Pericardial Mesothelioma Diagnosis

Quick Summary

Pericardial mesothelioma is the rarest form of mesothelioma, accounting for only 1% of all cases. Because of how uncommon it is, pericardial mesothelioma is usually diagnosed only after an autopsy. With growing research and awareness about pericardial mesothelioma, doctors are now able to better diagnose this condition and administer potentially life-extending treatments.

Pericardial Mesothelioma Diagnosis Overview

If you have a history of asbestos exposure and you’ve been experiencing symptoms of pericardial mesothelioma, then it’s important to be seen by a pericardial mesothelioma specialist to get an accurate diagnosis. Here is what everyone with pericardial mesothelioma needs to know about diagnosing this type of cancer:

  • Pericardial mesothelioma is a rare and complex cancer that can only be diagnosed by experienced specialists
  • Specialists identify different factors such as cell type and rate of metastasis to make an accurate diagnosis
  • Using image scans and blood tests, specialists can rule out other conditions that may mimic pericardial mesothelioma symptoms
  • The only way to conclusively diagnose pericardial mesothelioma is a biopsy that tests tumor tissue
  • Pericardial mesothelioma may be misdiagnosed as heart disease
  • Seeking a second opinion from a pericardial mesothelioma specialist can open up new treatment options for you

How Pericardial Mesothelioma is Diagnosed

The only way for pericardial mesothelioma receive an accurate diagnosis is by seeing a specialist. With years of experience researching and treating pericardial mesothelioma, specialists are experts in knowing what to look for in this rare and complex cancer.

Pericardial Mesothelioma Diagnosis Update

Pericardial mesothelioma diagnoses are rare for a few reasons. Firstly, the disease has a long latency period of 10-50 years before symptoms develop after initial asbestos exposure. Secondly, patients remain relatively asymptomatic (showing no signs) until the disease has significantly advanced. Many patients die before a doctor can diagnose their condition. Finally, pericardial mesothelioma is often misdiagnosed as another condition or cancer type. All of these factors lead to lower rates of pericardial mesothelioma diagnoses.

To reach a pericardial mesothelioma diagnosis, doctors follow multiple steps and work cooperatively with other specialists. It can take weeks or months for a final diagnosis to be reached, and the disease can advance significantly during this time.

Here are the steps involved in diagnosing pericardial mesothelioma:

  1. Physical examination
  2. Image tests
  3. Blood and biomarker tests
  4. Biopsies

1. Physical Examination

When patients first report their symptoms to their family doctor, he or she will perform a physical exam to identify any signs of an underlying condition. The most common symptom that pericardial mesothelioma patients report to their doctors is chest pain. However, chest pain is a vague symptom often associated with heart disease, especially in older, unhealthy patients.

It’s important for all patients to inform their doctor of their past exposure to asbestos. This is a critical fact that can help doctors identify mesothelioma sooner.

2. Image Scans and Tests

Based on the physical exam, doctors will order imaging tests to look closer at the chest to see if you have any abnormalities. At this point, it is highly unlikely that a doctor suspects pericardial mesothelioma because there are far more common conditions that may be causing chest pain.

However, if doctors are alerted to heart-related symptoms, then they can order the following tests:

  • CT Scan: CT (computed tomography) scans take multiple x-ray pictures with a machine that rotates around the chest. CT scans piece together cross-sectional images of the chest to help doctors have a closer look at the heart. CT scans can reveal abnormalities such as tumor masses or pericardial effusions (fluid buildup in the heart lining)—a sign of pericardial mesothelioma. CT scans cannot tell doctors whether or not the tumor masses are cancerous.
  • Echocardiogram: An echocardiogram is a test that identifies irregularities in the heart. Using sound waves, doctors can hear fluid buildup, an irregular heartbeat and any other signs that indicate the heart isn’t properly pumping blood. A pericardial mesothelioma patient’s chest pain is caused by a damaged heart muscle.

It is helpful for pericardial mesothelioma patients to understand how these tests fit into the overall diagnostic picture. Tests only help doctors identify irregularities so they can start narrowing down possible conditions. CT scans and echocardiograms do not tell doctors whether or not you have cancer.

3. Blood and Biomarker Tests

Doctors can test biomarker levels in patients to help identify certain diseases. Biomarkers are substances (usually proteins) that indicate abnormalities in the patient. With mesothelioma, researchers have identified several biomarkers that may indicate the patient has mesothelioma. Though none of these biomarkers is reliable enough yet to diagnose mesothelioma, they can be helpful tools.

The MesoMark® test was developed to test a biomarker called soluble-mesothelin related protein (SMRP), which appears at elevated levels in the 84% of mesothelioma cases. Many other biomarkers are currently being researched to help identify genetic links to mesothelioma.

4. Biopsies

When imaging scans show tumor masses in the pericardium, doctors must next determine if these masses are malignant (cancerous) or benign (non-cancerous). Doctors can find out if tumors are cancerous with a biopsy, whereby they collect tissue samples from the pericardium and view them under a microscope. Tissue samples can also tell doctors what type of cancer the patient has.

There are different biopsy methods for diagnosing pericardial mesothelioma, including:

  • Pericardiocentesis: A common sign of pericardial mesothelioma is fluid buildup in the heart sac. Doctors can test this fluid for cancer cells to help diagnose pericardial mesothelioma. Using a hollow needle, doctors withdraw fluid from the pericardium and drain it into a catheter so it can be tested for cancer cells.
  • Percardiooscopy: Using a pericardioscope—a tiny camera inserted into the area surrounding the heart—doctors can examine tumor tissue. They then remove samples of tissue and view them under a microscope to identify cancer cells.

Histology and Cytology for Pericardial Mesothelioma

Doctors use histology and cytology findings to diagnose pericardial mesothelioma. With histology, doctors look at the diseased tissue under the microscope to determine the type of cancer cells present. With cytology, doctors look for cancer cells in the fluid samples pulled from the pericardial tissue.

These are the only conclusive methods of diagnosing pericardial mesothelioma because they show doctors not only that the patient has cancer, but that they specifically have pericardial mesothelioma. Doctors also learn which cell type a pericardial mesothelioma patient has—epithelioid, sarcomatoid or mixed—which helps them developed the most effective treatment plans.

Common Pericardial Mesothelioma Misdiagnoses

As with all mesothelioma, pericardial mesothelioma is often misdiagnosed, which wastes the precious time patients have left. Because it’s so rare, doctors often attribute heart-related symptoms to much more common conditions—, especially in older patients.

Some of the possible conditions that doctors misdiagnose pericardial mesothelioma as include:

  • Heart failure
  • Coronary artery disease
  • Pericarditis (pericardial inflammation)

Even when doctors do diagnose pericardial mesothelioma, they may not stage it correctly, which can severely limit a patient’s treatment options.

Second Opinions From Pericardial Mesothelioma Specialists

It’s important for patients to get a second opinion from a mesothelioma specialist who can accurately diagnose this rare disease. Pericardial mesothelioma specialists, are cardiothoracic surgeons who specialize in mesothelioma treatment and research.

If you’ve been diagnosed with pericardial mesothelioma, or you suspect you may have symptoms, then contact Mesothelioma Help Now. Our team of dedicated Patient Advocates can answer questions and help you with the next steps toward treatment.

View Author and Sources

  1. Molecular and Clinical Oncology, “Primary malignant pericardial mesothelioma with increased serum mesothelin diagnosed by surgical pericardial resection: A case report.” Retrieved from: Accessed on December 28, 2017.
  2. American Cancer Society, “How is Malignant Mesothelioma Diagnosed?” Retrieved from: Accessed on December 28, 2017.
  3. Journal of Clinical Imaging Science, “A Rare Case of Primary Malignant Pericardial Mesothelioma” Retrieved from: Accessed on December 28, 2017.

Last modified: May 7, 2018