Epithelioid Mesothelioma

Quick Summary

One of three main mesothelioma cell types, epithelioid mesothelioma makes up approximately 70% of all mesothelioma cases. Epithelial cells spread slower than other cell types, giving epithelioid mesothelioma patients a better prognosis and treatment options.

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What Is Epithelioid Mesothelioma?

Malignant epithelioid mesothelioma, also called epithelial mesothelioma, is the most common mesothelioma cell type. The other two main mesothelioma cell types are sarcomatoid and biphasic.

Did you know

Approximately 70% of mesothelioma cases are epithelioid mesothelioma, according to the American Society of Clinical Oncology (ASCO).

Mesothelioma, including epithelioid mesothelioma, is a rare and aggressive cancer caused by asbestos exposure. Before the 1980s, asbestos was widely used in building materials and consumer products.

Although the manufacturers of these products knew the risks of inhaling asbestos fibers, they hid that information from the public and the military.

Because the U.S. military used asbestos in its bases, ships, and vehicles, veterans have an increased risk of mesothelioma and other asbestos-related diseases. In fact, veterans make up over 30% of all cases of malignant mesothelioma.

Testimonial

“I served in the Navy for 20 years. I always knew that there was asbestos, and when I went aboard ship, that’s when I found out that it was asbestos in the products. Nobody ever said anything about it being dangerous.”

Walter TwidwellWalter Twidwell
U.S. Navy Veteran
Mesothelioma Patient
There is no cure for any type of mesothelioma, but those with epithelioid mesothelioma have better survival rates and more treatment options when compared to the other cell types.

Characteristics of Epithelial Mesothelioma Cells

Epithelioid mesothelioma pathology outlines show that epithelial cells are characterized by their polygonal, oval, or cube-like shapes.

These cells divide rapidly but stick to one another, preventing epithelioid mesothelioma from spreading as quickly as the other cell types.

Since epithelioid mesothelioma does not spread as fast, doctors are often able to treat this cell type more effectively than the others, according to the UPMC Hillman Cancer Center.

Epithelial Mesothelioma Symptoms

Symptoms of mesothelioma do not vary widely by cell type. Instead, epithelioid mesothelioma symptoms depend on where the cancerous tumors first develop. Most cases of mesothelioma develop in the lining of the lungs (pleura) or abdomen (peritoneum).

Patients with epithelioid mesothelioma may experience:

  • Pain in the chest or abdomen
  • Shortness of breath
  • Dry cough or coughing up blood
  • Unexplained weight loss
  • Fatigue
  • Nausea or vomiting
  • Loss of appetite
  • Fluid buildup in the chest or abdomen
  • Anemia
  • Bloating or feeling full easily

Epithelioid Mesothelioma Diagnosis

When doctors suspect a patient has epithelioid mesothelioma, they must perform a series of diagnostic tests. They will first perform imaging tests on the area of the body in which symptoms originated.

Common imaging tests include:

  • X-rays
  • CT scans
  • MRIs
  • PET scans

These tests may help identify possible signs of epithelioid mesothelioma, but they cannot confirm a diagnosis alone. A biopsy is the only way for doctors to confirm a mesothelioma diagnosis.

Through a biopsy, doctors extract fluid or tissue samples from a possibly cancerous growth. Doctors then send the biopsy off to be reviewed by a pathologist (doctor who studies body tissues).

The pathologist will analyze the biopsy sample under a microscope to see if any epithelial mesothelioma cells are present.

Call (877) 450-8973 to speak with someone about diagnosis options.

Immunohistochemistry and Epithelioid Mesothelioma

Even with a biopsy, epithelial mesothelioma can be hard to diagnose as the cells often resemble other types of cancers, such as lung cancer. For this reason, pathologists may perform immunohistochemistry to confirm their diagnosis.

Immunohistochemistry allows pathologists to track certain proteins or other cell components. Pathologists may use immunohistochemistry to look for the protein calretinin, which is present in 95% of epithelioid mesothelioma cases.

Subtypes of Epithelioid Mesothelioma

Epithelioid mesothelioma cells are broken down into various subtypes. Epithelial subtypes possess different characteristics, which doctors can use to avoid misdiagnosis.

Adenomatoid Mesothelioma

Also called microglandular, this subtype accounts for about 6% of all cases of malignant pleural mesothelioma.

Adenomatoid cells look like cubes arranged in the shape of tiny glands and may resemble the cells of other cancers.

Deciduoid Mesothelioma

Deciduoid mesothelioma has round or polygonal-shaped cells and is relatively rare. It is often mistaken for squamous cell cancer of the lungs or large cell lymphoma.

Glandular Mesothelioma

Glandular cells are cube-shaped and usually found in the lungs. This epithelioid subtype often looks like metastatic adenocarcinoma of the lungs.

Solid Mesothelioma

This subtype can be classified as immature or, more commonly, mature. Mature cells form small nests or sheets, while immature cells are rounder and resemble lymphoma under a microscope.

Tubulopapillary Mesothelioma

This common epithelioid mesothelioma subtype has cube-shaped cells and looks like tiny tubules. Tubulopapillary cells usually don’t grow as quickly as other cancer cell types.

Well-Differentiated Papillary Mesothelioma

This is a very rare subtype of epithelioid mesothelioma. It is rather unique in that most cases are considered benign (non-cancerous) and the cells spread at a very slow rate.

A 2017 report noted that most cases are found in women without any history of asbestos exposure, it sometimes affects men as well.

Epithelioid Mesothelioma Treatment Options

Once a mesothelioma diagnosis is confirmed, pathologists can work with a patient’s health care providers to recommend a treatment plan.

Common mesothelioma treatments for the epithelioid cell type are surgery, chemotherapy, and radiation. Learn more about top epithelioid mesothelioma treatment options below.

Epithelioid Mesothelioma Surgery

Doctors may recommend a mesothelioma surgery if the patient is eligible and healthy enough to recover from the aggressive operation.

Surgeries used to treat epithelioid mesothelioma vary depending on where in the body the cancer first developed.

Epithelioid mesothelioma surgeries include: 



Other Treatment Options

Chemotherapy:
Epithelioid mesothelioma responds better to chemotherapy than does sarcomatoid mesothelioma. A combination of Alimta (pemetrexed) and cisplatin or carboplatin is typically used to treat mesothelioma.

Radiation Therapy:
Radiation therapy may be used to kill epithelioid mesothelioma cells alongside surgery and/or chemotherapy.

Clinical Trials:
Patients with epithelioid mesothelioma may be eligible for clinical trials, which study emerging treatment options and new drug combinations.

Multimodal Therapy
A combination of treatments may be used in what is known as multimodal therapy, which often leads to longer survival times.

Immunotherapy:
Immunotherapy treatments amplify the body’s natural immune response to attack mesothelioma cells. After years of research, the Food and Drug Administration (FDA) approved immunotherapy drugs Opdivo® and Yervoy® as a mesothelioma treatment in 2020.

Epithelioid Mesothelioma Prognosis & Life Expectancy

Epithelioid mesothelioma patients have the best prognosis and may live longer than patients with sarcomatoid cells since doctors can often treat this form of the disease more effectively.

Pleural epithelioid mesothelioma patients survived 14.5 months on average without treatment, according to a 2017 study from ASCO. However, different treatment combinations can improve survival times.

Epithelioid mesothelioma prognosis can improve through:

  • Chemotherapy

    Pleural epithelioid mesothelioma patients treated with just chemotherapy lived for 15.4 months on average, according to 2019 data from the Annals of Thoracic Surgery.

  • Surgery

    Patients who underwent surgeries for pleural epithelioid mesothelioma had a median survival time of nearly 21 months, a 2018 study found.

  • Multimodal Therapy

    Epithelioid mesothelioma life expectancy increased to 23.4 months when patients received a combination of surgery, chemotherapy, and radiation, according to the 2017 ASCO study.

Researchers also continue to study how different treatments like immunotherapy can improve the lifespan of patients specifically diagnosed with epithelioid mesothelioma.

Call (877) 450-8973 to speak with someone about treatment options.

Resources for Veterans With Epithelioid Mesothelioma

As previously mentioned, veterans continue to be one of the largest populations affected by mesothelioma.

Thankfully, the U.S. Department of Veterans Affairs (VA) now offers a wide range of benefits to help veterans with mesothelioma and other asbestos-related diseases.

Through the VA, veterans can access monthly financial payments to help themselves and their family members.

These financial benefits typically award over $3,000 a month — or more — to veterans with epithelioid mesothelioma or any other cell type.

In addition, some of the nation’s leading mesothelioma specialists treat veterans at VA hospitals. Veterans with VA Health Care can access care from these doctors at little to no cost.

Mesothelioma cancer centers within the VA include: 

The Mesothelioma Veterans Center can help you get connected with these medical facilities and learn more about affording treatment.

See What VA Benefits Are Available

Veterans Support Team
Todd Gersten, MD PhotoReviewed by:Todd Gersten, MD

Double Board-Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Todd Gersten, MD is a double board-certified medical oncologist and hematologist specializing in general adult oncology and hematologic disease. He is a physician partner with the Florida Cancer Specialists and practices in Wellington, Florida.

Dr. Todd Gersten is an independently paid medical reviewer.

Christopher Dryfoos PhotoWritten by:

Contributing Author

Christopher Dryfoos is a journalist and member of the American Medical Writers Association (AMWA). As the grandson of the U.S. Navy’s first forensic pathologist, he aims to help veterans with mesothelioma access needed care.

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