Epithelioid Mesothelioma

Quick Summary

Epithelioid mesothelioma represents about 70% of all mesothelioma cell types. Veterans with this cell type have the best treatment options and life expectancies.

Understanding Epithelioid Cell Type

Epithelioid mesothelioma comes from epithelial cells that have come into contact with asbestos fibers. Many veterans have asbestos in their system from their military service. These fibers find their way into the body through the lungs and esophagus, which are full of epithelial cells.

Epithelial cells make up the lining for many body tissues. They are cube-shaped cells in their normal state. Sometimes this shape changes when they mutate into cancerous cells. Epithelioid mesothelioma is found more often in pleural disease and among men who are more than 45 years of age.

This cell type divides faster than the other mesothelioma cell types. But the cells stick to one another so that they actually spread more slowly. Instead, there is greater growth at the original site of the cancer. This makes surgery a greater likelihood for patients with epithelioid cell types.

Signs and Symptoms of Epithelioid Mesothelioma

People with epithelioid mesothelioma tend to get these symptoms:

  • Chest pain at the site of the tumor
  • Fluid around the lung tissue
  • Shortness of breath
  • Unexplained weight loss

Doctors use different techniques to identify the source of these symptoms. Eventually, they arrive at a diagnosis, along with cell type and specific subtype.

Subtypes of Epithelioid Mesothelioma

Here are the subtypes you might want to look for:

  • Adenomatoid subtype: This accounts for only about 6% of all mesothelioma found in pleural tissue. It is also called the microglandular subtype. The cells look like cubes arranged in the shape of tiny glands. It looks like other forms of metastatic cancer of the pleura. This makes it difficult to diagnose under the microscope.
  • Deciduoid subtype: This subtype is relatively rare. It has round or polygonal-shaped cells with a large amount of intracellular fluid in the cells. The nucleoli inside the nucleus of the cells of this subtype tend to be large. It is often mistaken for squamous cell cancer of the lungs or large cell lymphoma, among others.
  • Glandular subtype: These are cells shaped like glands. The cells are cube-like in shape and are usually found in the lungs. It often looks like metastatic adenocarcinoma of the lungs.
  • Solid subtype: This subtype can be very mature or very immature. The mature type is common in mesothelioma diagnoses. Cells form small nests or sheets of cells. The nucleoli within the nucleus of the cells are large. If this subtype is immature, it looks more disorganized, and the cells are rounder. The immature type of solid epithelioid mesothelioma often looks a lot like lymphoma, a type of blood cancer.
  • Tubulopapillary subtype: This is a common subtype of epithelioid mesothelioma. It looks like tiny tubules with cells shaped like cubes. The cells are mostly identical to one another. Inside the cells, there are tiny nucleoli. The cells are usually mature, meaning they don’t grow as fast as other cancer cell types. Tubulopapillary mesothelioma looks a lot like adenocarcinoma of the lung. Doctors must be careful before diagnosing a patient with epithelioid mesothelioma.
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Treatment of Epithelioid Mesothelioma

Because epithelioid mesothelioma spreads slowly, doctors can use aggressive therapies. More aggressive treatment, like surgery, leads to longer survival times.

Common surgeries for epithelioid mesothelioma include:

  • Extrapleural Pneumonectomy: This is when the pleural lining, the entire lung, and parts of the diaphragm and pericardium are removed. This is the most radical type of pleural mesothelioma surgery.
  • Pleurectomy with decortication: The pleural lining containing the cancer cells is removed. Doctors also extract tumors found throughout the chest cavity. The lung and other nearby areas are not removed as part of this procedure. This helps the patient recover faster.

Surgery is often combined with radiation or chemotherapy. This multimodal treatment helps to get rid of any microscopic cancer cells surgery may have missed.

Prognosis of Epithelioid Mesothelioma

The median survival for epithelioid mesothelioma is about a year. This accounts for patients of all stages, including those with advanced disease at diagnosis.

Statistics tell us that 60% of all patients with this type of cancer are still alive after one year post-diagnosis. A full 25% of all patients can manage to live past the five-year mark.

Did you know?

Most survival statistics suggest patients with advanced mesothelioma live about 12-16 months after diagnosis. But being diagnosed with an epithelioid cell type can drastically improve these statistics. Dr. Joseph Friedberg led a study published in 2017 that showed this. It found that patients with stage 3 and 4 pleural mesothelioma had a median survival of three years.

About half of the patients in Dr. Friedberg’s study had survival times well beyond three years. Patients in the study received chemotherapy, surgery and photodynamic therapy. (Photodynamic therapy is an experimental treatment that uses light to kill cancer cells.)

“These are among the best results ever published for patients with an epithelial subtype of pleural mesothelioma,” Dr. Joseph Friedberg said in an article for Science Daily.

Next Steps for Vets with Epithelioid Cell Type

Veterans with epithelioid mesothelioma have the best chances of survival. Even if you’ve been diagnosed with later-stage mesothelioma, surgery may still be possible.

Important points on epithelioid mesothelioma:

  • Epithelioid cells spread more slowly.
  • Many epithelioid patients are eligible for surgery.
  • Epithelioid mesothelioma has the best prognosis.

Surgery is your best chance of extending your life. There are specialists across the country who can help. Two of the top mesothelioma surgeons also work with veterans in the VA system. There’s Dr. Cameron in California and Dr. Lebenthal in Massachusetts.

Visit the UCLA Health website to learn more about Dr. Robert Cameron.


The Mesothelioma Veterans Center has no affiliation with and is not endorsed or sponsored by Dr. Robert B. Cameron. The contact information above is listed for informational purposes only. You have the right to contact Dr. Cameron directly.

Veterans Support Team
Reviewed 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 DryfoosWritten by:

Contributing Author

Christopher Dryfoos works hard to help veterans with mesothelioma learn how to access the care they need. Using his experiences as a journalist and Boy Scout, he strives to keep our content trustworthy, helpful, and easy to read.

View Sources

American Cancer Association. “Early Detection, Diagnosis, and Staging.” 2016. Retrieved from: https://www.cancer.org/content/dam/CRC/PDF/Public/8735.00.pdf. Accessed on August 21st, 2017.

Friedberg, Joseph S. “Extended Pleurectomy-Decortication–Based Treatment for Advanced Stage Epithelial Mesothelioma Yielding a Median Survival of Nearly Three Years.” Annals of Thoracic Surgery. 2017. Retrieved from: http://www.sciencedirect.com/science/article/pii/S0003497516311390. Accessed on August 21st, 2017.

Science Daily. “Lung-sparing surgery for patients with advanced mesothelioma results in prolonged survival, new study shows.” 2016. Retrieved from: https://www.sciencedaily.com/releases/2016/12/161214145608.htm. Accessed on August 21st, 2017.

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