Pericardial mesothelioma is the rarest of the three forms of asbestos-caused cancer. Accounting for less than 10% of all mesothelioma cases worldwide, the pericardial form of the disease attacks the lining of the heart, known as the pericardium. Doctors view this form of mesothelioma as even more serious than the other forms, simply given the fact that the cancer lodges in the area around the heart.
What Causes Pericardial Mesothelioma?
Prolonged exposure to asbestos is - to this day - the only known cause of pericardial mesothelioma as well as the other types of the disease. With mesothelioma, loose asbestos particles are inhaled and gather in or near the internal organs, most often the pleural, which is the lining of the lungs.
There is no exact answer as to how an individual develops pericardial mesothelioma and how the dangerous asbestos fibers make their way into the pericardium. Researchers theorize that asbestos fibers, once they are broken up into smaller pieces in the lungs, are carried from the lungs into the blood stream. As the fibers are pumped through the heart, they may become lodged in the heart lining. Once lodged in the pericardium, the chronic inflammation process, which leads to the formation of cancerous growths or tumors, is similar to what occurs in the more common pleural mesothelioma.
Symptoms of Pericardial Mesothelioma
As with both the pleura and the peritoneum, the growth of tumors in the pericardial region causes the expansion of tissue and allows fluid to accumulate around the heart. The fluid can interfere with the functioning of the heart. It is this fluid that is responsible for most of the symptoms of pericardial mesothelioma. These symptoms include:
- Chest pain, ranging from uncomfortable to severe
- Shortness of breath
- Heart palpitations
- Persistent coughing
- Extreme fatigue after minimal activity or exertion
Pericardial mesothelioma resembles the other types of asbestos-caused mesothelioma in that the symptoms are often mistaken for something more common. In this case, heart attack or some other sort of heart disease is suspected, especially when the patient begins complaining of persistent chest pains.
Symptoms can vary with each patient and can be affected by a number of variables, including the location and size of the tumors and the overall health of the patient. The age of the patient may also factor into the equation.
A thorough patient history is the key to the proper diagnosis of the disease. Anyone who worked with asbestos or asbestos-containing products, particularly in shipyards or in the construction field, should always mention their exposure to their doctor. Because this is a rare disease, other diagnoses are usually considered before doctors investigate the possibilities of mesothelioma.
Diagnosis and Treatment
All forms of mesothelioma can be difficult to diagnose, and the pericardial variety is certainly no exception. The first line of diagnosis is usually the traditional x-ray, which will give doctors a cursory glance at the heart. Because the diagnostic abilities of traditional x-rays are limited, doctors will usually order a more sophisticated test that gives them a better look at the internal organs, such as a CT scan or MRI.
The CT scans and MRIs can lead doctors to their next step in diagnosing the disease. If these tests seem to indicate the presence of mesothelioma, the doctor will most likely order a tissue biopsy. A biopsy is a medical procedure that uses a thin needle to remove tissue from the affected area. In this case, a biopsy of the pericardium - the lining around the heart - would be performed. While the test may sound frightening and can be uncomfortable, it takes just a few minutes and doctors will do everything possible to lessen any discomfort. Results of the biopsy - which can sometimes take more than a week - will confirm or deny the diagnosis of mesothelioma.
If tests are positive for mesothelioma, patients will probably be given a choice of just a few options. Because the disease is usually diagnosed in its late stages, due to the fact that it can lay dormant for up to 40 or 50 years, options are less than for cancers that can be diagnosed early.
Surgery is rarely recommended in the case of pericardial mesothelioma. If it is suggested, it may be used to remove a small piece of the affected pericardium or to remove the fluid around the heart.
Because there is no cure for this or any type of mesothelioma, oncologists will usually suggest mesothelioma treatment options that relieve symptoms, reduce pain, or improve the overall quality of life for the patient. These treatments include radiation, which is used to reduce the build up of fluid. Chemotherapy is also suggested for this type of cancer, but patients will want to consider this option carefully as it can greatly compromise one's quality of life while providing little or no chance for a cure.
Doctors and research scientists are still searching for a way to cure mesothelioma or at least extend the life of those suffering from all types of the disease. Because it is almost always diagnosed in its late stages, some patients die within weeks of learning they have the disease. Few last longer than a year.
Diagnostic aids that will result in earlier diagnosis of mesothelioma are currently being tested and other forms of treatment are being surveyed in clinical trials, all in hopes that the lives of mesothelioma patients can someday be prolonged.
- Warren WH: The clinical manifestations and diagnosis of mesothelioma. In Mesothelioma: Diagnosis and Management. Edited by Kittle CF. Chicago: Year Book; 1987: 31.
- Pass HI: Emerging translational therapies for mesothelioma. Chest 1999, 116:455S-460S.
- Kralstein J: Malignant pericardial diseases: diagnosis and treatment. Am Heart J 1987, 113:785-790.
Last modified: February 15, 2010.