What Is Sarcomatoid Mesothelioma?
Sarcomatoid mesothelioma is a rare and aggressive form of mesothelioma, a cancer that develops in the lining of the lungs, abdomen, or heart after asbestos exposure. It’s characterized by long, spindle-shaped cancer cells and accounts for about 10-20% of all mesothelioma cases.
Sarcomatoid malignant mesothelioma is one of the three main cell types of mesothelioma. The others are epithelioid and biphasic. Sarcomatoid mesothelioma cancer cells are long and slender but grow in a spread-out pattern. Because of this, the disease tends to spread more quickly than the other cell types, making it more challenging to treat.
However, there are several treatment options that can help manage sarcomatoid mesothelioma, such as chemotherapy, immunotherapy, radiation, and palliative care.
Sarcomatoid Mesothelioma Causes
Asbestos exposure is the only known cause of sarcomatoid mesothelioma. For most people, the exposure happens 10 to 50 years before symptoms first appear. Asbestos was once widely used in nearly every blue-collar industry, especially before the early 1980s.
The danger comes when asbestos-containing materials are damaged or disturbed, which can release microscopic fibers into the air. Once asbestos gets inside the body, there’s no way to get rid of it. Over time, the small fibers irritate and damage sensitive tissues.
This ongoing damage can eventually cause changes in the cells — called genetic mutations — that lead to mesothelioma. In the case of sarcomatoid malignant mesothelioma, these changes create spindle-shaped cancer cells that tend to spread faster than other cell types.
Get our Free Mesothelioma Guide to learn what to expect with the sarcomatoid cell type and how to find the best treatments.
Sarcomatoid Mesothelioma Symptoms
The symptoms of sarcomatoid malignant mesothelioma vary depending on where the cancer develops. Recognizing the early signs can help you or a loved one get a timely and accurate diagnosis.
| Type of Sarcomatoid Mesothelioma | Location | Common Symptoms |
| Pleural sarcomatoid mesothelioma | Lining of the lungs (pleura) | – Chest pain – Shortness of breath – Fatigue – Worsening cough – Fluid buildup in the chest (pleural effusion) |
| Peritoneal sarcomatoid mesothelioma | Lining of the abdomen (peritoneum) | – Stomach pain – Constipation or diarrhea – Night sweats – Unexplained weight loss – Fluid buildup in the abdomen (peritoneal effusion) |
If you’re noticing any of these symptoms, it’s a good idea to talk to a mesothelioma specialist. The sooner you get checked out, the more treatment options you may have.
How Patients Get a Sarcomatoid Mesothelioma Diagnosis
Most patients visit a mesothelioma specialist when they start experiencing symptoms like shortness of breath, chest pain, or digestive issues.
- The doctor will usually perform a physical exam and then order imaging tests such as X-rays or CT scans to look for anything unusual.
- If these tests suggest the possibility of mesothelioma, the next step is a biopsy. This involves taking a small sample of tissue or fluid and sending it to a lab to be examined under a microscope. A biopsy is the only way to confirm a mesothelioma diagnosis.
- To diagnose the sarcomatoid cell type, doctors use a special technique called immunohistochemistry. This test shows how the cancer cells react to certain substances. The reaction helps doctors tell sarcomatoid mesothelioma apart from epithelioid or biphasic mesothelioma.
Sarcomatoid mesothelioma can be mistaken for other cancers, especially by more general providers who don’t have experience diagnosing mesothelioma. If you’re unsure or want to be certain about what you’re facing, it’s okay to ask for a second opinion. A specialist can help you get the right diagnosis and develop the most tailored treatment plan for you.
“One of the most important things I tell patients is to find a doctor who truly specializes in mesothelioma at a facility that treats many cases per year. Experience matters when it comes to mesothelioma.”
Sarcomatoid Mesothelioma Stages
Sarcomatoid mesothelioma is classified into four stages based on how far the cancer has spread. Staging helps doctors determine which treatments may be most effective.
- Stage 1: At this point, the cancer is limited to one area.
- Stage 2: Here, the tumor begins to grow into nearby tissues or lymph nodes.
- Stage 3: By this stage, the cancer has spread more extensively throughout the chest or abdomen.
- Stage 4: In the final stage, the cancer has reached distant parts of the body, such as the other lung, the liver, or other organs.
Because sarcomatoid mesothelioma starts with mild symptoms and grows quickly, most people aren’t diagnosed until stage 3 or 4. But even in the advanced stages, newer treatments — especially immunotherapy — are helping many patients live longer and feel better.
Sarcomatoid Mesothelioma Treatment Options
Sarcomatoid mesothelioma can be harder to treat than other cell types, but that doesn’t mean you’re out of options. In fact, thanks to recent advances in mesothelioma treatment, patients with the sarcomatoid cell type now have a more effective option in the form of immunotherapy.
Immunotherapy
Unlike chemotherapy, which attacks all fast-growing cells (including some healthy ones), immunotherapy works by helping your own immune system recognize and fight cancer cells more effectively. Immunotherapy is now the preferred first-line treatment for sarcomatoid mesothelioma, according to 2025 guidelines from the National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO).
Sarcomatoid mesothelioma tends to have a high number of immune checkpoint proteins, which are signals that help cancer cells hide from the immune system. Immunotherapy blocks those signals so immune cells can detect and attack the tumor.
“Immune therapy can be very, very helpful for patients with sarcomatoid histologies. Nivolumab and ipilimumab, which are Yervoy and Opdivo, can really prolong the patient’s life and make them feel better if they’re having a lot of symptoms.”
Chemotherapy
Chemotherapy works by using powerful cancer-fighting drugs to stop cancer cells from growing or spreading. It’s usually given through an IV in cycles — with treatment days followed by rest periods to let your body recover.
The standard chemotherapy combination for sarcomatoid mesothelioma includes:
- Pemetrexed (Alimta®)
- Cisplatin or sometimes carboplatin (for patients who can’t tolerate cisplatin)
These drugs are approved for all mesothelioma types, including sarcomatoid. While sarcomatoid tumors often don’t respond as well as other cell types do, chemotherapy can still slow tumor growth, relieve symptoms, and improve quality of life for some patients.
Use our Free Doctor Match to find experienced mesothelioma specialists who can help you understand your options and create a personalized care plan.
Radiation Therapy
Radiation uses high-energy X-rays or particles to target and destroy cancer cells. While it’s not often used as a primary treatment for sarcomatoid mesothelioma, radiation therapy can still play a helpful role in combination with other treatments.
During each session, radiation is delivered externally using a machine that directs beams to the tumor site. It’s usually painless and takes only a few minutes, though you may need multiple sessions over several days or weeks.
Surgery
Mesothelioma surgery is now only recommended for sarcomatoid patients with early-stage cancer who are healthy enough to undergo major operations.
For pleural mesothelioma, possible surgeries include:
- Pleurectomy with decortication (P/D)
- Extrapleural pneumonectomy (EPP)
For peritoneal sarcomatoid mesothelioma, patients may qualify for cytoreductive surgery with HIPEC (heated chemotherapy).
Emerging Treatments in Clinical Trials
Doctors and researchers are testing better treatment options for sarcomatoid mesothelioma in clinical trials. For example, one study sponsored by the University of Chicago Medicine Comprehensive Cancer Center is looking at how patients respond to the immunotherapy drug pembrolizumab (Keytruda®).
Other promising treatments include:
- Cancer vaccines
- Gene therapy
- Targeted drug therapy
- Virotherapy
A mesothelioma specialist can help you determine which clinical trials or combination treatments may be most effective for your specific diagnosis.
Palliative Care
Palliative care is an important part of treatment for sarcomatoid malignant mesothelioma. It’s focused on relieving pain, easing symptoms, and allowing you to maintain your daily routine. You can get palliative care at any stage of sarcomatoid mesothelioma, not just toward the end of life.
Palliative treatments may include:
- Medications to reduce pain
- Minor procedures to drain fluid buildup
- Light radiation to shrink tumors
- Emotional or faith-based support
Palliative care can be used alongside standard treatments or on its own, depending on your situation and personal goals.
Sarcomatoid Mesothelioma Prognosis
People diagnosed with sarcomatoid mesothelioma have an average prognosis (disease outlook) of 4 to 7 months, but some patients live much longer, especially when they’re diagnosed early and able to receive treatment right away. About 15% of patients are still living 2 years after diagnosis, but that number may improve with more widespread use of immunotherapy.
Your doctor will consider various factors when discussing prognosis, including:
- Your age and overall health
- The stage of your cancer
- Whether the cancer is pleural or peritoneal
- Your response to treatments
- Whether you’re able to have surgery or join clinical trials
The most important thing you can do to improve your prognosis is work with a mesothelioma specialist. They can make sure you get the best possible care, improve your quality of life, and explore every available option to help you live longer.
Rare Types of Sarcomatoid Mesothelioma
Sometimes, people with sarcomatoid mesothelioma are found to have a rare type of this disease. These rare types (called subtypes) can affect how the cancer grows and how doctors treat it. Your care team can find out if you have one of these rare subtypes by looking closely at your biopsy results.
Here are a few rare subtypes of sarcomatoid mesothelioma:
- Desmoplastic: This type forms a lot of thick, scar-like tissue and can be hard to detect. It often appears in the lining of the lungs.
- Lymphohistiocytoid: This very rare type includes a mix of unusual cells that can look like an infection or inflammation, which can make it trickier to diagnose.
- Transitional: This type has features of both sarcomatoid and epithelioid mesothelioma. It may respond to treatment differently from the individual types.
Knowing exactly what type of sarcomatoid mesothelioma you have helps your doctor choose the best treatments. Some rare types may need a different approach or may qualify you for special therapies or clinical trials.
Get Treatment and Support for Sarcomatoid Mesothelioma
Facing sarcomatoid mesothelioma can feel overwhelming — but you don’t have to go through it alone. Mesothelioma Hope can provide the expert care and support you need every step of the way. We’ve been helping patients and families get personalized medical guidance and support resources for over 25 years.
Our nurses and Patient Advocates are here to:
- Match you with top sarcomatoid mesothelioma doctors
- Help schedule appointments with various specialists
- Explain your treatment options & answer common questions
- Go over ways to cover treatment, travel, and other expenses
Call us now at (866) 608-8933 or try our Free Doctor Match to get started.
Sarcomatoid Malignant Mesothelioma FAQs
What is the most aggressive mesothelioma?
Sarcomatoid mesothelioma is the most aggressive type of this cancer. It’s the hardest to treat because the cancer cells are more resistant to therapies like surgery, chemotherapy, and radiation.
What is stage 4 mesothelioma sarcomatoid?
Stage 4 sarcomatoid mesothelioma is the most advanced form of this cancer. At this point, the cancer has spread far from where it started, often to the opposite lung, liver, or bones.
Even though treatment can’t remove all the cancer, it can still help patients feel better and possibly live longer. Doctors may recommend palliative care with radiation therapy to slow the disease and manage symptoms.
The average life expectancy at this stage is less than 1 year, but every case is different, and some patients live much longer.
What is the sarcomatoid mesothelioma survival rate?
Survival rate estimates how long people tend to live after being diagnosed with sarcomatoid malignant mesothelioma.
Based on data from the National Cancer Database:
- 2-year survival rate: 15%
This means that 15 out of every 100 people diagnosed with sarcomatoid mesothelioma were still alive 2 years after their diagnosis. - 5-year survival rate: 5%
About 5 out of every 100 people lived 5 years or longer after being diagnosed.
These survival rates are averages based on a large number of patients. Everyone responds differently to treatment, and it’s possible to live longer with sarcomatoid mesothelioma today thanks to immunotherapy and other advances in cancer care.
What is the surgery for sarcomatoid mesothelioma?
Surgery for sarcomatoid mesothelioma aims to remove as much cancerous tissue as possible. The type of surgery used will depend on various factors, including the location of your cancer.
The most common types of surgery include:
- Cytoreductive surgery with HIPEC: Combines tumor-removing surgery and heated chemotherapy applied to the abdominal cavity for peritoneal mesothelioma
- Extrapleural pneumonectomy (EPP): Extensive surgery that removes the cancerous lung, lung lining (pleura), and parts of the diaphragm and heart lining
- Pleurectomy with decortication (P/D): Removal of the pleura while preserving the lung
What is stage 4 mesothelioma with sarcomatoid cells?
In stage 4 mesothelioma with sarcomatoid cells, a patient’s cancer has spread extensively beyond the lung lining (pleura). This is the most advanced stage of mesothelioma.
Sarcomatoid cells are known for their long, slender shape and are one of the three main types of mesothelioma cells. The other two cell types are epithelioid and biphasic.
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