Epithelioid Mesothelioma
Epithelioid is the most common mesothelioma cell type, making up 50-70% of cases. It responds best to surgery and chemotherapy, with survival of 14-19 months.
Overview
Epithelioid cells grow more slowly than other types and tend to cluster together rather than spreading rapidly. This makes treatment more effective. Patients with epithelioid mesothelioma have the best prognosis of all cell types.
Characteristics
- Uniform, cube-shaped or oval cells
- Well-defined cell boundaries
- Cells tend to stick together in clusters
- Slower growth rate compared to other types
- Less likely to metastasize quickly
- Most responsive to standard treatments
Subtypes
Tubulopapillary
Forms tube-like structures; associated with better prognosis
Acinar
Forms gland-like clusters; moderate prognosis
Solid
Dense sheets of cells; less favorable than other epithelioid subtypes
Trabecular
Cells arranged in cords or ribbons
Micropapillary
Small papillary structures; may indicate poorer prognosis
Diagnosis
Accurate cell type identification is critical for treatment planning. Diagnosis typically involves:
- Tissue biopsy analyzed by pathologist
- Immunohistochemistry staining (calretinin, WT1, D2-40 positive)
- Distinguished from adenocarcinoma using marker panels
- May require second opinion from specialized pathologist
Treatment Options
Treatment for epithelioid mesothelioma may include:
- Surgery often recommended (pleurectomy or EPP)
- Best response to chemotherapy (pemetrexed + cisplatin)
- Immunotherapy effective (CheckMate 743 trial)
- Multimodal therapy typically offers best outcomes
- Clinical trials widely available
Prognosis
Patients with epithelioid mesothelioma who undergo surgery may survive 2-4 years or longer. The slower growth and localized tumors make aggressive treatment worthwhile for many patients.
Learn about mesothelioma prognosis factors →Getting a Second Opinion
Because cell type significantly affects treatment options and prognosis, obtaining a second opinion on your pathology results from a mesothelioma specialist is often recommended. Pathologists with mesothelioma experience are more likely to accurately identify cell type, subtypes, and any unusual features that may affect your treatment plan.
Cell Type Q&A
Frequently Asked Questions
What is the survival rate for epithelial mesothelioma?
Epithelioid (epithelial) mesothelioma has the most favorable outlook among mesothelioma cell types, but survival varies widely by stage, treatment, and tumor location. Large registry analyses report a general 5‑year survival rate for mesothelioma of about 10% to 12%, although people with epithelioid disease typically live longer than those with sarcomatoid or biphasic types. For epithelioid mesothelioma treated with surgery, recent data show about a 45% 2‑year survival rate and a 14% 5‑year survival rate. Some sources report average survival of roughly 18 months for people with epithelioid mesothelioma overall, with ranges from about 1.5 to 6.5 years when the cancer is diagnosed earlier and treated aggressively.
How did Steve McQueen get mesothelioma?
Steve McQueen was exposed to asbestos through multiple occupational and military sources over several decades. His primary exposure occurred during his service in the U.S. Marine Corps from 1947 to 1950, when he worked aboard naval ships and in shipyards, including removing asbestos lagging from pipes at Camp Lejeune. After his military service, he encountered additional asbestos exposure on movie soundstages where insulation contained the mineral, while wearing flame-resistant racing suits made with asbestos, and while working on race car and motorcycle brakes. McQueen did not develop symptoms until 1978, nearly 30 years after his initial military exposure, reflecting the typical latency period of 20 to 50 years between asbestos exposure and mesothelioma diagnosis. He was diagnosed with pleural mesothelioma in December 1979 and died in November 1980 at age 50.
How do you treat epithelial mesothelioma?
Treatment for epithelioid mesothelioma commonly combines surgery, chemotherapy, immunotherapy, and sometimes radiation, depending on where the cancer is and whether it can be removed. Current guidelines list pemetrexed plus cisplatin or carboplatin as a standard chemotherapy backbone, and they also include ipilimumab plus nivolumab as a first-line option for newly diagnosed epithelioid pleural mesothelioma. For people with resectable pleural disease, lung-sparing pleurectomy/decortication is often used, while peritoneal disease is often treated with cytoreductive surgery plus HIPEC. Studies also show that epithelioid cells tend to respond better to multimodal treatment than other mesothelioma cell types.
What are 5 signs and symptoms of mesothelioma?
Five frequently reported signs and symptoms of mesothelioma include chest pain, shortness of breath, persistent cough, fatigue, and unintended weight loss , ,. These symptoms are most often linked to pleural mesothelioma but can occur with other mesothelioma types as well ,. Fluid buildup around the lungs (pleural effusion) is also very common in people with pleural mesothelioma and often drives chest pain and breathing difficulty ,. Because these problems overlap with many other conditions, researchers note that mesothelioma is often diagnosed at a later stage ,. **Sources:** Cleveland Clinic , American Lung Association , Mayo Clinic.