The term malignant epithelial mesothelioma describes a specific cell type that may be involved in your case. If epithelial mesothelioma (also called "epithelioid") cells are present, you may have a better prognosis and be more responsive to treatment in comparison to patients with other cell types. Understanding the characteristics of epithelioid mesothelioma, how it is diagnosed, and what treatments are available will help you understand how cell types affect your prognosis.
Because this form of cancer accounts for 50 to 70 percent of all cases, more research has been performed on this cell type. Although treatment does not typically differ from one cell type to the next, knowing which type is present may dictate which clinical trials are available to you. Some doctors consider cell type during their research in an effort to further understand the response rates patients have towards certain treatments.
Characteristics of Epithelioid Mesothelioma
Mesothelioma cell types are classified by the appearance of the cells that form the cancer. Epithelial cells are part of the epithelium, or layers of cells that cover the internal surfaces of the body. The cells look like small, tube-like structures. When the epithelial cells turn cancerous, they are called epithelioid cells. Epithelioid mesothelioma most commonly occurs in malignant pleural mesothelioma.
How Epithelioid Mesothelioma is Diagnosed
Epithelioid mesothelioma is not easily identified through the microscopic inspection of cells. To determine which type in present, a thoracoscopy or another type of surgical biopsy needs to be performed. Biopsies offer doctors a way to examine the cells and tissue associated with the tumor. During a biopsy, a sample of the tumor is extracted for further evaluation.
This disease may be confused with adenocarcinoma, or a type of cancer that develops in the cells in internal organs such as the lungs, breasts and colon. Glandular mesothelioma, an epithelial cell subtype, may resemble adenocarcinoma of the lungs. It may be difficult to diagnose these two conditions, as simple biopsies of the pleura are often ineffective and surgical biopsy may be necessary.
The specific cell type that is involved in your case will be revealed in the pathology report. If you haven't been told your cell type yet, just ask your doctor and consider requesting a copy of the pathology report for your records.
Epithelioid Mesothelioma Subtypes
When epithelial cells turn cancerous (mesothelioma), they can be classified as epithelioid or sarcomatoid (or "biphasic" if both epithelioid and sarcomatoid cells are present). Both types are determined by their physical characteristics: the size, shape and structure of the cell. Epithelial cells may even be further classified as one of the following subtypes:
Subtypes of Epithelial Mesothelioma:
- Deciduoid
- Tubulopapillary
- Glandular
- Histiocytoid
- Adenoid cystic
- Microcystic
- Macrocystic
- Signet Ring
- Single File
- Diffuse - NOS
- Glomeruloid
- Small Cell
- Poorly Differentiated
- Mucin Positive
- Gaucher Cell-Like
- Well Differentiated Papillary
Deciduoid mesothelioma is an uncommon subtype of epithelial mesothelioma. It accounts for less than 5 percent of all mesotheliomas in general.
How Epithelial Cells Affect Treatment and Prognosis
Treatment for epithelial mesothelioma is similar to the treatments for other cell types. In fact, mesothelioma treatment more often depends on the stage and location of the cancer rather than the specific cell type. But because epithelioid cells respond best to treatment compared with other forms of mesothelioma, someone with this form of cancer may be considered for a more aggressive treatment plan than patients with other cell types.
The presence of epithelial cells usually results in a better prognosis in comparison to sarcomatoid and biphasic subtypes. The median survival time of patients with epithelial mesothelioma is about one year following diagnosis, and the survival rates for one year (77 percent), two years (50 percent) and three years (42 percent) are higher than those for the other subtypes.
The best prognosis appears to come in patients when cancer does not spread to the lymph nodes near the middle of the chest. In those cases, the five-year survival rate is 45 percent.
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