Mesothelioma develops in the mesothelium, a thin membrane that lines several body cavities. The four types are named for their location: pleural (lungs), peritoneal (abdomen), pericardial (heart), and testicular. Each type presents unique challenges for diagnosis and treatment.

Pleural Mesothelioma

75% of cases

Location: Lungs

Develops in the pleura (lining around the lungs). Most common type.

Common symptoms:
  • Chest pain
  • Shortness of breath
  • Persistent cough
  • Fluid buildup

Prognosis: 12-21 months median survival

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Peritoneal Mesothelioma

20% of cases

Location: Abdomen

Develops in the peritoneum (abdominal lining). Second most common.

Common symptoms:
  • Abdominal pain
  • Swelling
  • Nausea
  • Weight loss

Prognosis: 53+ months with HIPEC surgery

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Pericardial Mesothelioma

<1% of cases

Location: Heart

Develops in the pericardium (heart lining). Extremely rare.

Common symptoms:
  • Chest pain
  • Heart palpitations
  • Difficulty breathing
  • Fatigue

Prognosis: 6-10 months median survival

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Testicular Mesothelioma

<1% of cases

Location: Testes

Develops in the tunica vaginalis (testicular lining). Rarest type.

Common symptoms:
  • Testicular swelling
  • Painless lumps
  • Hydrocele

Prognosis: 20-23 months median survival

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How Type Affects Treatment

The location of mesothelioma determines which treatment approaches are possible:

  • Pleural mesothelioma — May be treated with pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP), along with chemotherapy and radiation
  • Peritoneal mesothelioma — Often treated with cytoreductive surgery and HIPEC (heated chemotherapy), which has significantly improved survival rates
  • Pericardial mesothelioma — Treatment is challenging due to location; may include pericardiectomy and systemic chemotherapy
  • Testicular mesothelioma — Typically treated with surgery (orchiectomy); may include chemotherapy if cancer has spread
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Cell Types Also Matter

In addition to location, mesothelioma is classified by cell type, which also affects prognosis:

  • Epithelioid — Most common (50-70%), best prognosis, responds well to treatment
  • Sarcomatoid — Least common (10-20%), most aggressive, harder to treat
  • Biphasic — Mix of both cell types (20-30%), prognosis depends on ratio
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Why Location Matters for Diagnosis

The type of mesothelioma affects how the disease is diagnosed:

  • Pleural mesothelioma is often found during chest X-rays or CT scans
  • Peritoneal mesothelioma may be discovered during abdominal imaging or surgery
  • Pericardial mesothelioma is frequently diagnosed only after symptoms become severe
  • Testicular mesothelioma is often found incidentally during surgery for other conditions

All types require tissue biopsy for definitive diagnosis, as mesothelioma can be confused with other cancers.