Epithelioid Mesothelioma

Quick Summary

Epithelioid mesothelioma (also called epithelial mesothelioma) is the most common of the three mesothelioma cell types and is caused by asbestos exposure. Its cells spread slower than other cell types, giving many epithelioid mesothelioma patients a better prognosis (overall health outlook). Epithelioid mesothelioma is also often easier to treat than the other cell types.

Get a Free Veterans Packet

What is Epithelioid Mesothelioma?

Epithelioid mesothelioma is the most common mesothelioma cell type. The American Society of Clinical Oncology (ASCO) notes that around 70% of all cases are epithelioid. The other cell types are sarcomatoid and biphasic.

Veterans have a high risk of this cancer as the U.S. military used asbestos until the early 1980s. Companies knew asbestos was harmful but hid the risks from the military and general public.

There is no cure for any mesothelioma cell type, but those with epithelioid mesothelioma have better survival rates than the other cell types.

Characteristics of Epithelial Mesothelioma Cells

Epithelioid CellsIllustration of cell type under microscope

Epithelial mesothelioma cells are shaped like ovals or cubes.

These cancer cells divide rapidly but stick to one another.

This prevents the cancer from spreading quickly and makes it easier to treat, according to the UPMC Hillman Cancer Center.

Mesothelioma Veterans GuideGet a FREE Veterans Packet

Get information on:

  • Treatment Options
  • Mesothelioma Specialists
  • Veterans Benefits

Get a Free Veterans Packet

What Causes Malignant Epithelioid Mesothelioma?

All types of mesothelioma (including epithelial mesothelioma) are caused by asbestos.

If asbestos fibers are inhaled or swallowed, they can get stuck in the body for decades. Long-term irritation due to asbestos fibers can lead to cellular mutations and cancer tumors after 20-50 years.

Researchers don’t know why some patients develop epithelioid mesothelioma, and others don’t.

Epithelial Mesothelioma Symptoms

A doctor holds up a stethoscope to the chest of an older male patient
Symptoms of mesothelioma do not vary widely by cell type. Instead, epithelial mesothelioma symptoms depend on where the cancer forms. Most mesothelioma cases develop in the lining of the lungs (pleura) or abdomen (peritoneum).

Symptoms of epithelial mesothelioma can include:

  • Chest pain and a cough
  • Loss of appetite
  • Lump on the chest wall beneath the skin
  • Nausea or vomiting
  • Pleural effusions (fluid buildup in lung lining)
  • Shortness of breath
  • Unexplained weight loss

If you have possible symptoms of epithelioid mesothelioma, call (877) 450-8973 to connect with our on-staff nurses.

Epithelioid Mesothelioma Diagnosis

If doctors think a patient has mesothelioma, they’ll first take note of their symptoms and then perform imaging tests to look for tumors in the body.

Common imaging tests include:

  • CT (computed tomography) scans
  • MRI (magnetic resonance imaging) scans
  • PET (positron emission tomography) scans
  • X-rays

If doctors think a patient has cancer after these tests, they may order a biopsy. A biopsy is the only way to confirm a mesothelioma diagnosis.

With a biopsy, doctors extract fluid or tissue samples from a possibly cancerous area and study them to see if cancer cells are present.

Subtypes of Epithelioid Mesothelioma

Epithelial mesothelioma cells are broken down into various subtypes. Knowing these subtypes can help doctors avoid a misdiagnosis.

Subtypes of epithelial mesothelioma include:

  • Adenomatoid mesothelioma: Also called microglandular, it accounts for about 6% of all cases of malignant pleural mesothelioma. These cells look like cubes arranged in the shape of tiny glands.
  • Deciduoid mesothelioma: This type has round cells and is relatively rare. It could be mistaken for squamous lung cell cancer or large cell lymphoma.
  • Glandular mesothelioma: These cells are cube-shaped and usually found in the lungs. It 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. Immature cells are rounder and resemble lymphoma under a microscope.
  • Tubulopapillary mesothelioma: This common subtype has cube-shaped cells and looks like tiny tubules and usually don’t grow as quickly as other cancer cell types.
  • Well-differentiated papillary mesothelioma: This is a very rare subtype. Most cases are considered benign (non-cancerous) and the cells spread slowly. A 2019 report noted that most cases are found in younger women with no history of asbestos exposure.

Epithelioid Mesothelioma Treatment Options

Once a patient has been diagnosed with mesothelioma, they can work with doctors to create a treatment plan.

Common epithelial mesothelioma treatments include surgery, chemotherapy, and radiation.

Epithelioid Mesothelioma Surgery

Doctors may recommend mesothelioma surgery if there is no metastasis (i.e. the cancer hasn’t spread far) and the patient is otherwise healthy. Surgeries used to treat mesothelioma vary based on where the cancer formed.

Epithelioid mesothelioma surgeries include: 

Extrapleural pneumonectomy (EPP)
Extrapleural pneumonectomy (EPP) – epithelioid pleural mesothelioma
Learn More

Pleurectomy with decortication (P/D)
Pleurectomy with decortication (P/D) – epithelioid pleural mesothelioma
Learn More

Cytoreduction with HIPEC
Cytoreduction with HIPEC – epithelioid peritoneal mesothelioma
Learn More


Epithelial mesothelioma usually responds better to chemotherapy than sarcomatoid mesothelioma does. A combination of pemetrexed and cisplatin or carboplatin is typically used to treat mesothelioma.

Radiation Therapy

Radiation therapy kills mesothelioma cells alongside surgery and/or chemotherapy.

Clinical Trials

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


Immunotherapy treatments help the immune system fight cancer. The Food and Drug Administration (FDA) approved the immunotherapy drugs Opdivo® and Yervoy® to treat mesothelioma in 2020.

Multimodal Therapy

A combination of treatments may be used in what is known as multimodal therapy. Combining mesothelioma treatment methods may help patients live longer.

Mesothelioma Veterans GuideGet a FREE Veterans Packet

Get information on:

  • Treatment Options
  • Mesothelioma Specialists
  • Veterans Benefits

Get a Free Veterans Packet

Epithelioid Mesothelioma Prognosis & Life Expectancy

Epithelial patients often have a better mesothelioma prognosis and longer life expectancy than sarcomatoid patients.

According to the medical journal Human Pathology, epithelioid mesothelioma patients live for 12-24 months on average. Further, different treatments can improve survival times.

Epithelioid mesothelioma prognosis can improve through:

  • Chemotherapy

    Pleural epithelial 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 surgery for pleural epithelial 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 a 2019 study.

Researchers also continue to study how other treatments can help mesothelioma patients. Our qualified nursing staff can help you with the best treatment options. Call (877) 450-8973 to get started.

Help for Epithelioid Mesothelioma Patients

Veterans make up 33% of all mesothelioma cases. Thankfully, the U.S. Department of Veterans Affairs (VA) offers many benefits to help veterans with mesothelioma and other asbestos-related diseases.

Through the VA, veterans can access:

Veterans can also pursue medical care from non-VA mesothelioma hospitals if they wish.

The Mesothelioma Veterans Center can help you access medical and financial VA benefits right now if you have epithelial mesothelioma.

See What VA Benefits Are Available.

FAQs About Epithelioid Mesothelioma

Is epithelioid mesothelioma a type of malignant mesothelioma?

Yes. Epithelial mesothelioma is almost always a form of mesothelioma cancer. It is not cancer of the epithelium (a tissue that covers major organs). Doctors refer to that type of cancer as carcinoma.

Patients with epithelial mesothelioma need medical treatment if they want to ease their symptoms and live longer.

What is the health outlook for epithelial mesothelioma patients?

All forms of mesothelioma are aggressive and deadly. That said, patients with epithelioid mesothelioma may have a better outlook than those with sarcomatoid or biphasic mesothelioma.

Epithelial cells do not spread as quickly through the body as sarcomatoid cells, so they’re easier for doctors to treat.

How can I find treatments for epithelioid mesothelioma?

You can access treatments for mesothelioma by working with doctors who have treated this cancer before.

We can help you find the best doctors and treatments for mesothelioma. Contact us now. Our registered nurses and veterans advocates are standing by to help you.

How is epithelioid mesothelioma diagnosed?

Doctors diagnose epithelioid mesothelioma by examining a patient’s symptoms, then performing a biopsy to look for cancer cells under a microscope.

That said, epithelial mesothelioma can be hard to diagnose as the cells often resemble other types of cancers (such as lung cancer) under a microscope.

For this reason, pathologists may use immunohistochemical staining to confirm their diagnosis. Staining allows doctors to look for unique proteins that mean a patient might have cancer using special dyes.

Pathologists may use immunohistochemical stains to look for the protein calretinin, which is present in 95% of epithelioid mesothelioma cases.

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.

View 11 Sources
  1. American Society of Clinical Oncology. (2019, June 26). Mesothelioma - Introduction. Retrieved May 21, 2020, from https://www.cancer.net/cancer-types/mesothelioma/introduction
  2. Blanquart, C., Jaurand, M., & Jean, D. (2020, March 25). The biology of malignant mesothelioma and the relevance of preclinical models. Retrieved October 25, 2021, from https://www.frontiersin.org/articles/10.3389/fonc.2020.00388/full
  3. Espinoza-Mercado, F., & Borgella, J. (2019, September 01). Disparities in Compliance With National Guidelines for the Treatment of Malignant Pleural Mesothelioma. Retrieved January 28, 2021, from https://www.annalsthoracicsurgery.org/article/S0003-4975(19)30559-4/fulltext
  4. Gray, S., & Mutti, L. (2020, February). Immunotherapy for mesothelioma: A critical review of current clinical trials and future perspectives. Retrieved May 21, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082257/
  5. Hameed, M. (n.d.). The Role of Pathology. Retrieved May 21, 2020, from https://www.mskcc.org/cancer-care/diagnosis-treatment/diagnosing/role-pathology
  6. Long-Term Survival Outcomes of Cancer-Directed Surgery for Malignant Pleural Mesothelioma: Propensity Score Matching Analysis. (n.d.). Retrieved May 21, 2020, from https://ascopubs.org/doi/10.1200/JCO.2017.73.8401
  7. Smith-Hannah, A., & Naous, R. (2019, January). Primary peritoneal epithelioid mesothelioma of clear cell type with a novel VHL gene mutation: A case report. Retrieved October 25, 2021, from https://www.sciencedirect.com/science/article/pii/S0046817718303034
  8. Stevers, M., Rabban, J., Garg, K., Van Ziffle, J., Onodera, C., Grenert, J., . . . Solomon, D. (2019, January). Well-differentiated papillary mesothelioma of the peritoneum is genetically defined by mutually exclusive mutations in TRAF7 and CDC42. Retrieved October 25, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6309365/
  9. UPMC Hillman Cancer Center. (n.d.) Mesothelioma Types, Risks, Diagnosis, & Treatment. Retrieved May 21, 2020, from https://hillman.upmc.com/cancer-care/lung/types/mesothelioma
  10. Verma, V. et. al. (n.d.). Survival by Histologic Subtype of Malignant Pleural Mesothelioma and the Impact of Surgical Resection on Overall Survival. Retrieved January 28, 2021, from https://pubmed.ncbi.nlm.nih.gov/30224273/
  11. Yaziji H., et. al. (n.d.). Evaluation of 12 Antibodies for Distinguishing Epithelioid Mesothelioma From Adenocarcinoma: Identification of a Three-Antibody Immunohistochemical Panel With Maximal Sensitivity and Specificity. Retrieved May 21, 2020, from https://pubmed.ncbi.nlm.nih.gov/16554731/
Back to Top