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Biphasic Mesothelioma

A diagnosis of mesothelioma is life-altering. It’s a terminal cancer caused by asbestos exposure that happened many years earlier.

But it doesn’t end with that diagnosis. From there, one needs to figure out which mesothelioma cell type is involved. There are three:

  • Epithelial (link to new Epithelial page)
  • Sarcomatoid (link to new Sacromatiod page)
  • Biphasic

Biphasic mesothelioma is not so much its own separate type as a mix of sarcomatoid and epithelial mesothelioma cells. Because sarcomatoid mesothelioma is known to be much more aggressive than epithelial mesothelioma, the prognosis and treatment for biphasic mesothelioma patients will depend largely on the ratio of sarcomatoid to epithelial cells.

At The Law Offices of Jeffrey S. Glassman, our mesothelioma attorneys know that with all these terms swimming around in their heads and their bodies growing weaker, mesothelioma patients are often reeling. Their families may be stunned and unsure of what to do next. The first order of business, of course, is to tend to one’s health. Legal action, however, should not be overlooked.

The truth of the matter is treatment for biphasic mesothelioma is expensive, and patients can sometimes live for several more years. Some of avenues of financial relief may include:

Knowing that you and your loved ones will be financially secure in your last days can give you great peace of mind. It’s also important to hold accountable those entities that may have denied you and other workers and individuals important information about the dangers of asbestos or your risk of exposure. This kind of action ensures companies think twice about such actions in the future.

What is Biphasic Mesothelioma?

Biphasic mesothelioma is sometimes referred to as “mixed mesothelioma,” and is one of three major cell types when it comes to mesothelioma.

If you’re reading this, you probably know that mesothelioma is cancer of the mesothelial tissue, which lines the major organs of the chest and abdomen. Most typically, we see it arise in the tissue surrounding the lungs, stomach and intestines. It is a rare, aggressive cancer that is caused by exposure asbestos. There is no known cure and the prognosis is poor.

Epithelial mesothelioma is the type of this cancer associated with the best outcomes. Sarcomatoid mesothelioma is known to have the worst. Because biphasic mesothelioma is a mixture of the two, afflicted individuals may have varying outcomes, depending on which cells are more dominant: the epithelial or the sarcomatoid.

Some things to know about biphasic mesothelioma:

  • It’s the second most-common type of mesothelioma, behind epithelial mesothelioma, accounting for between 20 and 40 percent of all mesothelioma diagnoses.
  • Gleaning only small amounts of biopsy tissue could easily lead to a misdiagnosis, as it may not reveal the presence of both types of cells.
  • One of two cells generally comprises the majority of biphasic cases.
  • Median survival rates are typically between 10 and 15 months after diagnosis.

In many cases, the epithelial and the sarcomatoid cells exist in separate areas of the tumor or even in separate areas of the body. Where the epithelioid cells are more common, we tend to see the mesothelioma tumor spreading locally. Where the sarcomatoid cells are dominant, we see both local and distant metastases.

Diagnosis of Biphasic Mesothelioma

Mesothelioma on its own is prone to misdiagnosis or missed diagnosis because:

  • It’s relatively rare, in comparison to other forms of cancer.
  • The symptoms mirror many other conditions that are far less serious.
  • The disease occurs decades after the causal toxic exposure occurred.

If a doctor does not know or has no reason to suspect a history of asbestos exposure, it may not be on their radar as a possible diagnosis.

Biphasic mesothelioma is particularly prone to misdiagnosis or missed diagnosis because not only is it a form of this rarer cancer, it contains elements of both cellular types.

Most early biopsies, those conducted before a curative surgery, result in doctors taking a small sample of tissue. But because epithelial and sarcomatoid cells tend to grow in different locations of the same tumor, doctors may only see one or the other. It’s estimated that approximately 20 to 50 percent of patients with biphasic mesothelioma or initially diagnosed with epithelioid mesothelioma.

Needle biopsies are believed to be less accurate than thoracotomy (surgical incision in the chest wall) in diagnosing biphasic mesothelioma. These kinds of inaccuracies may seem incidental when you’re talking about a disease that is terminal no matter what. However, it can potentially result in precious time lost where time is not a resource one can afford.

To avoid this, some doctors will use a technique known as “immunohistochemistry.” This method, according to the National Cancer Institute, has been shown to detect specific proteins that may be present in both types of cells.

Doctors also use immunohistochemistry to rule out other types of diseases that could look very similar to biphasic mesothelioma, such as carcinosarcoma and synovial sarcoma. One study published in the journal Case Reports in Pulmonology by researchers at the Cleveland Clinic revealed how biphasic malignant pleural mesothelioma could “masquerade” as a primary skeletal tumor.

That is why it is important to have an expert pathologist to analyze the biopsy samples. The World Health Organization outlines that in order for a doctor to diagnose biphasic mesothelioma, there must be at least 10 percent of epithelial and sarcomatoid cells.

Treatment of Biphasic Mesothelioma

Unfortunately, patients with biphasic mesothelioma may have a poorer prognosis than those with epithelial mesothelioma, which means they may not be candidates for the same types of treatment. But this depends again on the ratio of epithelial to sarcomatoid cells.

It will also depend on the stage and location of the tumor. Mesothelioma cell type is important, though, in determining the aggressiveness of the treatment plan. In general, epithelial cells respond better to treatments such as surgery and radiation than do sarcomatoid cells. Therefore, biphasic mesothelioma patients with more epithelial cells will have a slightly better prognosis and may want to pursue a more aggressive treatment plan than someone with more sarcomatoid cells, who may be directed toward more palliative (pain relieving) treatments.

Contact the Law Offices of Jeffrey S. Glassman today for a free and confidential consultation.

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