Epithelioid Mesothelioma: Types, Diagnose & Prognosis

Key points

1. Epithelioid mesothelioma is the most common cell type of mesothelioma cancer.
2. The epithelioid cell type spreads more slowly than other mesothelioma cell types.
3. Survival for epithelioid mesothelioma, with treatment, is generally 18 months or more.
4. Multimodal treatment generally leads to the most favorable results.

There are three main types of mesothelioma cancer cells:

• Epithelial / Epithelioid
• sarcomatoid
• biphasic

The epithelioid cell type causes 70% of mesothelioma cases. Being the most prevalent of the three cell types as a result. This particular mesothelioma forms when normal epithelial cells change and become a malignancy.

What Causes Epithelioid Mesothelioma?

The only known cause of mesothelioma in all its forms is asbestos. Asbestos fibers in the air can be inhaled or consumed by people. These fibers cannot be removed or broken down once they are within the body. Around epithelial cells, asbestos fibers can irritate and inflame the area. This can eventually result in mesothelioma.

The human body has healthy epithelial cells in all parts, including the mesothelium. The membrane that lines many body cavities, including the chest and abdominal cavities, is called the mesothelium. Epithelioid mesothelioma occurs when the mesothelium’s epithelial cells get malignant.

All known mesothelioma cell types have asbestos exposure as their sole known cause. However, research indicates that many risk factors can influence the disease’s onset.

Characteristics Of Epithelial Cells

Cancer cells are classified based on many factors, including:

• cell shape
• cell size
• How fast they grow or spread
• Markers on the cell surface.

The morphology of epithelial carcinoma cells is generally consistent. They have an obvious cell core (nucleus). Pathologists can use this feature to identify them in biopsy samples. Healthy epithelial cells are flat or cube-shaped. Epithelioid mesothelioma cells can take on a new shape once they become cancerous.

In comparison to sarcomatoid cancer cells, epithelioid mesothelioma cells proliferate more slowly. However, lymph nodes and other adjacent organs can become infected with epithelioid mesothelioma cells.

Epithelioid mesothelioma can occur in the pleura, or lining, of the lungs. It can also develop in theabdomen,genitals, and heart.

Epithelial Mesothelioma Subtypes

There are many subtypes of epithelioid mesothelioma. They vary depending on the shape of the cell, the location of cancer, and the symptoms. These properties may affect treatment options, side effects, andprognosis for mesothelioma patients.

Rare Subtypes Of Epithelioid Mesothelioma

Adenomatoid Mesothelioma

• Location:gland-like structures, usually the genital glands
• Cell pattern:flat or cube-shaped with lace-like structures
• Also known as epithelial or micro glandular mesothelioma

Cystic Mesothelioma

• Location:peritoneum (lining of the abdomen) or pelvic peritoneum (lining of the pelvis), or other pelvic structures
• Cellular pattern:flat or cube-shaped cells forming localized thin-walled cysts without metastases
• Also known as multicystic mesothelioma

Papillary Mesothelioma

• Location:peritoneum (lining of the abdomen), tunica vaginal (lining of the testes), or pleura (lining of the lungs)
• Cellular pattern:round or oval cells forming papillae and laminae with slow microscopic metastases
• Also known as well-differentiated papillary mesothelioma (WDPM)

Deciduoid Mesothelioma

• Location:Pleura (lining of the lungs) and peritoneum (lining of the abdomen)
• Cell pattern:Large polygonal or oval cells forming nodular tumors with distant metastases
• Survival times vary from two to more than 38 months, depending on individual factors.

Another subtype of mesothelioma is small cell mesothelioma. But biphasic cancers are more likely to have this subtype than not. Epithelial and sarcomatoid cells coexist in biphasic tumors.

Multiple biopsies could be required in some circumstances to confirm epithelioid mesothelioma. By doing this, medical professionals can prevent misdiagnosis and guarantee that patients are treated appropriately.

Symptoms Of Epithelioid Mesothelioma

Epithelioid mesothelioma can develop in the lungs, abdomen, heart, or genitalia lining. The symptoms of mesothelioma vary depending on where it develops. Symptoms are also affected by the patient’s age, general health, and stage at diagnosis.

Common Symptoms of Epithelioid Mesothelioma

• chest or stomach pain
• cough or hoarseness
• Difficulty breathing (dyspnea)
• fatigue or weakness
• Accumulation of fluid around the lungs.
• Accumulation of fluid around the abdomen.

The Importance Of Recognizing The Symptoms

A diagnosis of mesothelioma can be extremely jarring. However, earlier diagnosis improves treatment options and life expectancy.

Unfortunately, early diagnosis of mesothelioma is difficult. Cancer takes many years to develop and causes generic symptoms.

People exposed to asbestos fibers should be aware of and recognizethe symptoms of mesothelioma. If symptoms occur, the person should seek medical attention as soon as possible. Epithelioid Mesothelioma should report symptoms and previous asbestos exposure to a doctor.

Diagnosis Of Epithelioid Mesothelioma

Imaging studies are the first step in the diagnosis of epithelioid mesothelioma. These could be X-rays, MRIs, CT scans, or PET scans. If the tests reveal abnormal tissue, the patient might undergo a blood test or a biopsy. Biomarkers found through blood tests can be used to choose the best course of treatment.

Biopsy Procedures

A biopsy is required for a certain diagnosis of epithelioid mesothelioma. There are numerous distinct types of biopsies. These consist of surgical, camera-assisted, and needle biopsies.

Purpose of biopsies during the diagnosis of epithelioid mesothelioma

• Collect a sample of cancerous tissue for examination.
• Determine if a tumor is benign or malignant
• Confirm that the cancer is mesothelioma
• Determine cell type
• Determine nuclear grade (assessing the shape and size of cell nuclei)

A biopsy sample can be analyzed for histology and cytology. These tests provide information about the characteristics of the cells. They also help prevent misdiagnosis by ruling out other diseases.

Histological analysis is sometimes calledimmunohistochemistry. This long name means that doctors use antibodies to analyze the biopsy sample. Calretinin, D2-40, and WT1 antibodies are used to identify epithelioid mesothelioma.

Doctors can use information from a biopsy to help determine the best treatment plan.

Treatment For Epithelioid Mesothelioma

Patients generally have more treatment options when epithelioid malignant mesothelioma is detected early. These options includechemotherapy,surgery,immunotherapy, andradiation. Research shows that combining these options generally results in the most favorable life expectancy. Combined treatment is known as amultimodal treatment.

Unfortunately, individuals may have fewer alternatives if epithelioid mesothelioma is discovered later. In such circumstances, the patient might be unable to endure the adverse consequences of aggressive treatment. As a result, individuals might only have access to palliative care choices.

Common Treatment Options for Epithelioid Mesothelioma

Surgery

• Used therapeutically or palliatively
• targeted treatment
• Intended to remove as much of cancer as possible or reduce pain and discomfort
• Examples: cytoreductive surgery, pleurectomy and decortication (P/D), extrapleural pneumonectomy (EPP)

Chemotherapy

• Used therapeutically or palliatively
• It addresses mesothelioma cells throughout the body.
• Intended to destroy cancer cells and shrink tumors
• Examples: pemetrexed and cisplatin

Radiotherapy

• Used therapeutically or palliatively
• It aims to kill cancer cells.
• Known to help with pain and shortness of breath.
• Example: locally directed radiation

These treatments aim to slow or stop the growth and symptoms of cancer. However, the treatments can cause side effects.Mesothelioma doctorswill consider this when choosing the best treatment plan for each patient.

Palliative Care For Mesothelioma

Some people believe that palliative care is only for patients nearing the end of their lives. This is a common mistake. Any patient has the choice of receiving palliative care. They may find comfort in it throughout their healing process.

Palliative care choices come in a wide range, from chemotherapy and surgery to yoga and support groups. Patients should talk to their doctor about these possibilities. You can create a palliative care strategy that is specific to the patient.

Epithelioid Mesothelioma Prognosis

Prognosis vs. Life Expectancy

• The prognosisoffers a prediction of how the disease will develop.
• Life expectancyrefers to the life expectancy of the patient.

The prognosis varies from patient to patient and depends on various factors. Patients receiving multimodal care generally experience a more favorable prognosis and life expectancy. However, researchers continue improving existing treatments and creating new technologies daily.

Epithelioid Mesothelioma Life Expectancy

The median survival rate for people diagnosed with epithelioid mesothelioma is 18 months. Accordingly, half of all epithelioid patients have a survival rate of more than 18 months. This might be because they are less hostile to other cell types. Additionally, epithelioid mesothelioma responds well to therapy.

The life expectancy for all types of malignant mesothelioma can seem bleak. However, clinical trials and emerging treatments continue to bring hope to mesothelioma patients. Multiple studies now report that patients survive for ten years after diagnosis and treatment.