Cardiac Mesothelioma

Subarna Debbarma (BPT, DNHE)

What is Cardiac Mesothelioma?

Cardiac mesothelioma, also known as pericardial mesothelioma, is a rare and highly lethal cardiac cancer that originates in the pericardium (a fibrous sac that encloses the heart and great vessels). This disease is one of the least common types of mesothelioma. Cardiac mesothelioma is extremely rare, accounting for less than 1% of all mesothelioma cases.

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Cardiac Mesothelioma Cancer Causes

1. Inhalation of Asbestos Fibers: 

When asbestos fibers are inhaled, they can become lodged in the lining of the lungs (pleura), and some fibers may travel through the lymphatic system or bloodstream to the pericardium.

2. Ingestion of Asbestos Fibers: 

Ingested asbestos fibers can also reach the pericardium through the digestive tract and lymphatic system.

The development of cardiac mesothelioma involves several steps:

1. Inflammation and Cellular Damage: Asbestos fibers cause persistent inflammation and damage to the mesothelial cells in the pericardium.
2. Genetic Mutations: The chronic inflammation and cellular damage can lead to genetic mutations in the mesothelial cells.
3. Malignant Transformation: Over time, these mutations can result in the uncontrolled growth of mesothelial cells, forming a malignant tumor.
Cardiac mesothelioma
A) Chest computed tomography revealed an irregular, thickened pericardium with large amounts of pericardial effusion. (B) Fluorodeoxyglucose (FDG) positron emission tomography imaging demonstrated intrapericardial FDG accumulation

Pericardial Mesothelioma Symptoms

1. Chest Pain: Often similar to the pain experienced in heart attacks.
2. Pericardial Effusion: Accumulation of fluid in the pericardial sac, leading to swelling and discomfort.
3. Heart Palpitations: Irregular or rapid heartbeat.
4. Shortness of Breath or Dyspnea: Difficulty breathing, especially when lying down.
5. Weight Loss: Unintentional loss of weight and loss of appetite.
6. Fever: Occasional low-grade fever.
7. Fatigue: Persistent tiredness not alleviated by rest.

Cardiac or Pericardial Mesothelioma Treatment

Pericardial mesothelioma treatment typically involves a combination of surgery, chemotherapy, and radiation therapy.

1. Surgery

Surgery aims to remove as much of the tumor as possible and procedures are:
  • Pericardiectomy: Removal of part or all of the pericardium (the lining around the heart) to relieve symptoms and improve cardiac function.
  • Tumor Debulking: Surgical removal of as much of the tumor mass as possible to reduce symptoms and improve the effectiveness of other treatments.
  • Pericardiocentesis: A less invasive procedure to drain excess fluid from the pericardial sac, relieving pressure on the heart.

2. Chemotherapy

Chemotherapy uses drugs to kill cancer cells or stop them from growing.
  • Cisplatin and Gemcitabine: Commonly used drugs that can help shrink the tumor and control symptoms.
  • Cisplatin, Gemcitabine, and Vinorelbine: This combination has shown positive results in some cases, such as a 47-year-old woman who lived two years after treatment.

3. Radiation Therapy

Radiation therapy uses high-energy rays to target and kill cancer cells. It can be used in combination with surgery to improve outcomes.

4. Multimodal Therapy

A combination of surgery, chemotherapy, and radiation therapy, known as multimodal therapy, can be more effective than any single treatment alone.

5. Palliative Care

Palliative care focuses on relieving symptoms and improving quality of life for patients. This include pain management, oxygen therapy for dyspnea, and other supportive measures.

Pericardial Cancer Life Expectancy

The prognosis for  Cardiac or pericardial mesothelioma cancer is generally poor, especially when compared to peritoneal or pleural mesothelioma.

1. 50% to 60% of patients die within six months of diagnosis.
2. Over 20% of patients live for one year or more.
3. The 5-year survival rate is 9%.

However, individual cases have shown that some patients can live longer with appropriate treatment:

1. Chemotherapy: In 2016, Elizabeth McGehee, David E Gerber, Joan Reisch, Jonathan E Dowell  published a study. In this retrospective systematic review, a survival benefit was seen in patients who received chemotherapy.
2. Surgery and Radiation Therapy: A 27-year-old woman who underwent surgery and radiation therapy had no evidence of recurrence during 28 years of follow-up, according to a 1995 case report.
3. Combination Treatments: Surgery to remove part of the heart’s lining combined with radiation therapy improved survival in two patients treated in the late 1960s and early 1970s. One patient lived a year after treatment, and another survived five years post-treatment.


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