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Sarcomatoid Mesothelioma

Sarcomatoid malignant (cancerous) mesothelioma is the toughest mesothelioma cell type to treat. Its spindle-shaped cells have a tendency to break apart and spread around the body more quickly than epithelioid or biphasic cells. However, there’s always room for hope — learn how our team can connect you with experts who treat sarcomatoid mesothelioma.

Medically reviewed by: Mark Levin, MD

Last updated:

What Is Sarcomatoid Mesothelioma?

Sarcomatoid mesothelioma is a rare cancer that starts in the lining of the lungs and other organs and is classified by mesothelioma tumors that contain sarcomatoid cells.

Microscopic view of sarcomatoid mesothelioma cells
Illustration of sarcomatoid mesothelioma cells under a microscope

Sarcomatoid cells are shaped like spindles that look like long cylinders. Instead of growing in place, sarcomatoid mesothelioma cells move easily and quickly, which means metastasis (cancer spread) is common.

The American Cancer Society (ACS) estimates that 10% to 20% of mesothelioma patients have the malignant mesothelioma sarcomatoid type.

Even though it’s the most resistant to treatment, it’s also the least common of the three mesothelioma cell types (the others being epithelioid and biphasic).

Facing a sarcomatoid mesothelioma diagnosis? Our Patient Advocates have relationships with top mesothelioma doctors across the country who can provide the best treatment.

Read all the details in our Free Mesothelioma Guide, shipped directly to you overnight.

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What Causes Sarcomatoid Mesothelioma?

The only known cause of sarcomatoid malignant mesothelioma is asbestos exposure.

Asbestos was used in a wide range of industries up to the early 1980s because of its heat-resistant and insulating properties. Unfortunately, the tiny fibers released when asbestos-containing products are damaged or disturbed carry severe health risks to workers and their families when they’re inhaled or swallowed.

Asbestos fibers can become lodged in the lining of major organs (known as the mesothelium) and cause healthy cells to mutate into mesothelioma cancer.

Sarcomatoid Mesothelioma Symptoms

If you have sarcomatoid malignant mesothelioma, the signs and symptoms can differ depending on where the cancer shows up in your body (near the lungs or abdomen).

Recognizing the symptoms of sarcomatoid mesothelioma is crucial for getting a timely and accurate diagnosis. Learn more about the symptoms of each type of mesothelioma below.

Symptoms of Pleural Sarcomatoid Mesothelioma

Pleural sarcomatoid mesothelioma develops in the lung lining (pleura). About 20% of patients with pleural mesothelioma have the sarcomatoid cell type, according to a report in Respiratory Research.

Common symptoms include:

  • Chest pain
  • Fatigue
  • Fluid buildup in the chest (pleural effusion)
  • Shortness of breath
  • Worsening cough

Symptoms of Peritoneal Sarcomatoid Mesothelioma

Peritoneal mesothelioma with sarcomatoid cells is a cancer that affects the abdominal lining (peritoneum). It’s very rare, with only 32 cases reported in medical literature since 2006.

Common symptoms include:

  • Abdominal pain
  • Constipation or diarrhea
  • Fluid buildup in the abdomen (peritoneal effusion)
  • Night sweats
  • Unexplainable weight loss

Learn more about what signs and symptoms to watch for and how to get an accurate diagnosis in our Free Mesothelioma Guide.

Getting a Sarcomatoid Mesothelioma Diagnosis

Most patients begin the diagnosis process when they go to the doctor for shortness of breath, chest or stomach pain, or other symptoms.

From there, the doctor will perform a physical exam and order a series of tests and imaging scans to help them rule out other conditions.

Procedures that may be used to help diagnose sarcomatoid malignant mesothelioma include:

  • Blood tests for biomarkers (indicators of mesothelioma cancer)
  • Chest X-rays
  • Computed tomography scans (CT scans)
  • Echocardiograms
  • Magnetic resonance imaging (MRI) scans
  • Positron emission tomography (PET) scans

If mesothelioma is suspected, doctors will take a sample of tissue or fluid and send it to a lab, where a pathologist will analyze it under a microscope to see what mesothelioma cells (if any) are present. This is what’s known as a biopsy.

A biopsy is the only test that can confirm sarcomatoid malignant mesothelioma since it allows doctors to look at the cancer on a cellular level. During the biopsy, the pathologist may use a technique called immunohistochemistry staining to help them distinguish sarcomatoid malignant mesothelioma from other types of cancer.

Can Sarcomatoid Mesothelioma Be Misdiagnosed?

Yes, sarcomatoid malignant mesothelioma can be misdiagnosed because this cancer shares symptoms with other diseases.

Sarcomatoid mesothelioma is commonly misdiagnosed as:

  • Fibrous pleurisy
  • Fibrous tumors
  • Fibrosarcoma
  • Metastasized renal sarcoma (kidney cancer)
  • Non-Hodgkin’s lymphoma
  • Pleural liposarcoma (cancer of the fat cells)
  • Sarcomatoid carcinoma
  • Soft tissue sarcomas

A mesothelioma misdiagnosis is dangerous because it can keep you from getting the right treatment to improve your life expectancy — or send you down a path of expensive and ineffective treatments. If you think you may have been incorrectly diagnosed, you should ask for a second opinion from a mesothelioma doctor.

Our Patient Advocates can help you get a second opinion from a top doctor in your area. Sign up for our Free Doctor Match service to start the process — it only takes a few seconds.

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Sarcomatoid Mesothelioma Life Expectancy

The sarcomatoid mesothelioma prognosis (overall outlook of the disease) is generally poor because of how quickly this cell type spreads to other parts of the body.

  • The average life expectancy for sarcomatoid mesothelioma is 4-7 months.
  • Sarcomatoid malignant mesothelioma has a 2-year survival rate of 15% (percentage of patients still alive 2 years after diagnosis).

Still, each case is unique, and your prognosis with sarcomatoid mesothelioma depends on your age, overall health, cancer stage, and other factors. Patients diagnosed in the early stages — before their cancer has a chance to spread — usually have more treatment options and may receive a better prognosis.

Subtypes of Sarcomatoid Mesothelioma

Although it’s uncommon, some patients have been diagnosed with a rare subtype of sarcomatoid mesothelioma. Pathologists can determine whether a patient has one of these sarcomatoid cell subtypes when reviewing their biopsy samples under a microscope.

Saracomatoid mesothelioma subtypes include:

  • Desmoplastic mesothelioma: Recognized by the growth of dense, fibrous tissue
  • Lymphohistiocytoid mesothelioma: Defined by unique inflammatory cells that look like immune system white blood cells called lymphocytes and histiocytes
  • Transitional mesothelioma: Identified by cells that are both long and more rounded, combining features of both epithelioid and sarcomatoid types

Sarcomatoid Mesothelioma Treatment Options

Even though sarcomatoid mesothelioma tumors are more resistant to mesothelioma treatment than those of other cell types, there are still several options that patients can explore with their doctor.

Learn more about standard and emerging treatments for sarcomatoid malignant mesothelioma below.


Research shows chemotherapy can help keep sarcomatoid mesothelioma from spreading when used before or after surgery.

Chemotherapy medications currently approved by the U.S. Food and Drug Administration (FDA) for mesothelioma include pemetrexed in combination with cisplatin, both of which are now considered first-line (standard) treatments.


Immunotherapy for sarcomatoid malignant mesothelioma enhances the body’s immune system so it can destroy more tumor cells.

The FDA approved the immunotherapy drugs Opdivo® and Yervoy® (nivolumab and ipilimumab) in 2020 to treat pleural mesothelioma patients who aren’t eligible for surgery.

The approval came after the CheckMate 743 clinical trial found that immunotherapy helped sarcomatoid and biphasic mesothelioma patients live 4 months longer than those treated with chemotherapy.

Did You Know?

A more recent clinical trial sponsored by the Alliance for Clinical Trials in Oncology is testing whether pre-surgery immunotherapy with Opdivo and Yervoy helps control cancer spread in the first three stages of sarcomatoid mesothelioma.

The trial is currently recruiting patients and should be completed in December 2024.


Common surgeries used to treat pleural sarcomatoid mesothelioma include the pleurectomy with decortication (P/D), where the affected lung lining is removed, and the extrapleural pneumonectomy (EPP), which removes the entire lung, lung lining, and surrounding structures.

Peritoneal sarcomatoid mesothelioma patients may be able to undergo tumor-debulking followed by heated chemotherapy, a procedure commonly referred to as cytoreduction with HIPEC.

Sarcomatoid mesothelioma’s aggressive nature can limit the effectiveness of surgery. Additionally, complete tumor removal may not be possible due to the patient’s health and the stage of their cancer.

Get essential information on surgery, immunotherapy, and other ways to fight a sarcomatoid diagnosis in our Free Mesothelioma Guide.

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Radiation Therapy

Radiation therapy for sarcomatoid mesothelioma involves using high-energy rays to target and destroy cancer cells. It’s a treatment option that can help shrink tumors, reduce symptoms, and slow down the progression of the disease.

During each treatment session, precise doses of radiation are directed at the affected area, damaging the DNA of cancer cells and preventing them from growing.

Radiation therapy may be used alone or in combination with other treatments like surgery and chemotherapy.

Emerging Treatments in Clinical Trials

The hope is to find potentially more effective treatments for sarcomatoid mesothelioma through clinical trials.

For example, the University of Chicago is currently studying how patients with sarcomatoid mesothelioma respond to the immunotherapy drug Keytruda®.

Other emerging treatment options for sarcomatoid mesothelioma include:

  • Cancer vaccines
  • Gene therapy
  • Targeted therapy

A mesothelioma doctor can determine the right treatment or clinical trials for you based on the location and stage of your sarcomatoid cancer.

Find Doctors Who Treat Sarcomatoid Malignant Mesothelioma

Confronting sarcomatoid mesothelioma is challenging, but having a strong support system makes all the difference. Our compassionate nurses and Patient Advocates have connections with top mesothelioma specialists and cancer centers nationwide.

Whether it’s getting you in to see the best surgeons or helping you seek financial assistance for treatment-related expenses, we’re here to make the journey easier on you and your family.

Reach out to us today at (866) 608-8933 or use our Free Doctor Match for personalized support when you need it most.

Mesothelioma With Sarcomatoid Cell Type FAQs

What is the prognosis for malignant mesothelioma with sarcomatoid type?

Sarcomatoid mesothelioma has an average prognosis of 4-7 months since it has a tendency to invade surrounding tissues and metastasize (spread) more rapidly.

As new treatments continue to be studied in clinical trials, there may be opportunities to improve outcomes in patients with sarcomatoid mesothelioma.

Call our team at (866) 608-8933 to learn more about joining a clinical trial and other ways to potentially improve your prognosis.

What is the survival rate of sarcomatoid mesothelioma?

According to a 2022 review of the National Cancer Database:

  • The 2-year survival rate is 15%.
    • This is the percentage of sarcomatoid mesothelioma patients alive 2 years after diagnosis.
  • The 5-year survival rate is 5%.
    • This is the percentage of sarcomatoid mesothelioma patients alive 5 years after diagnosis.

These rates are averages based on a large number of patients. Everyone responds differently to treatment, and it’s possible to beat the odds with the right medical 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.

Dr. Mark LevinReviewed by:Mark Levin, MD

Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Mark Levin, MD, has over 30 years of experience in academic and community hematology and oncology. In addition to serving as Chief or Director at four different teaching institutions throughout his life, he is still a practicing clinician, has taught and designed formal education programs, and has authored numerous publications in various fields related to hematology and oncology.

Dr. Mark Levin is an independently paid medical reviewer.

  • Board Certified Oncologist
  • 30+ Years Experience
  • Published Medical Author
Jenna TozziWritten by:

Director of Patient Advocacy

Jenna Tozzi, RN, is the Director of Patient Advocacy at Mesothelioma Hope. With more than 15 years of experience as an adult and pediatric oncology nurse navigator, Jenna provides exceptional guidance and support to mesothelioma patients and their loved ones. Jenna has been featured in Oncology Nursing News and is a member of the Academy of Oncology Nurse & Patient Navigators & the American Nurses Association.

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  1. Amin, W., Linkov, F., Landsittel, D., Silverstein, J., Bashara, W., Gaudioso, C., . . . Becich, M. (2018, August 3). Factors influencing malignant mesothelioma survival: A retrospective review of the National Mesothelioma Virtual Bank cohort. Retrieved May 10, 2024, from
  2. Avadhani, V. (2022). Mesothelioma — Sarcomatoid. Retrieved May 10, 2024, from
  3. Brockwell, N., Alamgeer, M., Kumar, B., Rivalland, G., John, T., & Parker, B. (2020, June). Preliminary study highlights the potential of immune checkpoint inhibitors in sarcomatoid mesothelioma. Retrieved May 10, 2024, from
  4. Clopton, B., & Et al. (2022, November 19). Sarcomatoid mesothelioma: Unusual findings and literature review. Retrieved May 10, 2024, from
  5. Nakajima, E., Vellanki, P., Larkins, E., Chatterjee, S., Mishra-Kalyani, P., Bi, Y., . . . Donoghue, M. (2022, February 1). FDA approval summary: Nivolumab in combination with ipilimumab for the treatment of unresectable malignant pleural mesothelioma. Retrieved May 10, 2024, from
  6. Pavlisko, E., & Roggli, V. (2015, November). Sarcomatoid Peritoneal Mesothelioma: Clinicopathologic Correlation of 13 Cases. Retrieved May 10, 2024, from
  7. Sakai, T., & Et al. (2018, February 21). Utility of Site-Specific Biopsy for Diagnosis of Desmoplastic Malignant Mesothelioma. Retrieved May 10, 2024, from
  8. U.S. National Library of Medicine. (2022, April 25). Pembrolizumab in treating patients with malignant mesothelioma. Retrieved May 10, 2024, from
  9. Verma, V., Bueno, R., Burt, B., Wolf, A., Baud, M., Taioli, E., . . . Bovolato, P. (2018, September 29). Is there a role for cancer-directed surgery in early-stage sarcomatoid or biphasic mesothelioma? Retrieved May 10, 2024, from
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