What is Diffuse Epithelioid Malignant Mesothelioma?

By - on February 17, 2020

Last Updated: May 4th, 2020

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Diffuse epithelioid mesothelioma affects the lining of the organs, including the lungs, stomach, or heart. This type of mesothelioma is the most common, accounting for approximately 70% of cases. This form of cancer may be referred to as either epithelial or epithelioid mesothelioma.

What Are Epithelioid Cells?

Diffuse epithelioid mesothelioma cells tend to cluster together in groups. Each cell is cubic or square in appearance. The nucleus, which is the part of the cell that has genetic material, is visible in every cell. (asbestos.com)

Diffuse epithelioid cells do not have a high degree of mobility and adhere to one another, so they are less likely to spread than sarcomatoid cells. That is one of the reasons that diffuse epithelioid malignant mesothelioma has the best prognosis of all mesothelioma cancers.

Symptoms of Diffuse Epithelioid Malignant Mesothelioma

Early symptoms of this form of mesothelioma are cough, shortness of breath, and poor appetite. As the disease gets worse, more serious symptoms can appear: (Cancer.org)

  • Shortness of breath
  • Persistent, dry cough
  • Hoarseness
  • Coughing up blood
  • Low blood oxygen levels
  • Weight loss
  • Feeling full without eating
  • Lack of appetite and nausea
  • Fatigue and weakness

Diagnosis for Diffuse Epithelioid Malignant Mesothelioma

To accurately diagnose this form of mesothelioma, several steps are required. Many patients have delays when they feel symptoms and getting a proper diagnosis.

  • The early symptoms of diffuse epithelioid malignant mesothelioma mimic minor respiratory problems. Many people with this form of cancer have a cough and fatigue, and doctors diagnose with the flu or pneumonia.
  • Doctors usually want to rule out the most common causes of mesothelioma symptoms before they have chest scans done.
  • Even after the patient is referred for X-rays, CT scans, or an MRI, the tests can take days or weeks to schedule.
  • Imaging tests only show abnormalities; they do not determine what the cause is.
  • After the imaging results are available, it can take weeks to get an appointment with the surgeon.
  • It can take several months to get on the surgeon’s schedule.

All of the above can make it challenging to obtain a tissue sample. Only a tumor biopsy that is usually gotten with thoracoscopy or thoracic surgery will result in the accurate identification of epithelial surgery.

To minimize the delays in your diagnosis, it is vital to share your asbestos exposure history with your doctor. If he or she knows you were exposed to asbestos, they are more likely to consider that you have an asbestos-related illness.

Treatment Options for Diffuse Epithelial Mesothelioma

Fortunately, of the several types of the disease, diffuse epithelial mesothelioma responds the most favorably to treatment. Patients who have been diagnosed with the disease tend to have more treatment and clinical trial choices.

Common treatments for epithelioid mesothelioma include the following:

  • Surgery: Having surgery is the major treatment option for diffuse epithelial mesothelioma. But some patients may not be able to tolerate surgery because they have other health problems.
  • Chemotherapy: The most-used chemotherapy for this form of cancer is a combination of Alimta, in addition to cisplatin or carboplatin.
  • Radiation therapy: This treatment option can be used by itself or combined with surgery and chemotherapy. While radiation will not cure mesothelioma, it can reduce symptoms and pain.
  • Immunotherapy: A recent clinical study found that the immunotherapy drug Avastin added to traditional chemotherapy drugs boosted survival compared to patients who only had chemotherapy.
  • Multimodal: A combination of two or more therapies can result in better patient outcomes for people with diffuse epithelioid malignant mesothelioma.

As noted above, surgery is one of the best options for this type of mesothelioma. If you are diagnosed at an earlier stage of mesothelioma cancer, you may be eligible for a pleurectomy/decortication (P/D) and extrapleural pneumonectomy (EPP). These surgeries involve removing as much cancerous tissue as possible from the lung and tissue around the lung.

Prognosis for Diffuse Epithelioid Malignant Mesothelioma

In 2018, clinical investigators released a detailed analysis of data that is in the National Mesothelioma Virtual Bank. Compared with the other types of the disease, people who have the epithelioid version of the disease have a prognosis that is approximately 200 more days. If the disease is caught early, the survival rate could be increased by years.

The median survival rate for epithelioid patients was 18 months, and 10 months for people with the biphasic cell type. It is only seven months for people that have a sarcomatoid version of cancer.

If you have epithelioid malignant mesothelioma, you will have access to more aggressive types of treatments and more innovative clinical trials. This is especially the case if the patient is being seen at a cancer center that specializes in mesothelioma.

Subtypes of Diffuse Epithelioid Malignant Mesothelioma

Subtypes of this type of cancer have different shapes, structures and sizes. All of them contain epithelioid cells, but these subtypes could react differently to different forms of treatment. (mesotheliomaguide.com). Some of the subtypes are:

  • Adenoid: These cells can be present in all forms of mesothelioma. But it most often develops in the genital tract. This is a form of benign mesothelioma that is most common in men.
  • Small cell: Distinct because of its cell shape. It is only 6% of mesotheliomas. It may form in the lining of the pleura or peritoneum. It rarely develops in the pericardium. This form of mesothelioma may be misdiagnosed as small cell lung cancer. See also Mesothelioma vs Lung Cancer
  • Cystic: Non-cancerous and can grow in the pleural or peritoneal cavity. Asbestos does not cause this form of the disease.
  • Papillary: Noncancerous and is not considered an asbestos-related disease. It is more common in women. It most often forms in the abdomen or lung lining. It can be treated in the same way as malignant mesothelioma.
  • Deciduoid: Can appear in the pleura and peritoneum. There are few cases reported of this subtype. In the ones that have been reported, it is most likely to form in the female abdominal cavity.