Pericardial mesothelioma is a rare form of an already rare type of cancer. This is the type of mesothelioma that affects the lining of the heart, called the pericardium. This type of cancer can cause a painful condition called pericardial effusion in which fluid builds up between the two layers of the pericardium around the heart. A fairly simple procedure called a pericardiocentesis can be used to drain the fluid and relieve symptoms.
A pericardiocentesis is a treatment used for patients with mesothelioma, but it is not a treatment of the cancer itself. It is used as palliative care, to help bring relief from pain and other symptoms of the cancer. It does not require general anesthetic and is low-risk, but there is a potential for complications and the effusion and its symptoms may return after the fluid has been drained during the procedure.
Mesothelioma and Pericardial Effusion
Mesothelioma is the cancer of the mesothelium, a double layer of tissue lining organs in the body. Pleural mesothelioma is the most common form and is cancer of the pleura, the lining around the chest cavity and lungs. One side effect of having tumors in the pleura is that fluid builds up between the two layers. This is called a pleural effusion. The same thing can happen in pericardial mesothelioma: fluid builds up between the two layers of the pericardium around the heart.
Pericardial effusion occurs when more fluid than normal accumulates in the pericardium and this can be caused by mesothelioma or other conditions. Inflammation in the pericardium caused by a heart attack or heart surgery, kidney failure, infections, trauma, and even autoimmune disorders all may cause pericardial effusion. In rare cases a cause cannot be found.
The symptoms of a pericardial effusion may include a feeling of fullness in the chest, shortness of breath and difficulty breathing generally, trouble breathing when lying down, and chest pains, especially on the left side, near the heart. Pericardial effusion is not just uncomfortable; it can impair how the heart functions and if left untreated can lead cause heart failure and ultimately death.
Treatment with Pericardiocentesis
The simplest and most common way to treat pericardial effusion is with a pericardiocentesis. The procedure is typically done in a specialized setting at the hospital, or if the patient is hospitalized it can be done at the bedside. The usual location for the procedure is a cardiac catheterization lab. This is not a procedure that is normally done in a doctor’s office.
To drain the fluid from the pericardium, a thin needle is inserted through the skin and in between the two layers of tissue. A syringe can then be used to withdraw the fluid. The patient may need to have intravenous fluids administered at the same time to provide fluids and medications that can reverse a drop in blood pressure or a slowed heartbeat. General anesthetic is not needed for a pericardiocentesis; the patient only receives an injection of local anesthesia to numb the area in which the needle is inserted. The doctor performing the procedure may use an ultrasound or other image to help guide the needle more accurately.
For a patient with mesothelioma, pericardiocentesis is generally used as a way to relieve symptoms from effusion and to make sure the heart continues to function normally. Pericardial mesothelioma causes this effusion, but pleural mesothelioma may cause it too. When the tumors from the pleura spread, they may eventually invade the pericardium and this can lead to pericardial effusion.
Recovery from a pericardiocentesis does not take very long since it is not too invasive and does not require putting the patient under general anesthesia. There may be some pain from the procedure, which can be treated with medication. There also may be some complications, although these are not common. The patient is typically monitored for at least a few hours in the medical setting to be sure there are no complications, or if there are to address them.
Pericardiocentesis as a Diagnostic Tool
For mesothelioma patients, pericardiocentesis is often used as a treatment to relieve symptoms and to drain all of the fluid from around the heart, but it may also be used for a diagnosis. The fluid withdrawn from the pericardium can be investigated by a pathologist to find the underlying cause of the effusion. This may be done for someone presenting symptoms of pericardial effusion, but who has not yet been diagnosed with mesothelioma or some other condition.
Examining the fluid from the pericardium may help a doctor diagnose congestive heart failure, inflammation or infection in the pericardium, kidney failure, trauma or damage to the heart, and other causes of effusion. Cancer may also be diagnosed, but pericardial mesothelioma cannot be confirmed with this test. Cancer cells are not necessarily present in the fluid, but if other potential causes of effusion have been ruled out by the test, a biopsy may be done to remove a section of the pericardium. This can then be examined to diagnose cancer.
Risks and Complications
The procedure of draining the fluid from the pericardium is fairly simple and low-risk. This is especially true if the doctor performing the pericardiocentesis uses an ultrasound or other image to guide the insertion of the needle and the withdrawal of fluid. Without the guiding image it can be easier for a mistake to be made that could lead to a complication. Potential complications include puncturing the lung and causing it to collapse, excessive bleeding, infection of the pericardium, a heart arrhythmia, getting air in the pericardium, or puncturing the heart or a blood vessel.
Benefits for Mesothelioma Patients
Undergoing a pericardiocentesis has several benefits for cancer patients and the risks are minimal in comparison. The main benefit is simply relieving the symptoms caused by pleural effusion. The procedure also reduces the risk of having complications, such as heart failure, as a result of having fluid around the heart. Symptoms caused by effusion, like breathlessness and pain, make life difficult and relieving them can provide patients with a better quality of life.
Pericardial effusion is treated with pericardiocentesis, but it is not treated indefinitely. The fluid is likely to re-enter the pericardium eventually and cause symptoms once again. If a patient is hospitalized, a catheter may remain in place to continuously drain fluid, but for other patients the recurrence may mean undergoing repeated pericardiocentesis procedures. If you are facing this procedure, make sure you get all your questions answered and that you feel comfortable going forward.
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