Pericardial mesothelioma is a very rare cancer that attacks the tissue layers surrounding the heart. Two layers comprise the mesothelium membrane: one that is found in the internal organ like the lungs or heart; and the other forms a sac around the organ. There is a lubricant secreted by the tissues which allows easy movement of the active organ against the structures close by, like the diaphragm and rib cage.
Peritoneum is the mesothelial layer lining the abdominal cavity; the pericardium is the one surrounding the heart and the pleura is the one lining the chest cavity. Growth of cancer cells in any one of these structures is called mesothelioma.
Seventy to eighty percent of mesothelioma cases are primarily caused by asbestos exposure in the workplace, however brief the period. Symptoms of this cancer disease sometimes take up to 50 years after exposure to become apparent. Employees who have worked in dusty conditions without protection and those who worked with asbestos in shipbuilding and construction sites are among those most affected by mesothelioma. However, there is still no adequate evidence linking asbestos exposure to pericardial mesothelioma. In the same way, it doesn't appear that smoking is a risk factor for the disease.
In medicine history, variations in the terms used to refer to pericardial mesothelioma include coelothelioma, endothelioma and endothelial carcinoma. About half of the varieties of pericardial tumors are mesothelioma; others may be angiosarcoma (sarcoma) and are sometimes difficult to distinguish apart from sarcomatoid pericardial mesothelioma. Histological types are sarcomatous, ephithelial and mixed. Advanced stages of pleural mesothelioma often scatters to the pericardium. In primary pericardial mesothelioma, tumor starts in the pericardium; this type is rare, making up only 1% of the total cases of mesothelioma.
Pericardial mesothelioma occurs to both sexes, in any age group. A decline in the incidence of mesothelioma is expected to decline in the next decades taking note of the elimination of asbestos in majority of building products. An extensive study of 500,000 autopsy records reveals that only 0.0022% of the cancer cases were caused by primary tumors of the pericardium. Only two to three percent of cardiac and pericardial primary tumor cases are associated with mesothelioma - as compared to rabdomyosarcoma (20%) and angiosarcoma (33%).

Pericardial Mesothelioma Symptoms

Among the symptoms of this disease are dyspnea, pleural effusion, pericarditis (inflammation of the pericardium) and cardiac tamponade which is a dangerous symptom where blood collects in the pericardium and lowers the volume of the heart's pumping. These symptoms may also be present in other forms of mesothelioma and other diseases of the heart and lungs. For most cases, the symptoms do not come out until the advanced stages, leaving only limited alternatives for treatment.

Pericardial Mesothelioma Diagnosis

Doctors can test the fluids from the pericardial cavity, but malignant cells are normally found only 30% of the time; this is one reason why this cancer is hard to diagnose. In pericardial mesothelioma, thickening of the pericardium and tumor is visible in a CT scan in less than 50% of the cases.
Most often, pericardial mesothelioma is diagnosed when it is already quite advanced, and the tumor and swelling already constrict the arteries, veins, airways and other thoracic structure. Swelling may also be correlated with cases of rheumatoid arthritis, tuberculosis and other sickneses.
A recent report tells of a Japanese patient who was found to have pericardial condition but in the end turned out to be mesothelioma. A British young man was also reported to surprise the doctors with the difficulty to diagnose the case with CT scan and echocardiography. Sometimes pericardial mesothelioma appears to be a rheumatic fever, tuberculosis pericarditis and lupus erythematocous.
To exhibit the enlargement of the pericardium, radiography or imaging techniques can be utilized such as magnetic resonance angiography and echocardiography. In several cases, the coronary arteries and myocardium may also be swollen. There will be a considerable decrease in the function of the blood cells and heart, which can be measured by cardiac catheterization and isotope scans with gallium. And to distinguish the tumor mass among the other swollen tissue around the heart, the use of post-contrast computerized tomography can be helpful. But even when the tumor is identified, imaging techniques by itself cannot result in an authoritative diagnosis because there may be involvement of leukemia, melanoma and lymphoma. To have a precise diagnosis it must be demonstrated that the tumor is not in relation with the pleural surfaces.
Conventional laboratory urine, blood and sputum tests can help very little in the detection of mesothelioma. Although the liquid taken from the swollen area may be examined for accurate diagnosis, but in many cases this has resulted in wrong diagnosis indicating another type of cancers like adenocarcinoma. The only way to verify the presence of mesothelioma is through a biopsy of a tissue sample by stemoscopy or thoracoscopy. And in sixty to eighty percent of mesothelioma cases, accurate diagnoses that were based on histological analysis of tissue samples were only carried out after the patients died.

Pericardial Mesothelioma Treatment

Several factors may determine the option for treating pericardial mesothelioma: the extent of the progression of the cancer during the diagnosis, as well as the weight, age, medical history and the general health condition of the patient. Early on, while the tumor mass is still small and localized, removal of cancer tissues through radical surgery may be possible but risky, considering that it is located close to the heart and lungs. As what normally occurs in twenty-five to forty-five percent of the cases where the cancer has affected the lungs, lymph nodes, chest wall and other organs, surgery is no longer recommended.
To alleviate symptoms, palliative surgery may be done to relieve pressure on proximal structures. This is done by draining fluid out of the pericardium and can be a way to obtain tissue samples for biopsy. This process can help prolong life as other treatments are administered simultaneously.
To kill cancers and shrink tumors, radiation therapy is the option, but there is a risk of heart and lung damage. Treatment involves transmitting radioactive elements direct to the cancer area through internal therapy or plastic tubing. As of yet, no chemotherapeutic agents have proven effective in treating pericardial mesothelioma. There was a success report about a case in India where pemetrexed and cisplatin were used, the same combination utilized in treating pleural mesothelioma.

Pericardial Mesothelioma Prognosis

There are only few primary cases of pericardial mesothelioma; however the prognosis for this type of cancer is far worse than peritoneal or pleural mesothelioma. Actually, the prognosis for pericardial mesothelioma patients is very poor, reporting an average survival period f only six months after diagnosis. This may be because of the difficulty of definitively diagnosing the disease and it doesn't show visible symptoms up until it is in its advanced stages. Often, due to congestive heart failure and occlusion of the superior vena cava, death occurs. Until there are remarkable developments in early detection methods and treatment regimens, this situation will likely remain for some time.