Pericardial mesothelioma is a very rare type of mesothelioma accounting for less than 5% of new mesothelioma cases each year. It arises from the outer surface of the membrane - the pericardium - that covers the surface of the heart.
The cell type can be epithelial, spindle cell, and mixed and the tumour either localised or diffuse.
Pericardial mesothelioma is almost twice as common in men than women and in the age group 50 – 70 years.
Like other forms of mesothelioma it is often found at a later stage of disease.
Most types of mesothelioma can be linked back to asbestos exposure but this may not always be the case with pericardial mesothelioma.
It is suggested that other risk factors may include radiation exposure, SV40 virus, erionite exposure but the low number of cases of pericardial mesothelioma make it difficult to make the etiology of the condition definitive.
Researchers continue to investigate the link between asbestos exposure and how the fibres reach the pericardium.
Following asbestos exposure it is thought that somehow the asbestos fibers reach the heart and lodge themselves in the pericardium surrounding the heart. The body is unable to rid itself of the fibres and they remain there ultimately causing the cells of the pericardium to undergo changes that result in mesothelioma cancer.
Pericardial mesothelioma can spread to the lung or the abdomen.
As with other types of mesothelioma, it is difficult to diagnose due to the fact that many symptoms resemble those of other heart conditions. Initial symptoms arise from the thickening of the pericardium and a build-up of fluid around the heart with related pressure issues. Further symptoms are due to compression of the coronary arteries and localised dissemination into the surrounding major vessels.
Common symptoms and clinical features for pericardial mesothelioma are as follows:
- Persistent Cough
- Dyspnoea – difficulty breathing / shortness of breath
- Orthopnea - dyspnea which occurs when lying down
- Chest pain / Heart palpitations / Arrythmia
- Fever / Night sweats
- Weight loss/ Fatigue / Generalised weakness
- Constrictive pericarditis - inflammation of the pericardial sac
- Pericardial effusion - fluid in the pericardial space
- Cardiac tamponade - bleeding in the pericardium
Management of Pericardial Mesothelioma
Diagnosis of pericardial mesothelioma usually involves a variety of tests including chest X-Rays, echocardiography, radionuclide imaging, CT and MRI scans to show the extent of involvement of surrounding structures.
A biopsy is required to confirm the presence of cancer and may be taken via the removal of fluid surrounding the heart.
Treatment for this type of mesothelioma is limited because of the proximity of the heart which can easily be damaged. Surgical resection of the tumour may be used but it can be difficult to remove all of it. Pericardiectomy (removal of part or the total pericardium) can relieve the symptoms and is often used as a palliative treatment. Pericardiocentesis may be used to remove excess fluid from the pericardium. It does not respond well to radiotherapy but chemotherapy agents such as doxorubicin, vincristine, and cyclophosphamide have been used to shrink the tumour.
Research is ongoing for this disease and includes intracavitary chemotherapy, photodynamic treatment, inhibition of growth factors, vaccines, and adenoviral molecular chemotherapy.
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