Pericardial Mesothelioma

Pericardial mesothelioma is a form of asbestos cancer which occurs in the pericardium – the membrane lining of the heart.  Pericardial mesothelioma is a rare form of asbestos induced cancer, and there have been less than 200 cases worldwide to date. As a result, there is limited medical research available, and it is still not known how the disease develops. Like pleural mesothelioma and peritoneal mesothelioma, pericardial mesothelioma has a very long latency period. In addition, the commonness of its symptoms means that pericardial mesothelioma usually isn’t diagnosed until it has progressed to a late stage of cancer.  Treatment options for pericardial mesothelioma are limited and the prognosis for life expectancy depends on the age of the person diagnosed.

What is the Pericardium?

The pericardium is a thin membrane which encloses the heart and major arteries.  It is the outermost layer of the heart. It functions to protect the heart and also keep it lubricated so it may move smoothly. The pericardium is actually made up of two layers. The fibrous pericardium layer comprises the connective tissue which anchors the heart in place and is attached to the sternum. The serous pericardium is a closed sac and is divided into two more layers: the parietal and visceral pericardium. There is a space between these two layers which contains a slippery fluid which serves to lubricate the heart’s moving surface.

What Causes Pericardial Mesothelioma? 

To date, asbestos exposure is the only known cause of pericardial mesothelioma.  However, recent studies have indicated that there may be a genetic influence affecting who develops pericardial mesothelioma. Much more research must be done.  Because of the rarity of this form of mesothelioma, researchers are not exactly certain of how asbestos causes cancer in the pericardium.  The most widely believed theory is that asbestos fibers enter the body through inhalation.  Then, the fibers enter the bloodstream and circulate to the heart.  Once at the heart, the asbestos fibers embed themselves into the heart’s lining.

If the cancer in the pericardial lining of the heart came from the pleura or peritoneum, then the cancer is identified as pleural mesothelioma or peritoneal mesothelioma. The cancer is said to have metastasized in this case or spread from another part of the body.

Regardless of how they arrive at the pericardium, asbestos fibers can cause severe damage once there.  In the case of pericardial mesothelioma, the fibers become entangled or caught in the lining of the heart where they cause inflammation and/or cell mutations. The mutated cells divide and pass on the mutated DNA during cell division.  The cells exhibit abnormal growth and begin to replicate wildly.  The abnormal cell growth may also cause excess fluid to form in the pericardium layers (pericardial effusion). Over time, the cells form cancerous tumors and the tumors and fluid build-up puts pressure on the heart and inhibit its functioning.  Even if the tumors are benign they may grow to a size at which they exert too much pressure on the heart as in some cases of pericardial multicystic mesothelioma.1

Pericardial Mesothelioma Symptoms and Diagnosis 

Mesothelioma is typically characterized by a long latency period meaning it’s present but not apparent.  With pericardial mesothelioma, the latency period can be well over a decade or longer.  During this time, cancerous pericardial cells form and start to grow into cancerous tumors.  There are generally no symptoms during this period at all.  Symptoms usually appear once pericardial effusion and tumors large enough to exert pressure start forming.

The most common symptoms of pericardial mesothelioma include:

  • Chest pain
  • Breathlessness, even while at rest
  • Unusual heart tremors or murmurs
  • Chronic coughing
  • Unexplained exhaustion
  • Night sweats

Because these symptoms are also signs of common conditions, many patients or doctors dismiss the symptoms as being related to a different medical issue or heart problem.  As a result, pericardial mesothelioma is usually not diagnosed until it has advanced. In one case, effusive-constrictive pericarditis syndrome was actually a symptom of pericardial mesothelioma. This syndrome is characterized by persistent pressure in the heart or arteries even after the pressure is relieved.2

Diagnosis of pericardial mesothelioma is usually done first by taking an x-ray.  Another image scan may also be performed, such as an MRI or CT scan.  These scans will show unusual growths or fluids in the heart area.  A doctor would then confirm pericardial mesothelioma and its source with a biopsy. A biopsy is a minimally invasive procedure which involves withdrawing a tissue sample from the pericardium. The sample is then analyzed by a pathologist.

After Pericardial Mesothelioma Diagnosis 

Unfortunately, there is often very little that can be done to treat pericardial mesothelioma.  The disease is usually diagnosed in its late stages when it has already spread in the heart.  Even if pericardial mesothelioma is caught early, surgery is not generally advised for pericardial mesothelioma because of the risks of operating on the heart. When surgery is used for treatment it is primarily to control effusion.3

Radiation and chemotherapy are the most common treatment options though they both have serious risks and can lead to other health complications.

In many cases, palliative treatment options are the only feasible ones available to patients. Sometimes the doctor can remove fluids around the peritoneum with a needle in order to lessen pressure on the heart so the patient is more comfortable.

If you have been diagnosed with pericardial mesothelioma, you may be able to take legal action and receive financial compensation. While financial compensation will not cure pericardial mesothelioma, it can be a valuable resource for you while dealing with your illness and can provide for your family in the future.   A reputable and experienced mesothelioma lawyer can help you file a claim.

References 

1 Morita, S., Goto, A., Sakatani, T., Ota, S., Murakawa, T., Nakajima, J., Maeda, E. and Fukayama, M. (2011), Multicystic mesothelioma of the pericardium. Pathology International, 61: 319–321.

2 Sharma P. S. and Katechis D. Primary malignant pericardial mesothelioma presenting as effusive constrictive pericarditis. (23 Aug 2011) Journal of Invasive Cardiology. v8, E197-9.

3 Eren, Neyyir Tuncay Eren and Akar, A. Ruchan. (2002) Current Treatment Options in Oncology. v3:5, 369-373.