What Is Epithelioid Mesothelioma?
Epithelioid mesothelioma is one of the three cell types of malignant mesothelioma. The other cell types are sarcomatoid and biphasic.
More than half of patients diagnosed with mesothelioma have the epithelioid cell type, according to the American Cancer Society.
Specially trained doctors called pathologists can identify epithelial cells based on how they look under a microscope.
Epithelioid cells are known for their:
- Clearly visible nucleus
- Slower movement
- Square, long, or flat shape
- Tendency to stick together
Epithelioid mesothelioma patients generally have a longer life expectancy than patients with sarcomatoid or biphasic cell types. This is because epithelioid tumors spread (metastasize) slower and are usually isolated in one area of the body, which makes them easier to treat.
Use our Free Doctor Match to find an epithelial mesothelioma specialist who can help you explore all of your treatment options.
What Causes Malignant Epithelioid Mesothelioma?
Malignant epithelioid mesothelioma, like other forms of mesothelioma, is caused by asbestos exposure.
Asbestos is a naturally occurring mineral that can release microscopic fibers into the air when disturbed. If you breathe in or swallow these fibers, they can become lodged in the lining of your lungs or abdomen and cause scarring and inflammation.
After years of irritation from the asbestos fibers, genetic changes can cause the healthy epithelial cells that line the inside of your organs to mutate and form epithelioid mesothelioma tumors.
Epithelial Mesothelioma Symptoms
The symptoms of epithelial mesothelioma vary depending on where the cancer develops.
Patients whose cancer forms in the lining of the lungs (pleural mesothelioma) will have different symptoms than those with cancer in the abdominal lining (peritoneal mesothelioma).
Learn the common signs of each type of epithelioid mesothelioma below.
Symptoms of Epithelioid Pleural Mesothelioma
- Chest pain
- Fluid buildup in the chest (pleural effusion)
- Shortness of breath
- Worsening cough
Symptoms of Epithelioid Peritoneal Mesothelioma
- Abdominal pain
- Constipation or diarrhea
- Fluid buildup in the abdomen (peritoneal ascites)
- Night sweats
- Unexplainable weight loss
Mesothelioma symptoms typically worsen as the cancer spreads, so it’s critical to see a specialist for proper diagnosis and treatment.
Get your Free Mesothelioma Guide for essential information on symptoms, diagnosis, and treatment.
Getting an Epithelioid Mesothelioma Diagnosis
If you think you have epithelioid mesothelioma, you should visit a specialist as soon as possible, since this cancer will spread to other areas if left untreated. Learn more about the process of getting an epithelial mesothelioma diagnosis below.
1. Physical Examination
The symptoms of epithelial mesothelioma can be vague, so they’re often mistaken for bronchitis, pneumonia, or digestive issues. A physical examination can help your doctor rule out these more common conditions.
The doctor will start by getting your medical history and checking your vital signs, heart rate, blood pressure. They will check your breathing with a stethoscope and listen for sounds of fluid buildup, which is one of the early warning signs of pleural mesothelioma.
Your doctor may also examine your chest and abdominal area for any visible lumps or masses.
2. Imaging Scans
If the doctor sees or hears anything unusual during your physical exam, they can use imaging scans to look for tumors, scar tissue, and other signs of cancer in your lungs or abdomen.
These scans may include:
- Computed tomography (CT) scans
- Magnetic resonance imaging (MRI) scans
- Positron emission tomography (PET) scans
Imaging tests are crucial as they can show abnormalities your doctor won’t be able to spot in a physical exam.
3. Blood Tests and Biomarkers
Some mesothelioma doctors may order blood tests as part of an epithelioid mesothelioma diagnosis. Certain blood tests can show biomarkers (measurable characteristics in the body) associated with mesothelioma.
For example, the American Society of Clinical Oncology (ASCO) recommends that doctors order a specific biomarker test known as immunohistochemistry staining. This allows doctors to look for specific proteins (such as calretinin) and other signs of mesothelioma cancer.
4. Fluid or Tissue Biopsy
If your doctor finds signs of cancer in imaging and blood tests, they will order a biopsy.
After numbing the area with an anesthetic, your doctor will collect a small fluid or tissue sample through a tiny needle. You may feel some pressure during the procedure, which is normal. A pathologist will then examine the sample under a microscope to see which type of mesothelioma cell is present, if any.
A biopsy is the only way to confirm an epithelial mesothelioma diagnosis.
Find specialists near you who can accurately diagnose epithelial mesothelioma with our Free Doctor Match.
Subtypes of Epithelial Mesothelioma Cells
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.
Epithelial mesothelioma subtypes include:
- Adenomatoid mesothelioma: This subtype makes up roughly 6% of epithelioid pleural mesothelioma cases.
- Cystic mesothelioma: The cystic cell subtype is typically benign (not cancerous) and found in women with peritoneal mesothelioma.
- Deciduoid mesothelioma: This cell subtype is diagnosed in 5% of mesothelioma patients and has a poor prognosis.
- Lymphohistiocytoid mesothelioma: Only a few lymphohistiocytiod mesothelioma cases have ever been reported (less than 1%).
- Small-cell mesothelioma: This extremely rare subtype is often mistaken for other small-cell cancers.
- Solid mesothelioma: This subtype forms in patterns that look like sheets or nests and has an average prognosis of just over 1 year.
- Tubulopapillary mesothelioma: Patients with these cube-shaped cells have an average prognosis of almost 2 years.
- Well-differentiated papillary mesothelioma: These cells are more common in women than men and do not spread quickly.
Your doctor can tell whether you have one of these epithelial subtypes when reviewing your biopsy results and customize treatment to your cell subtype.
Epithelioid Mesothelioma Life Expectancy & Prognosis
Epithelioid mesothelioma patients have an average life expectancy of nearly 2 years with surgery.
The table below shows the median survival time in months compared to the other mesothelioma cell types.
|Mesothelioma Cell Type||Median Survival With Surgery|
What Is the Survival Rate of Epithelioid Mesothelioma?
Mesothelioma doctors use survival rates to track the percentage of patients who are still alive a certain number of years after diagnosis.
According to a 2022 review of the National Cancer Database, 45% of epithelial mesothelioma patients who have surgery are alive at 2 years, and 14% of patients are still alive at 5 years.
Factors such as your age, cancer stage, and type of mesothelioma can also affect your survival time. A mesothelioma doctor will consider all of these factors and more when determining your prognosis and selecting the best treatments.
Get our Free Mesothelioma Guide shipped overnight to learn more about prognosis, life expectancy, and survival rates.
Treatments for Epithelioid Mesothelioma
Epithelial cells are more responsive to mesothelioma treatments than other cell types. Learn more about the different types of treatment for epithelioid mesothelioma below.
Tumor-removing surgery is the most effective way to treat mesothelioma. Patients who have the epithelioid type are more likely to qualify for mesothelioma surgery than those with sarcomatoid or biphasic cells.
The three most common mesothelioma surgeries are:
- Cytoreduction with heated chemotherapy for peritoneal mesothelioma
- Extrapleural pneumonectomy (EPP) for pleural mesothelioma
- Pleurectomy with decortication (P/D) for pleural mesothelioma
In a study of 355 malignant pleural mesothelioma patients, P/D surgery was more effective than EPP surgery for the epithelioid cell type. Patients who got a P/D had an overall survival time of over 2.5 years, compared to 1.5 years with an EPP.
With chemotherapy, cancer-fighting drugs are typically given through an IV to stop epithelial mesothelioma cells from spreading.
Common chemotherapy drugs for mesothelioma include:
Most patients receive multiple rounds of mesothelioma chemotherapy with a few weeks off between treatments so they can recover.
Radiation therapy for mesothelioma is a treatment that uses high-energy rays to target and kill cancer cells. It’s like shining a strong beam of light on the cancer to damage or destroy it.
This treatment is often used to shrink epithelioid mesothelioma tumors before surgery or to help reduce symptoms when surgery isn’t possible.
Use our Free Questions to Ask Your Doctor Checklist to get the answers you need about epithelioid mesothelioma treatment.
Mesothelioma immunotherapy is a type of treatment that helps the body’s immune system better recognize and attack cancer cells.
Two immunotherapy drugs have been approved to treat epithelioid pleural mesothelioma: nivolumab (Opdivo®) and ipilimumab (Yervoy®).
Results from the CheckMate 743 clinical trial showed that this combination immunotherapy helped patients live 4 months longer than chemotherapy alone.
Many other immunotherapy drugs are being tested in clinical trials to see if they can help pleural and peritoneal epithelioid mesothelioma patients live longer.
Emerging Treatments in Clinical Trials
In addition to the standard cancer treatments covered above, epithelial mesothelioma patients may be able to access new and emerging treatments by enrolling in clinical trials.
Examples of emerging treatments include:
- Epigenetic therapy
- Gene therapy
- Mesothelioma vaccines
- Photodynamic therapy
- Targeted therapy
If you’re interested in trying one of these cutting-edge treatments, a mesothelioma doctor can see if you qualify for a clinical trial.
Find Epithelioid Mesothelioma Doctors Near You
When you’re facing an epithelioid mesothelioma diagnosis, finding the right medical team is crucial.
Mesothelioma Hope has relationships with top epithelioid mesothelioma specialists and can help you start treatment quickly and easily.
Epithelial Mesothelioma FAQs
What is epithelioid mesothelioma?
Epithelioid mesothelioma is one of the three cell types of mesothelioma cancer.
Epithelial mesothelioma has the best prognosis and survival rates because its cells are flat and spread more slowly, making this cancer easier to control with treatment.
What is the survival rate for epithelioid mesothelioma?
The epithelioid mesothelioma survival rate is the percentage of mesothelioma patients who are still alive at a certain time after diagnosis.
The 2-year and 5-year survival rates for pleural epithelioid mesothelioma patients treated with surgery, chemotherapy, and radiation are as follows:
- 65% of patients are still alive at 2 years
- 27% of patients are still alive at 5 years
However, individual factors like age, cancer stage, and overall health can affect your survival time.
What are epithelial cells?
Epithelial cells are the building blocks that form the protective linings of various organs and tissues within the body.
If asbestos fibers get trapped in the lining of the lungs or abdomen, they can mutate healthy epithelial cells into cancerous mesothelioma cells.
Once epithelial cells become cancerous, they multiply and form tumors, leading to epithelioid mesothelioma.
What are the stages of epithelioid mesothelioma?
There are four stages of epithelioid pleural mesothelioma. Staging is based on how far the cancer has spread through the body, and it has a direct effect on which treatments you can get.
In the early stages (stages 1 and 2), the cancer is mostly contained to the lung lining (pleura) and is easier to treat with surgery and chemotherapy.
By the time the cancer has advanced to stages 3 and 4, tumors may have spread to distant areas of the body and usually can’t be removed with surgery.
What are the three types of mesothelioma cells?
The three types of mesothelioma cells are epithelial, sarcomatoid, and biphasic.
The epithelial cell type has the best prognosis compared to the other cell types because the tumors tend to stick together and spread more slowly.
Identifying mesothelioma cell type is key to determining your prognosis and treatment plan.