Pericardial Mesothelioma

Quick Summary

Pericardial mesothelioma is extremely rare. It is caused by asbestos fibers lodged in the lining of the heart. This results in tumors in the pericardium, the protective lining around the heart. Some patients have extended their life expectancy more than a year with the right treatment.

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Understanding Pericardial Mesothelioma

There are three main types of mesothelioma: peritoneal, pleural, and pericardial mesothelioma. Pericardial mesothelioma is the rarest type.

Only 200 cases of pericardial mesothelioma have been reported in medical journals. This represents about 1% of all mesothelioma diagnoses. Few veterans are ever diagnosed with pericardial mesothelioma.

There are two layers of the pericardium, an inner and an outer layer. Mesothelioma can develop in either layer. Experts consider asbestos to be the cause of mesothelioma. Yet, they can’t explain how asbestos fibers get into the pericardium. Doctors only know that asbestos fibers have the ability to migrate once inside the body. This also makes it hard to determine the cause of pericardial mesothelioma in veterans. Most veterans are exposed to asbestos in the military, but it’s not certain this could have been the cause of their diagnosis.

Pericardial mesothelioma is twice as common in men compared to women. Some experts think this is because men are more likely to get exposed to asbestos in the workplace.

Most people with this disease are 50-70 years of age when diagnosed. It often takes several decades before the asbestos exposure develops into mesothelioma cancer. Pericardial mesothelioma is a difficult disease to diagnose because of its rarity. It’s also difficult to diagnose because the symptoms are similar to those found in more common diseases.

Did you know?

Surgery is the best chance for prolonging a pericardial mesothelioma prognosis. A 2010 study showed that one patient was still alive 16 months after their operation. This treatment effectively quadrupled the patient’s life expectancy.

Symptoms of Pericardial Mesothelioma

There are few to no symptoms when the disease remains localized to the pericardium. This is why it is rarely diagnosed in its early stages. When symptoms do occur, they look like those seen in heart disease. As a result, people are often diagnosed with some type of heart condition before doctors find the mesothelioma.

The telltale symptoms of pericardial mesothelioma are usually found with visual imaging tests. One common sign is pericardial fluid buildup around the heart. This is often detected with an echocardiogram, X-rays or a CT scan of the chest.

Typical symptoms seen in pericardial mesothelioma include:

  • Chest pain
  • Dry cough
  • Exhaustion
  • Fever
  • Heart palpitations
  • Night sweats
  • New onset of a heart murmur
  • Shortness of breath (with or without activity)
  • Worsening of shortness of breath when lying down

If you have any of these symptoms, it is important to seek medical attention. These signs could show that you have fluid around your heart. If you know you have been exposed to asbestos, your symptoms could be a result of pericardial mesothelioma.

Causes of Pericardial Mesothelioma

Doctors and researchers have not yet found the exact cause of pericardial mesothelioma. Based on the other forms of mesothelioma, asbestos exposure is the most likely cause of the disease.

The exact relationship between asbestos and pericardial mesothelioma is less clear than it is in more common kinds of mesothelioma.

Theoretically, it could be possible for asbestos fibers to travel from the lungs to the lining around the heart. The asbestos fibers embed into the lining around the heart, irritating the tissue. It can take several decades for the asbestos fibers to migrate to the pericardium and turn the tissues into cancerous cells.

After pericardial cells mutate and turn into cancer, they divide quickly and form tumors around the heart. The cancer cells thicken the pericardial lining and fluid begins to build up in response to the irritation of the lining. This puts added stress on the heart, leading to heart-related symptoms.

Diagnosis of Pericardial Mesothelioma

During diagnosis, a doctor will first note your symptoms and perform a physical exam. Imaging tests, such as an echocardiogram, chest X-ray or a CT scan, may show thickening of the pericardium. These tests can also reveal fluid around the heart.

Doctors may then perform a procedure called a pericardiocentesis. Your doctor inserts a needle into the space between the heart and the pericardium. This allows the doctor to take a fluid sample. Sometimes cancer cells can be found when looking at this fluid under the microscope.

In some cases, it takes a biopsy of the affected area to definitively make the diagnosis of pericardial mesothelioma.

Another technique uses radioactive dye to find pericardial mesothelioma. An injection of this dye can show evidence of the disease on imaging tests. However, CT scans of the chest are still the most common imaging test. CT scans show the fluid around the heart and possibly the cancer itself.

Only about 10-20% of mesothelioma cases are diagnosed while the patient is still alive. The rest are found in an autopsy after the patient has already died of the disease.

Pericardial mesothelioma is often misdiagnosed as any of these other, more common, heart diseases:

  • Coronary artery disease
  • Tuberculosis of the pericardium
  • Acute heart failure
  • Intra-atrial myxoma
  • Cardiac tamponade
  • Pericarditis
  • Weakness of the heart muscle

If you were diagnosed with any of the above conditions and you suspect a misdiagnosis, you should seek a second opinion from a heart and lung specialist. They will be able to make sure the diagnosis isn’t something less common, such as pericardial mesothelioma.

Treatment of Pericardial Mesothelioma

Mesothelioma of the pericardium is difficult to treat because of the cancer’s proximity to the heart. There are several methods used to treat the disease. Surgery can remove the visible signs of a tumor. Radiation therapy can shrink the size of the tumor and relieve symptoms. Chemotherapy is often the first line of treatment. Doctors also use chemotherapy to kill tumor cells that weren’t removed by radiation and surgery.

Pericardial mesothelioma is so rare that doctors have little evidence of effective treatments to compare. Researchers wrote about this in a 2017 analysis of pericardial mesothelioma treatments. “Primary pericardial mesothelioma is a rare cancer, for which there is no consensus on treatment,” they said. The lack of consensus makes it worth considering clinical trials and emerging therapies. Some patients live years past their diagnosis after getting drugs from a clinical trial.

About 50% of people diagnosed with pericardial mesothelioma survive past the six-month mark. Yet, this means half of the patients out there are benefiting from their treatment. Only a mesothelioma specialist can determine the best course of treatment for you

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Taking Control of Your Diagnosis

Doctors have identified several factors that affect a mesothelioma prognosis, including age, sex, and how advanced the disease is. Another factor is the treatment you receive. Treatment is probably the most important factor in life expectancy. More importantly, it’s a factor that you can take control of.

Important points for veterans with pericardial mesothelioma:

  • Seeing a specialist is a must.
  • Consider being a part of clinical trials and experimental therapies.
  • You don’t have to accept your prognosis.

Remember that there isn’t a standard of treatment for pericardial mesothelioma. Take this into account when considering your treatment options. Every patient is different, and there are always people living longer than before. Learn More in our free Mesothelioma Veterans Packet.

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 Sources

American Cancer Association. “Surgery for Malignant Mesothelioma.” Retrieved from: Accessed: August 18, 2017.

Bang MD, Jung Hee. “Surgical experience of pericardial mesothelioma presenting as constrictive pericarditis.” Journal of Cardiology Cases. 2010. Retrieved from: Accessed: August 18, 2017.

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