Pericardial mesothelioma is a type of cancer that affects the lining of the heart and it is hardly recorded. Nearly all the mesotheliomas can be tracked down to asbestos fibres exposure and contact, but medical practitioners continue to study the relationship between asbestos and cancer of the heart.
Almost 25% of patients with this pericardial mesothelioma have a history of asbestos exposure and contact at their places of work. Researches have shown clearly on how inhaled microscopic asbestos fibers reach the lungs but less clear on how these Asbestos fibers get into the heart.
The symptoms of this kind of malignant mesothelioma is most often detected in patients between the ages of 50 and 70, with the median age being 55 because Malignant mesothelioma takes almost 20 to 60 years to manifest after a contact with asbestos fibres. According to research work published in 2017 in the Journal of Clinical Oncology, almost 60 percent of cases occur in men.
As observed in other kinds of mesothelioma, the ailment is typically developed at a later stage. Symptoms and signs include the following; chest pain, fatigue and shortness of breath. Diagnosis is very hard because signs mimic those of other heart disorders.
Mesothelioma of the heart treatment options include surgery, chemotherapy, palliative treatments to control symptoms and hardly radiation therapy. Surgery is the most common treatment with about 46 percent of patients electing surgery. About 37 percent receive chemotherapy and only 8 percent receive radiation therapy because it is risky to apply near the heart. Nearly 25 percent of patients elect no treatment.
Another findings in 2021 recorded that people with primary pericardial mesothelioma have a middle survival of about two months. However, some people have lived for years with this ailment after undergoing surgery or chemotherapy.
Up till now, less than 150 reported incidences of heart mesothelioma are described in medical records — that is 1% of all known diagnosed mesotheliomas.
SIGNS AND SYMPTOMS OF PERICARDIAL MESOTHELIOMA
Majority of heart mesothelioma patients experience no symptoms when the cancer initially develops, this is a finding that contributes to a late-stage diagnosis. The signs also looks like those of other heart diseases, making pericardial mesothelioma very difficult to accurately diagnose. Most symptoms are caused by fluid buildup around the heart and thickening of the pericardial inner lining tissues.
Majority of the signs are usually caused by the buildup of fluid and the thickening of pericardial inner lining tissues. The appearance of any of these symptoms should be followed by a visit to the hospital to see a physician with recommended screenings such as an X-ray, CT scan or echocardiogram.
NOTICEABLE PERICARDIAL MESOTHELIOMA SIGNS:
1. Difficulty breathing, even when at rest (dyspnea)
2. Heart palpitations or irregular heartbeat (arrhythmia)]
5. Shortness of breath when lying flat
6. Chest pain
9. Night sweats.
Whenever you are experiencing any of these mentioned symptoms above, most importantly heart-related symptoms, make an appointment with your medical advisor immediately. Examination tests like X-rays, CT scans and echocardiograms can always reveal the underlying cause of these health problems.
CAUSATIVE AGENTS OF PERICARDIAL MESOTHELIOMA:
Majorly, the main cause of heart mesothelioma is still a unknown. The normal interaction between contact with asbestos and exposure to it’s fibres and this type of mesothelioma is not fully known yet. Medical practitioners have confirm the pleural and peritoneal types are primarily caused by exposure to asbestos, yet the causes of the pericardial type are not precisely known.
Scientific review of medical records carried out in 2021 on heart mesothelioma showed contact with asbestos and exposure in 25% of cases. Another 2017 study published in the Annals of Epidemiology reported the majority of patients with pericardial mesothelioma have no history of asbestos exposure.
DIAGNOSIS OF PERICARDIAL MESOTHELIOMA:
To diagnose pericardial mesothelioma, doctors make an overall assessment of your symptoms, medical history and current medical condition. Next, you will receive a physical examination, imaging tests and biopsy to determine the location of tumors and confirm whether or not they are cancerous.
When you see a doctor to discuss heart-related symptoms, one of the first diagnostic tests you will receive is an echocardiogram, which is essentially an ultrasound for your heart. This noninvasive test uses sound waves to help doctors see the size and shape of your heart and determine how well it is working overall.
Although an echocardiogram can reveal fluid buildup around the heart and help guide a pericardiocentesis, which is the procedure doctors perform to drain the fluid, other imaging scans are needed to determine if potential tumors are present. If doctors spot abnormal growths, they need to take a fluid or tissue sample and perform a biopsy, which can confirm a mesothelioma diagnosis.
These tumors generally are not localized, and they tend to cover most of the heart. Furthermore, this cancer type accounts for approximately half of all pericardial tumors.
1. Physical Examination:
Unfortunately most cases of pericardial mesothelioma are only found at autopsy. Nonetheless, about 10-20 percent of these cases are diagnosed before a patient dies. Some of the challenges with early and accurate diagnosis of the pericardial type include the small number of people with the disease and the late presentation of symptoms.
2. Imaging Tests:
Computed tomography (CT) scans are effective for detecting pericardial tumors, making them a preferred diagnostic tool. Magnetic resonance imaging (MRI) can also yield successful results in identifying the cancer.
Radionuclide imaging is a detection method involving the injection of gallium, a radioactive material, to identify cancerous cells. It was reportedly used to detect at least one case of this type of cancer. Patterns of radioactivity show possible tumor sites in the human body.
A biopsy is a crucial diagnostic procedure that can be more suitable in determining the cancer’s point of origin. A surgeon will remove tissue or fluid from the pericardium, examine its cells under a microscope to positively confirm the presence of pericardial mesothelioma. According to a 2016 study in the Journal of Cardiac Failure, fluid biopsies often turn up cancer free even when pericardial tumors are present. A tissue sample of the tumor itself is usually required to confirm pericardial mesothelioma.
ISSUES ASSOCIATED WITH MISDIAGNOSIS:
Because pericardial mesothelioma symptoms such as chest pain, cough and difficulty breathing are shared with various other diseases, it’s crucial to meet with a specialist to confirm your diagnosis. To ensure an accurate diagnosis and prompt treatment, you need to speak with an expert who knows the intricacies of this rare cancer.
OTHER HEART AILMENTS MISTAKEN FOR PERICARDIAL MESOTHELIOMA:
1. Heart failure
2. Coronary heart disease
3. Tuberculosis pericarditis
4. Constrictive pericarditis
5. Cardiac tamponade
6. Intra-atrial myxoma
If you have been diagnosed with any of these conditions, always seek a specialist to confirm the diagnosis. Working with a specialist may get you access to a wider range of treatment options, but it may also lead to improved survival.
AVAILABLE TREATMENTS FOR PERICARDIAL MESOTHELIOMA:
Mesothelioma treatment options are limited because the heart lining rests so closely to the heart itself that most therapies can easily damage this delicate organ. Slightly more than half of patients with pericardial mesothelioma are not ideal candidates for surgery, which is often the most effective treatment for this cancer. However, there are rare cases where the cancer is diagnosed early and surgery can be carried out to remove small, localized tumors.
The primary treatment options for pericardial mesothelioma are pericardiectomy or tumor removal, chemotherapy and palliative treatment such as fine needle aspiration. Radiation therapy is considered minimally effective for this rare cancer and is risky to administer without harming the heart.
1. Pericardiectomy or Tumor Removal
Patients whose doctors decide they are good candidates for surgery are treated with a pericardiectomy or tumor removal.
A pericardiectomy is the surgical process of removing part or all of the pericardium. A pericardiectomy can relieve pressure and minimize fluid buildup, allowing the heart to continue functioning properly.
Tumor removal, also called tumor resection, can involve removal of the cancer without removing the pericardium. A 2017 review reported longer survival in patients who underwent tumor removal than patients who had a pericardiectomy.
The benefits of chemotherapy are minimal for most patients with pericardial mesothelioma. The chemotherapy drugs pemetrexed and cisplatin have shown a survival benefit, and gemcitabine has produced mixed results. A handful of cases have responded well to chemotherapy. One woman lived longer than two years thanks to a combination of the chemotherapy drugs cisplatin, gemcitabine and vinorelbine. Pembrolizumab, a new checkpoint inhibitor form of immunotherapy, has shown some benefit in cases of pleural mesothelioma. It may have some utility in this disease as well.
3. Palliative Treatment
Palliative treatment options aim to minimize pain and reduce symptoms caused by the buildup of fluid in the pericardium. Essentially, palliative care can improve quality of life and make patients more comfortable.
Palliative treatments can include therapies that relieve pain and pressure around the heart such as a pericardiocentesis or pain medication. A pericardiocentesis removes excess fluid from the pericardium to relieve pressure around the heart.
PROGNOSIS OF PERICARDIAL MESOTHELIOMA:
The common prognosis for the pericardial type is poor, compared to that of peritoneal or pleural mesothelioma. Nearly 50 to 60 percent of pericardial patients pass away within six months of receiving a diagnosis. However, this is not the case for everyone.
Hope exists for some patients because researchers have cited positive results after surgery to remove local tumors. Smaller, less impactful benefits have been demonstrated from chemotherapy, except for one case in which a 47-year-old woman was living two years after chemotherapy with cisplatin, gemcitabine and vinorelbine.
A 1995 case report of a 27-year-old woman who underwent surgery and radiation therapy for pericardial mesothelioma states that she had no evidence of recurrence during 28 years of follow-up.
A 1992 case report of a 12-year old boy with pericardial mesothelioma who underwent surgery and chemotherapy says that he remained free of symptoms and showed no sign of disease one year later.
Surgery to remove part of the heart’s lining combined with radiation therapy improved survival in two patients in the late 1960s and early 1970s. One patient lived a year after treatment, and another was alive five years after treatment.