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Biphasic Mesothelioma

A person is said to have biphasic mesothelioma when their cancer has both epithelioid and sarcomatoid cells within the same tumor. The prognosis of biphasic mesothelioma varies greatly and depends on how many cells are epithelioid and how many cells are sarcomatoid.

Understanding Biphasic Mesothelioma

Epithelioid cells grow faster but stick together so there is less metastases in these cell types, while sarcomatoid mesothelioma is more likely to spread to other body areas. Biphasic mesothelioma is identified in about a third of all mesothelioma cases.

Pathology of Biphasic Mesothelioma

Biphasic mesothelioma has both cell types in it. It is important for the pathologist to identify both kinds of cells and to estimate how many of the cells are epithelioid and how many are sarcomatoid. The more epithelioid cells visible under the microscope, the better the prognosis of the disease. The cells are more likely to have already metastasized if more cells are of the sarcomatoid variety.

Signs and Symptoms of Biphasic Mesothelioma

Doctors may suspect cancer and particularly mesothelioma if there is a known history of asbestos exposure. Typical signs and symptoms that may be found include:

  • Chest or abdominal pain
  • Shortness of breath
  • Fluid around the heart, abdomen or pleural space
  • Unexplained weight loss
  • Unexplained fever

Diagnosis of Biphasic Mesothelioma

The diagnosis of biphasic mesothelioma begins with identifying the exposure to asbestos and ordering chest or abdominal X-rays. CT scans of the abdomen and/or the chest may be ordered to find areas that might be associated with pleural or peritoneal cancer. PET scans are sometimes done to locate metastases. In a PET scan, the patient is given radioactive glucose which is taken up to a greater degree in cancer cells. The scan detects the areas of increased uptake of the radioactive cellular fuel.

When a biopsy is taken through the use of a thoracoscopy procedure, a mediastinoscopy, fine needle biopsy or laparoscopy procedure, samples of the cancer can be seen and collected directly from the cancerous area. Pathologists are specialists in identifying cell types under the microscope so they are in charge of identifying the cells as belonging to a person with biphasic mesothelioma. If the diagnosis is difficult, immunohistochemistry is used to identify those cell markers on the cancer cells that are specific to mesothelioma. Once the diagnosis is made, the patient is then often referred to a mesothelioma specialist for further evaluation and treatment.

Treatment of Biphasic Mesothelioma

Because there are two different cell types in varying amounts, treatment of this type of cancer is highly individualized. Cancers that have more epithelioid cells in them and are Stage 1 or Stage 2 disease can be treated with a combination of surgery, chemotherapy, and radiation therapy. For those identified in stage 3 or stage 4, the disease may already have spread too far throughout the body so that potentially curative surgery can not done. These patients may have palliative surgery to reduce symptoms or to have a better quality of life.

There are newer treatments out there for patients with biphasic therapy, including intensity-modulated radiation therapy, photodynamic therapy and gene therapy.

If more cells are of the sarcomatoid type, treatment focuses more on investigational therapies, traditional chemotherapy and radiation. Getting the correct diagnosis of biphasic mesothelioma can help determine which treatments will be more effective. Get a second or third opinion if you really want to make sure your diagnosis is correct. You can also join a clinical trial, which offers new and investigational therapies to patients who qualify for the study.

Prognosis of Biphasic Mesothelioma

The prognosis of biphasic mesothelioma depends on the relative ratio of epithelioid cells to sarcomatoid cells. Those who have more epithelioid cells often live longer than patients with more sarcomatoid cells. The average life expectancy of a patient with biphasic mesothelioma is 8-21 months.

Sources & Author Edited: September 8, 2015

About the Writer

Retired LCDR Carl Jewett

LCDR Carl Jewett is a retired Naval Officer, having served just under 24 years in the submarine force. He currently serves as a VA Accredited Claims Agent and as the Executive Director of the Veterans Assistance Network. He specializes in assisting veterans filing VA claims for asbestos-related disabilities such as mesothelioma and asbestos-related lung cancer.

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