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epithelial mesothelioma
the cells within a mesothelioma cancer tumor can vary from
patient to patient. If your tumor is mainly composed of epithelioid cells, you
may respond better to treatment and experience a more favorable outcome than
patients with other cell types.
Mesothelioma develops in the mesothelium, a lining made of
epithelial cells. When epithelial cells of the mesothelium turn cancerous, they
alter in appearance and take on patterns called epithelioid, sarcomatoid or
biphasic. Epithelioid mesothelioma, which is also called epithelial
mesothelioma, is the most common type of the asbestos-related disease.
Although treatment does not typically differ from one cell
type to the next, your type may dictate which clinical trials are available to
you.
How Is It Diagnosed?
Epithelioid cells cannot be identified with diagnostic
imaging scans. To determine which cell type is present, doctors need to perform
a thoracoscopy or similar form of surgical biopsy. Biopsies offer doctors a way
to examine the potentially cancerous cells under a high-powered microscope.
During a biopsy, a tissue sample of the tumor is extracted for further
evaluation of the cells it contains.
Epithelial mesothelioma distribution
Epithelioid mesothelioma accounts for the majority of cases.
One of the primary challenges of diagnosing epithelioid
mesothelioma is distinguishing it from other types of cancer. Cancer in
epithelial tissue could be a number of malignancies, which is why extensive
testing is important. Epithelioid mesothelioma is often confused with
adenocarcinoma, a common type of cancer that develops in the lungs, breasts and
colon. Glandular mesothelioma, an epithelial cell subtype, may resemble
adenocarcinoma of the lungs. It may be difficult to differentiate these two
conditions.
Immunohistochemistry
Immunohistochemistry is a process that detects proteins
called antibodies on the surface of cells. These proteins help classify a
cancer’s cell type. Pathologists use immunohistochemistry to identify
epithelioid mesothelioma cancer and differentiate it from adenocarcinoma.
Immunohistochemistry is used less often to differentiate sarcomatoid
mesothelioma from other sarcomatoid tumors.
QUICK FACT
Your doctor’s pathology will show the specific cell type of
your cancer. If you haven’t been told your cell type, be sure to ask your
doctor and request a copy of the pathology report for your records.
What Is the Best Epithelioid Mesothelioma Treatment?
Since epithelioid mesothelioma cells respond best to
treatment, a patient with this type may be considered for a more aggressive
treatment plan. Epithelioid patients diagnosed before the cancer has spread
throughout the chest often qualify for multimodal therapy, which attempts to
kill cancer cells using multiple types or modes of therapy. Multimodal therapy
combines the most effective anticancer treatments for mesothelioma, including
surgery, chemotherapy and radiation therapy.
Video of Karen Selby,
RN explaining epithelial mesothelioma
Patient Advocate Karen Selby explains malignant epithelioid mesothelioma.
In 1999, Dr. David Sugarbaker published impressive survival
results among a group of pleural mesothelioma patients with malignant
epithelial cells who had multimodal therapy that included an extrapleural
pneumonectomy surgery, chemotherapy and radiation therapy. About 46 percent of
patients who had epithelial cell type, no lymph node involvement and no
remaining cancer cells after surgery lived at least five years. The typical
five-year survival rate for mesothelioma cancer is around 10 percent.
Less than half of epithelioid patients qualify for
aggressive surgery and multimodal therapy. And more than half are diagnosed too
late to qualify for surgery regardless of cell type. When surgery isn’t an
option, chemotherapy is considered standard of care and clinical trials are
discussed.
Epithelioid patients have the widest variety of mesothelioma
clinical trials to choose from. Most mesothelioma trials recruit epithelioid
patients because their tumors respond best to treatment.
Have Questions About Ep
Prognosis of Epithelioid Mesothelioma Is Good
The best prognosis is associated with mesothelioma composed
of epithelioid cells. The median survival time with epithelioid mesothelioma is
about one year after diagnosis. Comparatively, patients with sarcomatoid
mesothelioma live an average of six months.
The improved prognosis is around 200 days on average, but it
could amount to years if the cancer is diagnosed in an early stage.
In 1996, a now well-known Swedish study examined tumor cell
type as a prognostic factor in 85 cases of pleural mesothelioma. Patients with
epithelioid mesothelioma survived about 200 days longer than patients with
sarcomatoid or biphasic cell types. Those with tubulopapillary cells, a subtype
of epithelial mesothelioma, lived 275 days longer than patients with other cell
types.
Overall, epithelioid mesothelioma is associated with better
response to treatment and longer survival. This cell type can open a window for
patients to access aggressive treatment plans and innovative clinical trials.
Judy Goodson, peritoneal mesothelioma survivor
I believe with my heart that those that survive are
warriors. I often joke with my friends that mesothelioma whispered in my ear,
‘You can’t handle me.’ And I told mesothelioma, ‘no, you can’t handle me.’
— Judy Goodson, peritoneal mesothelioma survivor diagnosed
in 2013
What Are the Characteristics of Epithelioid Cells?
Tumors are classified by the type and appearance of the
cells involved. Normal epithelial cells form the epithelium, which is the most
common of the four major tissue types in humans. Those types include
epithelial, connective, muscular and nervous tissue. With functions including
protection, sensory perception and fluid secretion, epithelial tissue lines
several major body cavities and most of our organs. Epithelial cells are also
present in our skin, eyes, taste buds and ears.
The structure of epithelial tissue will vary depending on
its location and function. Epithelial cells may appear thin and flat, and
shaped like cubes, hexagons or columns. When the epithelial cells turn
cancerous, they can take on several visual patterns: Epithelioid, sarcomatoid
and biphasic. Usually they lose uniformity or otherwise become atypical in
appearance, but they can also form small tubes or clusters that resemble a
raspberry.
Because epithelioid cells lack mobility and adhere closely
together, they are less likely to spread, as sarcomatoid cells do, to distant
locations. Epithelioid cells primarily spread to nearby lymph nodes and from
there migrate locally via the lymphatic system. Conversely, sarcomatoid cells
are loosely organized, and they can migrate easily, leading to quicker
metastasis.
Epithelioid cells are more common in cases of malignant
pleural mesothelioma than peritoneal mesothelioma. A certain type of
epithelioid mesothelioma occurs more commonly in women, and it’s known as
well-differentiated papillary mesothelioma. No other cell type is associated
with a particular gender, age or race.
What Are the Subtypes?
Epithelioid mesothelioma has many subtypes, each with its
own unique characteristics. Some subtypes are more likely to develop in
specific parts of the body, while others are extremely rare. While the subtype
you have won’t affect your treatment, it does help doctors tell mesothelioma
apart from similar cancers.
The following are technical descriptions of some cell
patterns doctors have observed in cases of epithelial mesothelioma.
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