pain
Difficulty Swallowing
Fatigue and Muscle Weakness
Gastrointestinal Complications
Diagnosis
Pathology
Staging
Stage 1
Stage 2
Stage 3
Stage 4
Metastasis and Progression
Brain Metastasis
Biopsy
miRview Test
Imaging
Fine Needle Aspiration Biopsy in Mesothelioma
Biomarkers and Blood Tests
Calretinin
Prognosis
Remission
Recurrence
Death Rate
Life Expectancy
Search for a Mesothelioma Cure
Types
Pleural
Peritoneal
Epithelioid
Sarcomatoid
Biphasic
Pericardial
Testicular
Cell Types
Rare Subtypes of Mesothelioma
Deciduoid
Desmoplastic
Heterologous
Lymphohistiocytoid
Well-Differentiated Papillary
Tubulopapillary
Small Cell
Benign
Adenomatoid
Cystic
Unresectable
Localized
Idiopathic
Omental
Causes
Risk Factors
Latest Research
Genetic Components
Incidence
Latency Period
Mesothelioma Tumor
Health Insurance Coverage
Related Conditions
Immunodeficiency Disorders
Cholangiocarcinoma
Atelectasis
Pleural Plaques
Pleural Thickening
Pleural Effusion
Peritoneal Effusion (Ascites)
Mesothelial Hyperplasia and Proliferation
Pleuritis and Pleurisy
COPD
Anemia
Breast Cancer
Prevention
Complications
Misdiagnosis
Mesothelioma Commercial
Talcum Baby Powder
Lawyer
Lawsuits
Class Action Lawsuits
Settlements
Simian Virus 40
Differences From Other Cancers
Lung Cancer
Women
Children and Young Adults
Unknown Asbestos Exposure
Mesothelioma Without Asbestos
Cause of Death
Facts 
History
Awareness
Government and Research
National Mesothelioma Virtual Bank
Support
What to Expect
Living with Mesothelioma
Help a Loved One
Wrong and Right Things to Say
Caregivers
Financial Tips
Faith
Nutrition and Lifestyle
Intimacy
Mesothelioma and Fertility in Men
Fertility in Women with Mesothelioma
Emotional Health
COVID-19
Assisted Living
Hospice Care
Dying from Mesothelioma
Mourning
Coping Guide for Children
End-of-Life Decisions
Mesothelioma Awareness Day
Compensation for Victims
Lawyer
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington D.C.
Washington
West Virginia
Wisconsin
Wyoming
Lawsuit
Settlements
Statute of Limitations
Treatment
Surgery
Side Effects
Pneumonectomy
Extrapleural Pneumonectomy
Lobectomy
Pleurectomy / Decortication
Post Op Care
Pleurectomy / Decortication vs. Extrapleural Pneumonectomy
Peritonectomy/Cytoreductive Surgery
Thoracotomy
Thoracoscopy
Pericardiectomy
Wedge Resection
Pleurodesis
Pericardiocentesis
Prosthetics
Paracentesis
Thoracentesis
Chemotherapy
Side Effects
Heated Intraperitoneal
Radiation Therapy
Side Effects
Intensity-Modulated
Brachytherapy
Proton Therapy
Image-Guided
External Beam
Three-Dimensional
Multimodal Therapy
New Treatments
SMART Protocol
Gene Therapy
Suicide Gene Therapy
Tumor-Based p53 Therapy
Cryotherapy for Mesothelioma
Tumor Treating Fields
MicroRNA
Palliative Treatment
Osteopathic
Doctors
Treatment Centers
Treatment & Doctors Near You
Mesothelioma Experts
Medications
Alimta (pemetrexed)
Adriamycin (doxorubicin)
Avastin (bevacizumab)
Cytoxan (cyclophosphamide)
Gemzar (gemcitabine)
Keytruda (Pembrolizumab)
Mitomycin
Navelbine (vinorelbine)
Opdivo (nivolumab) and Yervoy (ipilimumab)
Paraplatin (carboplatin)
Platinol (cisplatin)
Rheumatrex (methotrexate)
Sutent (sunitinib)
Taxol (paclitaxel)
Medical Marijuana
Care Providers
Clinical Trials
Anetumab Ravtansine
Atezolizumab
Chimeric Antigen Receptor (CAR) T-Cell
Durvalumab
Immunotoxin
Interferon Alfa-2b
Onconase (Ranpirnase)
VISTA Protein
Costs
Immunotherapy
Nanotechnology
Hyperbaric Oxygen Therapy
Home Medical Equipment
HMGB1 Secretion
Photodynamic Therapy
Targeted Therapies
Apoptosis
Stem Cells
Lung Transplantation
Body-Based Therapies
Alternative Therapies
Paul Kraus’s Method
Doctors and Treatment in Canada
Asbestos Trusts
Veterans
VA Claims for Mesothelioma
Vietnam Veterans
Military Branches and Asbestos
Navy Veterans
Navy Ships
Aircraft Carriers
Battleships
Destroyers
Asbestos on Navy Cruisers
Submarines
Amphibious Ships
Minesweepers
Auxiliary Ships
Marine Corps Veterans
Army Veterans
Air Force Veterans
U.S. Coast Guard
Asbestos
Occupational Exposure
Construction Workers
Shipyard Workers
Ship Repair
Steel Mill Workers
Industrial Workers
Boiler Workers
Power Plant Workers
Firefighters
Automotive Workers
Roofers
Oil Refineries
Mining
Transportation Industry
Machine Operators
Farmers and Agricultural Workers
Migrant Workers
Electrical Wiring
Labor Unions
Prisons
Chimneys, Furnaces, and Wood Stoves
Fiberglass Connection to Mesothelioma
Home Remodeling
School Buildings, Teachers
For Tech Students
Cancer
Lung Cancer
Pleural Based Cancers
Ovarian Cancer
Ovarian Cancer Lawsuits
Companies That Used Asbestos
Awareness and Education
Types of Asbestos & Mesothelioma Risk
Asbestosis
Interstitial Lung Disease
Smoking
Asbestos Ingestion
Exposure in a Natural Disaster
Ban Asbestos
Libby, Montana
Recycling Asbestos
Asbestos Detection
Legal Information by State
Canada
Mexico
United Kingdom
Australia
  • Malignant Mesothelioma
    • Treatment
    • Asbestos Trusts
  • Compensation
    • Veteran Assistance
    • Surviving Mesothelioma
  • FREE Mesothelioma Packet
    • Mesothelioma News
    • About Us / Contact
  • Privacy Policy
    • Disclaimer
    • Editorial Guidelines and Standards
This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information: verify here.
The information provided by Mesothelioma.net is not a substitute for professional medical advice, diagnosis or treatment.

Mesothelioma.net

5430 LBJ Freeway Suite 1200
Dallas, Texas 75240

Serving mesothelioma victims nationwide

1-800-692-8608

  • facebook
  • twitter
© 2022 Mesothelioma.net