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 mesothelioma cell types are sarcomatoid and biphasic.

Did you know

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

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.

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.

Epithelioid Mesothelioma Causes

Most cases of mesothelioma, including epithelioid mesothelioma, are caused by asbestos exposure.

Because the U.S. military used asbestos up through the 1980s, 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.

“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 Twidwell, U.S. Navy Veteran and Mesothelioma Patient

Epithelial Mesothelioma Symptoms

Symptoms of mesothelioma do not vary widely by cell type. Instead, epithelioid mesothelioma symptoms are dependent on where the cancerous tumors first develop.

  • People who inhale asbestos fibers and develop pleural mesothelioma (forms in the lining of the lungs) typically experience lung-related symptoms.
  • People who swallow or ingest asbestos fibers and develop peritoneal mesothelioma (forms in the lining of the abdomen) typically experience abdominal-related symptoms.

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

Doctors must perform a series of diagnostic tests to confirm epithelioid mesothelioma histology (cell type). Learn more about these diagnostic tests below.

Imaging Tests

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

Common imaging tests include:

  • X-rays
  • Computed tomography scans (CT scans)
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography scans (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 a sample of fluid or tissue 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.

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Patients who experience symptoms of mesothelioma should talk to their doctors about their history of asbestos exposure.

This may help lead to an early diagnosis.

Immunohistochemistry and Epithelioid Mesothelioma

Diagnosing epithelioid mesothelioma can be difficult even with a biopsy because epithelial cells often resemble the cells present in other types of cancers, such as lung cancer.

For this reason, pathologists may perform additional tests to confirm their diagnosis. One test is called immunohistochemistry, which 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.

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

Epithelioid Mesothelioma Treatment Options

According to the UPMC Hillman Cancer Center, doctors can treat epithelioid mesothelioma more easily than the other cell types.

Common mesothelioma treatments for the epithelioid cell type are surgery, chemotherapy, and radiation. A combination of treatments may be used in what is known as multimodal therapy.

Epithelioid Mesothelioma Surgery

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

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

Epithelioid mesothelioma surgeries include: 

  • Extrapleural pneumonectomy (EPP) – pleural epithelioid mesothelioma
  • Pleurectomy with decortication (P/D) – pleural epithelioid mesothelioma
  • Cytoreduction with HIPEC – peritoneal epithelioid mesothelioma

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.
Did you know

A 2020 clinical trial is underway, investigating whether mesothelioma patients can be treated by stimulating the immune system.

This clinical trial is studying the immune gene VISTA, which is often present in patients with epithelioid pleural mesothelioma.

Epithelioid Mesothelioma Prognosis & Life Expectancy

Epithelioid mesothelioma patients have the best prognosis and may live longer than patients with other cell types.

Pleural epithelioid mesothelioma patients survived 14.5 months on average without treatment, according to a 2017 study from the ASCO.

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

Subtypes of Epithelioid Mesothelioma

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


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


This subtype is classified as “immature” or, the more common type, “mature.” Mature cells form small nests or sheets, while immature cells are rounder and resemble lymphoma under a microscope.


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.

Resources for Veterans With Epithelioid Mesothelioma

The U.S. Department of Veterans Affairs (VA) offers numerous benefits and health care options for veterans with mesothelioma. In fact, some of the nation’s leading mesothelioma specialists treat veterans at VA hospitals.

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.

Get help filing for VA benefits, or call us at (877) 450-8973 for more information.

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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