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Epithelioid mesothelioma (EM) is a type of mesothelioma (a cancer of the parietal and visceral linings surrounding the organs and body cavities). Around 50-70% of all mesothelioma cases are of this type. Mesotheliomas are a rare type of cancer caused by asbestos exposure. Time between exposure and development of the disease can be as long as 40-50 years. There are three other types in addition to EM, sarcomatoid, desmoplastic, and mixed/biphasic. Of the four types, EM has the greatest survival rate. The direct cause of EM is asbestos exposure. The asbestos fibers are inhaled and bypass the natural filtration system of the lungs where they become embedded in lung tissue. These fibers cannot be broken down by the body. Manufacturers of asbestos as well as those in the construction, railroad, shipyard, and automobile industries are the most often afflicted, with males being 10 times more likely than females to have this type of cancer. It can be benign, but approximately 90-95% of the cases of EM are malignant. The survival rate is low, only 1-5 years at best depending on how early the diagnosis was made and type of treatment plan. Initial symptoms include chest pain, difficulty breathing, and an excessive accumulation of non-purulent fluid between the chest cavity and the lining of the lungs also known as a pleural effusion. These symptoms alone do not indicate EM, making it harder to diagnose early. Even a chest x-ray will not accurately diagnose this with the initial onset of symptoms; further investigation is necessary. There are numerous differential diagnoses associated with the above symptoms, so it takes time to make an accurate diagnosis, and even then it can be mistaken for lung adenocarcinoma due to the proximity and morphology of the cancer cells. However, 60% of EM cases occur on the right side, rarely occurring bilaterally (5%), differentiating it from lung adenocarcinoma. Once EM is suspected, a number of tests are required to make a definitive diagnosis. Withdrawing the excess fluid via thoracentesis and performing fluid cytology and biopsy are a first step. However, enough tissue needs to be withdrawn for an adequate sample. Also a negative result does not necessarily mean the absence of mesothelioma. Video-assisted thorascopy and bronchoscopy has been found to be more effective to establishing EM. Prophylactic radiation is performed to prevent seeding of the biopsy site with tumor cells. New research focuses on gene profiling. Aggressive treatment is usually the course of action to ensure a better prognosis. Depending on the stage, extent of the tumors, and age of patient, a pneumonectomy (removal of the tumor in the lungs) might be suggested. It is an extremely delicate procedure and carries the risk of death within a month. Chemotherapy in conjunction with radiation is considered to be the best course of action. Radiation therapy needs to be performed carefully as the surrounding organs, the heart and lungs, can be damaged with the radiation. Even with aggressive treatment, the survival rate from initial diagnosis is 1-5 years. Palliative care can keep pain at bay with advanced EM. Mesothelioma cancer patient resource with questions and answers about Epithelioid Mesothelioma – Some Basic Information, a deadly cancer caused by asbestos exposure.
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