Biphasic Mesothelioma: Prognosis and Treatment

Key points

1. Two-phase mesothelioma tumors contain both epithelioid and sarcomatoid cells.
2. Misdiagnosis is common as biopsy may not reveal both cell types.
3. Available treatments and prognosis vary depending on the dominant cell type.
4. The median survival usually ranges from 10 to 15 months after diagnosis.

One of the three primary cell types is mixed mesothelioma, often known as biphasic mesothelioma. Biphasic mesothelioma contains epithelioid and sarcomatoid malignant cells, the other two major types. The prognosis and treatment options for biphasic mesothelioma vary depending on the predominant cell type.

Characteristics of biphasic mesothelioma cells

Biphasic tumors are characterized by a combination of epithelioidand sarcomatoid malignant cells. Theepithelioid and sarcomatoid cells can cluster together in a tumor but are usually dispersed. This makes it challenging to take a biopsy and make an accurate diagnosis.

The ratio of each cell type can vary, affecting the range and intensity of symptoms that cancer patients experience, the growth characteristics, and the behavior of cancer. However, many different factors can call into question the general characteristics of cell types.

How the dominant cell type usually affects the development of cancer

Epithelial dominance

• Local metastases
• General symptoms include shortness of breath, chest pain, fever or night sweats, chest tightness, and unexplained weight loss.
• Extended Lifespan
• It is easier to heal.

Sarcomatoid dominance

• Local and distant metastases
• Pain, respiratory restriction, and symptoms associated with metastasis are in addition to the usual symptoms.
• Shorter lifespan
• Harder to treat

Diagnosis Of Biphasic Mesothelioma

Because mesothelioma is a rare form of cancer, it is often misdiagnosed as other diseases. Doctors will note any reported symptoms and perform various tests to ensure an accurate diagnosis. This will pinpoint cancer and provide the most effective treatment plan for the patient. Pathology or examination of the patient’s cells can be used in the diagnostic process of biphasic mesothelioma.

Common Symptoms of Biphasic Mesothelioma

As with all forms of mesothelioma, the extent and severity of symptoms associated with biphasic will vary depending on the extent of cancer progression. However, shortness of breath, heaviness in the chest, weight loss, fever, and night sweats are typical signs of biphasic mesothelioma.

The Role Of Image Testing

While imaging tests cannot diagnose mesothelioma, they can help doctors locate tumors, determine the stage, and monitor tumor progression. These types of images can be produced.

Common Imaging Tests to Diagnose Mesothelioma

• CT:Shows images of healthy and cancerous tissue.
• X-ray:Shows images of bone and soft tissue, fluid accumulation, blockage, and other complications.
• MRI Scan: Provides clear 3D images of the tumor and the contrast between healthy and cancerous tissue.
• PET Scan:Helps identify and localize cancers.

The role of the biopsy

20–50% of patients with biphasic mesothelioma are initially classified as epithelioid.

These inaccuracies can have serious consequences, especially if a radical operation is necessary to remove the tumor.

Radiological evaluation and laboratory analysis identify a potential mesothelioma diagnosis. The tumor tissue is then evaluated with a biopsy. The doctor will take a tissue sample for analysis and determine the cell type. A biopsy is the only way to diagnose mesothelioma definitively. The tumor must contain at least 10% of epithelial and sarcomatoid cells to diagnose cancer as biphasic.

A doctor might need more than a first biopsy to diagnose biphasic mesothelioma. Only one cell type may be discovered in a single tissue sample since the two cell types are frequently distributed throughout distinct regions of the tumor. In these circumstances, multiple biopsies may be required to collect samples of both cell types.

In a recent report, preoperative needle biopsy correctly classified the cell type in only 44% of cases. The latter was the most accurate, correctly classifying the cell type in 83% of cases, followed by thoracoscopy in 74%.

Prognosis And Treatment Of Biphasic Mesothelioma

Biphasic mesothelioma usually has a poor prognosis with a life expectancy of about a year. The prognosis is often further complicated by misdiagnosis and late diagnosis, prolonging active treatment. Patients with biphasic tumors composed primarily of epithelial cells may have a longer life expectancy than patients composed primarily of sarcomatoid cells. This is because epithelioid mesothelioma is usually less aggressive and better treated.

Traditional Treatment Options

Typically, the biphasic treatment of pleural-based mesothelioma can mimic that of malignant pleural mesothelioma. Radiation therapy, chemotherapy, and surgery are examples of conventional treatments.

Traditional Treatments For Mesothelioma

Operation

• Doctors do surgery to remove as much of the malignant material as feasible.
• Extrapleural pneumonectomy (EPP), pleurectomy/decortication (P/D), cytoreduction with HIPEC, and pericardiectomy are common procedures for mesothelioma.

Chemotherapy

• Chemotherapy is used to eradicate cancerous cells and lessen the signs and symptoms of cancer.
• Pemetrexed (Alimta), cisplatin, and bevacizumab are typical chemotherapy medications for mesothelioma (Avastin).

Radiation

• Radiation therapy aims to kill cancer cells and prevent tumour growth or metastasis.
• External beam radiation (EBRT), internal radiation, three-dimensional conformal radiation treatment (3D-CRT), intensity-modulated radiation therapy (IMRT), and intraoperative radiation are typical forms of radiation therapy.

In most cases, caregivers use a multimodal approach that includes various options. The aggressive treatment of patients with mixed may reduce or eliminate epithelioid cells due to aggressive treatment. Yet, the sarcomatoid component is often largely unaffected because the cells are resistant to treatment. Thus, palliative care may be the most appropriate course if sarcomatoid mesothelioma cells are dominant.

Palliative Treatment Of Biphasic Mesothelioma

Palliative care focuses on patient well-being, reducing symptoms, and providing a higher quality of life. This type of treatment can be used when the cancer is in advanced stages, or it can be used along with conventional therapies to reduce negative side effects. For example, chemotherapy has many negative effects, and palliative care can help mitigate them.

Traditional therapies can also be used in palliative care, such as surgery. Biphasic mesothelioma can cause fluid to build up in the lungs (pleural effusion). Limited surgical procedures such as pleurodesis or pleural effusion drainage may be considered if they can provide increased patient comfort or relieve difficult or painful breathing. Radiation and chemotherapy may also be included in palliative care plans to reduce tumour size, comfort, and relieve pain.

Treatment plans for biphasic mesothelioma may also include pain medication, yoga, meditation, and physical therapy to alleviate the physical condition. Palliative care also includes occupational therapy and support groups, which help mesothelioma patients emotionally as they adjust to their diagnosis.