Pericardial mesothelioma is one of the rarest types of this kind of cancer and it affects the pericardium, a layer of tissue that surrounds the heart. All types of mesothelioma are cancers of the mesothelium, the tissue that envelops many of the organs in the body. Depending on which organ it encloses, this tissue may have a unique name, such as the pericardium.
Like other types of mesothelioma, this type is strongly associated with asbestos exposure. How fibers of asbestos that are inhaled or ingested cause cancer in the lining of the heart is not fully understood. This type of mesothelioma is rare, much rarer than pleural mesothelioma, caused when inhaled asbestos fibers embed in the lining of the lungs. Pericardial mesothelioma is tricky to treat because of its proximity to the heart and prognoses are not often positive.
Mesothelioma and the Pericardium
All types of mesothelioma are rare, but among the four types pericardial is the second least common. It is a primary cancer of the pericardium, the layer of tissue that surrounds the heart, and it is difficult to treat. It is so rare that exact numbers of cases are unknown, but some estimates put it at only 200 reported diagnoses ever. One study reviewed the medical literature and found only 27 cases of pericardial mesothelioma between 1972 and 1992. This accounts for about one percent of all known cases of mesothelioma.
Mesothelioma is a cancer of the mesothelium, the tissue that surrounds most organs in the body. The vast majority of cases are primary cancers of the pleura, the part of the mesothelium that surrounds the lungs. Peritoneal mesothelioma, cancer of the tissue surrounding abdominal organs, is second most common. Third most common is the cancer of the pericardium. The pericardium is a thin tissue, made up of two layers. The inner layer is called the visceral layer or the epicardium and the outer layer is called the parietal layer or the heart sac. Tumors may begin growing in either or both layers.
Causes and Risk Factors
Because this type of cancer is so rare, studies are limited and it is difficult to determine what causes it. Like the more common pleural mesothelioma, causes are thought to include genetic factors and exposure to asbestos. Having a family history of this cancer and being exposed to asbestos over a long period of time are the two strongest risk factors. It has also been found that men are twice as likely as women to have this type of cancer.
Asbestos is the leading cause of most mesotheliomas, particularly pleural mesothelioma. This natural mineral is fibrous and when fibers come lose they can get into the air and be inhaled. They lodge in the lungs or pleura and over time can cause damage that leads to a number of illnesses, including cancer. People exposed to asbestos for years, usually at work, are at risk for mesothelioma, but not all will develop it.
Pericardial mesothelioma is also linked to asbestos exposure, but the connection is not as strong. It is not clear how the fibers of this mineral could get to the pericardium and cause a primary tumor there. In fact, the rates of asbestos exposure among people diagnosed with pericardial mesothelioma are much lower than in those with pleural or peritoneal mesothelioma. Limited studies of people with pericardial mesothelioma have estimated that only about 15 to 30 percent of people getting the diagnosis were ever exposed to asbestos.
As with other types of mesothelioma symptoms, pericardial mesothelioma has a long latency period and symptoms often don’t appear until decades after any exposure to asbestos. In those cases with no asbestos exposure, symptoms still don’t seem to be troubling until the cancer has developed into later stages. Many of the symptoms of this type of mesothelioma result from the fact that it causes fluid to build up between the two layers of the pericardium and from a thickening of this tissue.
Potential symptoms that someone with pericardial mesothelioma may experience include an irregular heartbeat, heart palpitations, trouble breathing, heart murmurs, weight loss, shortness of breath when lying down, chest pains, fatigue, coughing, night sweats, and fever. Patients may also experience heart failure and edema, or swelling, of the lower limbs.
The symptoms and the rarity of pericardial mesothelioma make it difficult to diagnose. The symptoms are often nonspecific and are caused by the fluid and thickening in the pericardium, both of which can be caused by other, more common conditions. A diagnosis will begin with a physical examination and medical history. The next step is most likely an image of the heart, usually by ultrasound, called an echocardiogram, which can show if there is fluid in the pericardium.
To image tumors, however, requires a better imaging scan. Radionuclide imaging is often used if tumors around the heart are suspected. This involves injecting the patient with a radioactive element, which is transported into cells that are rapidly dividing, like cancer cells. A radiologist can then see by detecting radiation, where in the body there are tumors.
A biopsy is likely to be the next step. This allows a pathologist to examine cells under a microscope to look for any that are abnormal. Examination of cells from the fluid in the pericardium or from suspected tumors can help make a diagnosis, but this technique is far from conclusive. In one study researchers were only able to find malignant cancer cells in four out of 17 cases of known pericardial mesothelioma.
Treatment for any type of mesothelioma is challenging, but this is especially true for pericardial mesothelioma. A surgery called a pericardiectomy is one possible option and involves removing the pericardium, either in part or completely. In very early stages of the cancer this may cure it, but in most cases the cancer is too far advanced and this will only prolong the patient’s life a little. It can also provide some relief from the pressure of the fluid buildup.
Chemotherapy and radiation treatment are standard treatments for other types of cancer, but are not considered useful treatments for pericardial mesothelioma. For most patients, unfortunately, this type of cancer is a death sentence and the prognosis is not good. Treatment most often involves palliative care to make the patient more comfortable. Removing fluid and parts of the pericardium, for instance, relieve pressure on the heart and reduce pain and other symptoms.
The overall prognosis for pericardial mesothelioma is grim and most patients do not survive this rare type of cancer. Although its connection to asbestos is not as strong as with pleural mesothelioma, a significant number of people who will die from this disease were exposed to it over the duration of a career, many of whom never knew of the risks.
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