What Is Epithelioid Mesothelioma?
Epithelioid mesothelioma is a cancer that starts in the cells that make up the lining of the body’s internal organs (also called epithelial cells).
Specially trained doctors called pathologists can identify epithelial mesothelioma cells by reviewing biopsy samples under a microscope.
Epithelioid mesothelioma cells are identified by their:
- Clearly visible nucleus
- Slow movement
- Square, cube, long, or flat shape
- Tendency to stick together
Compared to other mesothelioma cell types, epithelioid cells tend to grow more slowly and stay in one place longer, which gives patients more treatment options.
Epithelioid mesothelioma is the most common of three mesothelioma cell types, and it's also the easiest to treat since it doesn't spread as quickly. Call (866) 608-8933 to get help finding treatment. View Transcript.
Duration: 1 min 27 sec
Mesothelioma, a form of cancer that can develop in the lining of the lungs heart or abdomen has different cell types. Today we’ll shed some light on epithelioid mesothelioma, the most common cell type, about 70% of mesothelioma patients have the epithelioid or epithelial cell type. These patients have a distinct advantage when it comes to treatment options. Epithelial cells tend to grow relatively slowly allowing for more effective treatment strategies such as surgery, chemotherapy, and radiation. Thanks to this slower growth pattern, patients diagnosed with epithelioid mesothelioma have a better prognosis and higher survival rates compared to the other two cell types which are sarcomatoid and basic. If you or a loved one has been diagnosed with mesothelioma, it’s crucial to consult with a doctor who specializes in this rare cancer. They can provide you with the most up-to-date information on treatment options and guide you through your journey toward better health. Remember, early detection and Ely intervention are key to improving outcomes for mesothelioma patients. Stay informed, seek support, and explore all available resources to ensure the best possible care and support for yourself or your loved one. Remember, you are not alone in this fight. Help is just to call away. Contact us today to be connected with a patient advocate who can recommend doctors and treatments for epithelioid mesothelioma.
Get our Free Mesothelioma Guide to learn more about the epithelioid cell type and recommended treatments.
What Causes Epithelioid Mesothelioma Cancer?
Asbestos exposure is the only known cause of epithelioid mesothelioma and the other two cell types of this cancer.
When asbestos-containing products are disturbed or damaged, tiny fibers can be released into the air. If breathed in or swallowed, these asbestos fibers may settle in the lining of the lungs, leading to scarring and inflammation.
Over a latency period of 10 to 50 years, this irritation can damage healthy epithelial cells, eventually leading to mesothelioma cancer.
Asbestos was used in the U.S. armed forces and various industries up until the early 1980s, so many people diagnosed with epithelioid mesothelioma today are military veterans and retired blue-collar workers.
“Asbestos didn’t kill anybody on the spot, that’s for sure. It took years. That’s when it started catching up with us.”
Epithelioid Malignant Mesothelioma Symptoms
The symptoms of epithelioid mesothelioma depend on where the cancer is located in the body.
For example, cancer in the lining around the lungs (pleura) causes different mesothelioma symptoms than cancer in the abdominal lining (peritoneum).
| Symptoms of Pleural Epithelioid Mesothelioma | Symptoms of Peritoneal Epithelioid Mesothelioma |
|---|---|
| Chest pain | Abdominal pain |
| Fatigue | Constipation or diarrhea |
| Fluid buildup in the chest (pleural effusion) | Fluid buildup in the abdomen (peritoneal ascites) |
| Shortness of breath | Night sweats |
| Worsening cough | Unexplained weight loss |
These symptoms usually get worse as the cancer spreads, so make sure to see a specialist right away if you notice them. Contact our Patient Advocates so we can help you find a mesothelioma doctor in your area.
How Is Epithelioid Mesothelioma Diagnosed?
Your doctor will use a series of imaging scans and tests to confirm an epithelioid mesothelioma diagnosis. Learn more about how mesothelioma is diagnosed below.
1. Physical Examination
The symptoms of epithelial mesothelioma can be vague, so they’re often mistaken for bronchitis, pneumonia, or digestive problems. A physical exam is a good first step to help your doctor rule out these more common conditions.
During the exam, your doctor will review your medical history and check your vital signs. They’ll use a stethoscope to listen to your breathing and check for fluid buildup, which is an early sign of malignant pleural mesothelioma — the most common type of this cancer.
Your doctor might also check for any lumps or unusual masses around your chest and abdomen.
2. Imaging Scans
If your doctor sees or hears anything unusual during your physical exam, they can use imaging scans to look for tumors, nodules, scar tissue, or other signs of disease.
Mesothelioma imaging tests may include:
- Computed tomography (CT) scans
- Magnetic resonance imaging (MRI) scans
- Positron emission tomography (PET) scans
- X-rays
Imaging tests are a key part of an epithelial mesothelioma diagnosis since they show details your doctor wouldn’t be able to see in a physical exam.
3. Blood Tests for Biomarkers
Doctors may order blood tests to help them diagnose epithelioid mesothelioma. These tests look for biomarkers, substances in the blood that can be linked to cancer or past asbestos exposure.
Blood tests by themselves cannot confirm mesothelioma, but they can give helpful clues when analyzed with other tests like imaging scans or biopsies.
Some common biomarkers include:
- BAP1
- Calretinin
- Fibulin-3
- Mesothelin
- Osteopontin
These markers are often higher in people who have mesothelioma. They can also suggest if someone has been exposed to asbestos in the past.
4. Fluid or Tissue Biopsy
If imaging scans or blood tests suggest the presence of cancer, your doctor will order a biopsy. A biopsy is the only way to confirm whether you have mesothelioma, including the epithelioid type.
During a biopsy, your doctor will collect a fluid or tissue sample and send it to a pathologist, who will look at it under a microscope.
They will also use immunohistochemical (IHC) staining to:
- Confirm whether the cancer is mesothelioma
- Determine the cell type (epithelioid, sarcomatoid, or biphasic)
Knowing the cell type is important because it helps doctors choose the most effective treatments.
Download our Free Checklist of Questions to Ask Your Doctor to help you get clarity on your diagnosis and explore the best treatment options for you or a loved one.
Epithelioid Mesothelioma Life Expectancy and Prognosis
Epithelioid mesothelioma is the most common and easiest cell type to treat. Patients can live several years or longer if their cancer is found before it’s spread beyond the lymph nodes.
The average life expectancy for epithelial mesothelioma is about 2.5 years (31.5 months).
Average Life Expectancy by Treatment Type
- Some early-stage patients have lived nearly 6 years (69.8 months) with aggressive treatment.
- Immunotherapy with nivolumab and ipilimumab has helped patients live about 7 months on average.
- Patients treated with pemetrexed plus platinum-based chemotherapy have an average survival time of 5 months.
Your epithelioid mesothelioma prognosis depends on many factors, including your overall health, cancer stage, and response to treatment.
“When it comes to mesothelioma, the epithelioid type tends to have a better outlook than other cell types. That means there’s more reason to stay positive and hopeful about treatment possibilities.”
What Is the Epithelial Mesothelioma Survival Rate?
Survival rate refers to the percentage of people still alive for a specific period after being diagnosed with mesothelioma. It’s commonly measured at 2-year and 5-year intervals.
The table below provides overall survival rates for epithelioid mesothelioma with different treatment options.
| Treatment Type | 2-Year Survival Rate | 5-Year Survival Rate |
|---|---|---|
| Surgery | 45% | 14% |
| Chemotherapy | 35% | 9% |
| Radiotherapy | 40% | 12% |
| Immunotherapy | 37% | 7% |
| Surgery and Chemotherapy | 45% | 15% |
Source: National Cancer Database (NCDB)
These survival rates show how treatments have worked for others, but everyone’s situation is different.
Get our Free Mesothelioma Guide shipped overnight to learn more about treatments that may help you live longer with the epithelial cell type.
Epithelial Malignant Mesothelioma Treatment Options
The best treatment for epithelioid mesothelioma depends on where the cancer is located: in the chest (pleural) or abdomen (peritoneal).
The 2025 National Comprehensive Cancer Network (NCCN) guidelines outline the latest treatment recommendations for both.
Surgery
Surgery is now recommended only for patients with early-stage epithelioid mesothelioma.
For pleural mesothelioma, pleurectomy/decortication (P/D) is preferred over the more aggressive extrapleural pneumonectomy (EPP) since it allows the patient to keep both lungs.
“Surgery should only be considered for patients with early-stage (stage 1) disease that is limited to the pleura (the lining of the lungs) and has no lymph node involvement.”
This recommendation is based on findings from the MARS 2 trial. Researchers found that surgery combined with chemotherapy didn’t improve survival over chemotherapy alone. It also led to more complications.
The recommended treatment for peritoneal epithelioid mesothelioma is still cytoreductive surgery with HIPEC (heated chemotherapy applied directly inside the abdomen).
Chemotherapy
Chemotherapy uses cancer-fighting drugs to shrink mesothelioma tumors and kill cancer cells.
The NCCN’s 2025 treatment guidelines recommend first-line (initial) treatment with the chemotherapy drugs pemetrexed and cisplatin (or carboplatin) for epithelioid mesothelioma.
Patients can receive epithelioid mesothelioma chemotherapy alone or before/after surgery to keep the cancer from spreading.
Immunotherapy
This newer treatment method helps the body’s immune system better identify and attack cancer cells.
Immunotherapy can be used as a second-line (follow-up) treatment for epithelioid mesothelioma patients if their cancer doesn’t respond to first-line chemotherapy.
The latest treatment guidelines support using nivolumab and ipilimumab (brand names Opdivo® and Yervoy®) for patients who can’t have surgery.
Patients with newly diagnosed epithelioid pleural mesothelioma may be eligible for chemoimmunotherapy as a first-line treatment. This consists of pembrolizumab (brand name Keytruda®) and pemetrexed plus platinum-based chemotherapy.
According to a recent case study, one patient went into complete remission from epithelioid peritoneal mesothelioma with Keytruda and chemotherapy.
This means all signs and symptoms of his cancer disappeared. The patient is still in remission more than 4 years later.
Radiation Therapy
Radiation therapy for epithelial mesothelioma is now only recommended in certain situations:
- After P/D surgery: Some patients who have had P/D surgery may get a special type of radiation called intensity-modulated radiation therapy (IMRT) to help destroy any leftover cancer cells. IMRT is not recommended after EPP surgery, as it can be too risky for the remaining lung.
- To relieve symptoms: For people with advanced epithelioid mesothelioma, radiation can help reduce pain or breathing problems.
Get our Free Mesothelioma Guide to learn more about the latest treatments that could improve your prognosis and quality of life.
Emerging Treatments in Clinical Trials
New and innovative treatments for epithelioid mesothelioma are being tested in clinical trials. These emerging treatments could potentially help patients live longer with fewer symptoms.
Some active trials for epithelial mesothelioma include:
- CT-95 in Advanced Cancers: This early-phase study is testing a new drug designed to help the immune system target and attack mesothelin, a protein often found in epithelioid mesothelioma.
- Immunotherapy Before Surgery: This trial is evaluating whether early-stage epithelioid mesothelioma patients treated with durvalumab and tremelimumab before surgery stay cancer-free longer.
- MEDI5752 + Carboplatin + Pemetrexed: This study is testing a new immunotherapy drug called volrustomig combined with chemotherapy for advanced epithelioid mesothelioma.
Palliative Care
Patients with epithelial mesothelioma can also receive palliative care to manage symptoms and improve their quality of life.
Common examples of mesothelioma palliative care include:
- Breathing support: Procedures like thoracentesis or pleurodesis are used to drain fluid from around the lungs and make breathing easier.
- Diet and meal planning: Nutritionists may help create meal plans that support energy levels and manage side effects like nausea or poor appetite.
- Emotional support: Counseling, support groups, and therapy can help patients and families cope with stress, anxiety, or depression.
- Pain management: Medications or nerve blocks can be prescribed to ease chest, abdominal, or shoulder pain caused by tumors or fluid buildup.
- Radiation therapy: Low doses of radiation can shrink tumors that are pressing on nerves or organs and causing pain or other symptoms.
Epithelioid Mesothelioma Subtypes
There are several subtypes of epithelioid mesothelioma that can be harder to treat. Most of these cell subtypes are rare and affect a very small number of patients.
Your doctor can check your biopsy results to see if you have one of these epithelial subtypes and adjust your treatment plan accordingly.
- Adenomatoid: This subtype makes up roughly 6% of epithelioid pleural mesothelioma cases.
- Cystic: The cystic cell subtype is typically benign (not cancerous) and found in women with peritoneal mesothelioma.
- Deciduoid: This cell subtype is diagnosed in 5% of mesothelioma patients.
- Lymphohistiocytoid: Only a few lymphohistiocytoid mesothelioma cases have ever been reported (less than 1%).
- Small-cell: This extremely rare subtype is often mistaken for other small-cell cancers.
- Solid: This subtype forms in patterns that look like sheets or nests and has an average prognosis of just over 1 year.
- Tubulopapillary: Patients with these cube-shaped cells have an average prognosis of almost 2 years.
- Well-differentiated papillary: Papillary mesothelioma cells are more common in women than men and do not spread quickly.
Get Help for Malignant Epithelioid Mesothelioma
If you’ve been diagnosed with epitheloid mesothelioma, having the right support system by your side is crucial for your treatment and recovery.
Mesothelioma Hope’s dedicated Patient Advocates can:
- Connect you with top mesothelioma doctors
- Explain available treatment options and what to expect
- Help you pursue financial compensation from asbestos trust funds, legal claims, or VA disability benefits
- Recommend mesothelioma support groups and peer mentors
Call us today at (866) 608-8933 or get our Free Mesothelioma Guide shipped overnight to learn more about how we can help.
Mesothelioma Epithelioid Type FAQs
What is mesothelioma with epithelioid cells?
Mesothelioma with epithelioid cells is a type of cancer that starts in the thin lining around the lungs, abdomen, or heart.
It is the most common form of mesothelioma and is named for the shape of the cancer cells, which look like regular epithelial (protective lining) cells under a microscope.
Epithelioid mesothelioma grows more slowly and responds better to treatment than other types of mesothelioma. Because of that, patients with this cell type may have a greater chance of living longer, especially if they’re diagnosed early and qualify for surgery.
What are the markers for epithelioid mesothelioma?
Some common markers that are usually found in epithelioid mesothelioma are:
- Calretinin
- Cytokeratin 5/6
- D2-40 (Podoplanin)
- WT-1 (Wilms’ Tumor 1)
Doctors also check for markers that aren’t present in epithelioid mesothelioma to make sure it’s not a different type of cancer. Using both kinds of markers helps them make the right diagnosis.
What are the stages of epithelioid mesothelioma?
The stages of epithelioid mesothelioma are:
- Stage 1: The tumor is small and hasn’t spread to lymph nodes or other parts of the body.
- Stage 2: The tumor is larger or has spread to nearby lymph nodes but hasn’t spread to other areas of the body.
- Stage 3: The cancer is more advanced, with a larger tumor and possible spread to nearby tissues or multiple lymph nodes.
- Stage 4: Cancer has spread to other parts of the body (metastasis).
These stages help doctors understand how far the cancer has progressed and what types of treatment are best for each patient.
What is the standard epithelioid mesothelioma treatment?
According to the 2025 NCCN guidelines, the standard treatment for epithelioid mesothelioma starts with chemotherapy.
The recommended chemotherapy drugs are pemetrexed combined with either cisplatin or carboplatin. In some cases, bevacizumab may be added to help slow the disease and manage symptoms.
Surgery is only recommended for patients with stage 1 epithelioid mesothelioma that hasn’t spread to the lymph nodes.
Pleurectomy/decortication (P/D) surgery is preferred over extrapleural pneumonectomy (EPP) since it has fewer risks.
What is the average epithelioid mesothelioma prognosis?
Patients with epithelioid mesothelioma have an average prognosis of about 2.5 years, or around 31.5 months, after they are diagnosed.
Some people who are diagnosed early have lived much longer than this. In some cases, patients have lived nearly 6 years, or about 70 months, with aggressive treatment.
Can epithelioid mesothelioma be cured?
Right now, there is no known cure for epithelioid mesothelioma. Doctors focus on slowing the cancer down and helping patients live as long and as comfortably as possible.
Some people may live for many years if the cancer is found very early and a surgeon is able to remove all of it.
The key to surviving epithelioid mesothelioma is starting treatment as early as possible. Contact our team today to get matched with a mesothelioma specialist near you.
What is the survival rate for epithelioid mesothelioma?
The survival rate for epithelioid mesothelioma varies depending on the stage of the disease, the overall health of the patient, and the specific treatments used.
- With chemotherapy, 35% of patients survive 2 years, and 9% survive over 5 years.
- With immunotherapy and chemotherapy, 37% of patients survive 2 years, and 7% survive over 5 years.
- With chemotherapy and surgery, 45% of patients survive 2 years, and 15% survive over 5 years.
These numbers show that combining treatments — a practice known as multimodal therapy — can improve survival for patients with epithelioid mesothelioma.
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