Pericardial Mesothelioma

Pericardial mesothelioma affects the pericardium, the double-walled sac that contains the heart and the roots of the major blood vessels coming from it.

The mesothelium – for which mesothelioma-type cancers are named – is also a membrane that lines several body cavities, including the pleura, or lungs, the peritoneum, or abdominal cavity, and the pericardium. Mesothelial tissue also surrounds both the male and female internal reproductive organs.

Pericardial mesothelioma is one of the rarest forms of mesothelioma and usually arises only after significant exposure to asbestos. About five percent of mesothelioma cases involve the pericardium.

The pericardium, which acts as a sort of buffer to protect and cushion the heart, keeps the heart contained in the chest cavity and prevents it from hyper-expansion when blood flow increases, as during heavy exercise. Think of the system as two balloons, one inside the other, the space between them filled with fluid. This fluid-filled sac keeps the area lubricated and lessens the friction between the membranes, as well as cushioning the heart and its blood vessels against impact injuries.

Like all forms of mesothelioma, pericardial mesothelioma is caused by breathing in the ultra-fine fibers of asbestos, which lead to irritation and lesions in the lungs and heart, and the eventual development of cancerous growths. Because the body has no way of flushing asbestos fibers out, it “sees” these fibers as infectious, or invasive, and forms extra tissue around them, in much the same way an oyster forms a pearl around a grain of sand. These growths, or tumors, can become cancerous. That is, the cells can begin to multiply, or metastasize, more rapidly than normal.

In 1989, the Environmental Protection Agency moved to ban asbestos – which had been used for decades as pipe insulation and mastics, as well as in floor, ceiling and roofing tiles and acoustical spray. The ban was reversed by a court in a 1991 ruling, and asbestos can still be found in a number of products sold in the United States.

Common sites where asbestos was used in the past (and may still be used in the present) include naval shipyards, construction sites, power plants, and metal-working factories. Workers breathed the fibers, and sometimes brought them home on clothing, to be passed to other members of the family. This created a multi-generational impact, with older members of a family being diagnosed with mesothelioma while younger members were still developing the disease.

Unfortunately, mesothelioma – and particularly pericardial mesothelioma – is difficult to diagnose and rarely detected before two or three decades have passed, reducing the possibility of an effective cure because patients are elderly and suffering from other health issues which obscure a definitive diagnosis. There are reports of doctors mistaking pericardial mesothelioma for pericadial constriction and tuberculosis.

When a person develops mesothelioma in the pericardium, it is mainly the result of scar tissue present within the fluid-filled region. This scar tissue, caused by asbestos fibers, causes the pericardium to expand, putting pressure on the heart. The effects can include inflammation, heart palpitations or irregularities in heartbeat and heart function. Other symptoms reported by sufferers include shortness of breath, night sweating, chest pain associated with exertion, persistent cough, general malaise and some swelling of the face and upper extremities.

Diagnosis and Treatment

Like other mesotheliomas, pericardial mesothelioma is usually diagnosed in its later stages, which limits the treatment options available through chemotherapy, radiation, or surgery. Doctors usually assess treatment based on the patient’s age, physical condition and the stage the cancer has reached. Most doctors choose radiation therapy as the most effective and least invasive course of action. Another type of treatment involves "fine needle aspiration", which removes the excess fluid that collects in the pericardium and can help relieve some of the symptoms of pericardial mesothelioma, like irregular heartbeat and pain. In rare cases, doctors may opt for surgery to remove the pericardium, although this is usually withheld until all other options have failed, since the procedure is very invasive and the outcome often fatal.

Treatments for pericardial mesothelioma are usually aimed at providing pain relief and reducing symptoms. More than half of all patients die within six months of diagnosis, as a result of congestive heart failure or occlusion of the superior vena cava. A review of 140 cases of pericardial mesothelioma showed survival rates of 10 months regardless of treatment, while the 2-year rate of surgically treated cases was only 14 percent.

If you (or a loved one) have experienced asbestos exposure, even through as seemingly innocuous venues as clothing or safety equipment, visit a doctor experienced in treating mesothelioma. Early detection can lead to innovative treatment techniques.

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