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Understanding Metastatic Sarcomatoid Mesothelioma | Causes, Symptoms, and Treatment Options



Mesothelioma is a rare and aggressive cancer that affects the lining of the chest cavity, abdomen, or heart. It is primarily caused by exposure to asbestos, a mineral widely used in the construction and manufacturing industries before its harmful effects were known. While various subtypes of mesothelioma exist, sarcomatoid mesothelioma stands out as a particularly challenging form due to its aggressive nature and limited treatment options.

In this comprehensive review, we will delve into the complexities of metastatic sarcomatoid mesothelioma, examining its characteristics, diagnostic challenges, current treatment strategies, and emerging research avenues. Our goal is to provide a thorough understanding of this enigmatic disease and offer insights into its management to improve patient outcomes.

What is Metastatic Sarcomatoid Mesothelioma?

Metastatic sarcomatoid mesothelioma is a subtype of mesothelioma characterized by spindle-shaped cells resembling those found in sarcomas. It is also known as sarcomatous mesothelioma, and it comprises approximately 10-20% of all mesothelioma cases. This subtype is considered the most aggressive and difficult to treat, with a median survival rate of only 5-8 months.

Sarcomatoid mesothelioma can present in any part of the body that is lined by mesothelial tissue, such as the pleura, peritoneum, and pericardium. However, it most commonly affects the pleural cavity, which is the space between the lungs and the chest wall. The disease typically presents with advanced-stage disease, making it challenging to diagnose and treat effectively.

Causes of Metastatic Sarcomatoid Mesothelioma

The primary cause of metastatic sarcomatoid mesothelioma is exposure to asbestos. Asbestos is a naturally occurring mineral that was widely used in various industries due to its heat-resistant and insulating properties. When asbestos fibers are inhaled or ingested, they can become lodged in the lining of the lungs, abdomen, or heart, causing irritation and inflammation over time.

The exact mechanisms by which asbestos exposure leads to mesothelioma development are still not fully understood. However, it is believed that the fibers cause DNA damage and mutations in the cells, leading to cancerous growth. It is also thought that chronic inflammation caused by asbestos fibers contributes to the development of mesothelioma.

Apart from asbestos exposure, other risk factors for developing metastatic sarcomatoid mesothelioma include genetic predisposition, radiation exposure, and certain chemical exposures. However, these factors are not as strongly linked to the disease as asbestos exposure.

Symptoms of Metastatic Sarcomatoid Mesothelioma

Symptoms of metastatic sarcomatoid mesothelioma can vary depending on the location of the tumor. In most cases, patients do not experience any symptoms until the disease has progressed to an advanced stage. Some common symptoms associated with this subtype include:

  • Chest pain
  • Shortness of breath
  • Chronic cough
  • Unexplained weight loss
  • Fatigue
  • Difficulty swallowing
  • Abdominal pain
  • Nausea and vomiting
  • Swelling of the abdomen
  • Irregular heartbeat
  • Pericardial effusion (fluid buildup around the heart)

It is essential to note that these symptoms are nonspecific and can be present in other diseases as well. This makes it challenging to diagnose sarcomatoid mesothelioma at an early stage, as the symptoms can be mistaken for other more common conditions. However, if you have a history of asbestos exposure and experience any of these symptoms, it is crucial to seek medical attention immediately.

Diagnosis of Metastatic Sarcomatoid Mesothelioma

Diagnosing metastatic sarcomatoid mesothelioma is often a challenging and time-intensive process. It requires a combination of imaging tests, blood tests, and biopsies to confirm the presence of cancer cells and determine the disease’s extent.

Imaging Tests

The first step in diagnosing metastatic sarcomatoid mesothelioma is typically an imaging test, such as a chest X-ray, CT scan, or MRI scan. These tests can show any abnormalities in the affected area, such as fluid accumulation, thickening of the lining, or tumor growth.

Blood Tests

While there is currently no blood test that can definitively diagnose mesothelioma, several biomarkers can indicate its presence. These include soluble mesothelin-related peptide (SMRP) and osteopontin levels. However, these markers are not specific to sarcomatoid mesothelioma and may be elevated in other types of cancer as well.


A biopsy is the most critical step in diagnosing metastatic sarcomatoid mesothelioma. It involves removing a small sample of tissue from the affected area for examination under a microscope. The biopsy can be performed via different methods, including needle biopsy, thoracoscopy, laparoscopy, or open surgery. The type of biopsy performed will depend on the location of the tumor and the patient’s overall health.

Once a biopsy has been performed, a trained pathologist will examine the tissue sample for the presence of mesothelioma cells. They may also perform additional tests to determine the subtype of mesothelioma present, such as immunohistochemistry or electron microscopy.

Treatment Options for Metastatic Sarcomatoid Mesothelioma

Due to its aggressive nature, metastatic sarcomatoid mesothelioma is difficult to treat and has a poor prognosis. Treatment options for this subtype are limited, and the goal is often to improve symptoms and prolong survival as much as possible.


Surgery is the most effective treatment option for mesothelioma, but it is not always a viable option for metastatic sarcomatoid mesothelioma. The aggressive nature of this subtype means that the cancer has often spread beyond the primary site by the time of diagnosis, making surgery less effective at removing all cancerous cells.

In cases where the tumor is still localized, surgery may be recommended to remove as much of the cancer as possible. This can involve removing the affected lung (pneumonectomy) or part of the lining of the chest cavity (pleurectomy). However, even with surgery, there is a high risk of recurrence due to the aggressive nature of this subtype.


Chemotherapy involves using powerful drugs to kill cancer cells and slow down tumor growth. It is often the first-line treatment for metastatic sarcomatoid mesothelioma, either alone or in combination with other treatments. While chemotherapy cannot cure the disease, it can help alleviate symptoms and improve quality of life.

The most commonly used chemotherapy drugs for sarcomatoid mesothelioma include cisplatin, carboplatin, gemcitabine, and pemetrexed. These drugs have been shown to be more effective when used in combination rather than alone.

Radiation Therapy

Radiation therapy uses high-energy X-rays to destroy cancer cells and shrink tumors. It is often used alongside surgery or chemotherapy to target any remaining cancer cells after these treatments. However, radiation therapy is not a curative treatment for mesothelioma and is typically used to manage symptoms such as pain and difficulty breathing.

Emerging Treatment Options

Clinical trials are ongoing to evaluate the efficacy of new treatment options for metastatic sarcomatoid mesothelioma. These include immunotherapy, which uses the body’s immune system to fight cancer cells, and targeted therapy, which targets specific genes or proteins involved in cancer development.

While these treatments are still in the early stages of research, they offer hope for improved outcomes for patients with metastatic sarcomatoid mesothelioma.

Prognosis and Survival Rates

Unfortunately, the prognosis for metastatic sarcomatoid mesothelioma is extremely poor. Due to the aggressive nature of this subtype and its limited treatment options, the median survival rate is only 5-8 months from the time of diagnosis. This means that most patients will not survive past one year after their diagnosis.

The low survival rates can be attributed to the late-stage at which this subtype is usually diagnosed, making it challenging to treat effectively. Additionally, the disease is highly resistant to traditional treatments such as chemotherapy and radiation therapy, further reducing the chances of survival.


Metastatic sarcomatoid mesothelioma is a rare, aggressive, and difficult-to-treat subtype of mesothelioma. It is primarily caused by exposure to asbestos and has a poor prognosis, with a median survival rate of only 5-8 months. However, ongoing research offers hope for improved treatment options and better outcomes for patients with this enigmatic disease.

Early detection and diagnosis are crucial in improving the prognosis for metastatic sarcomatoid mesothelioma. If you have a history of asbestos exposure and experience any symptoms associated with this subtype, seek medical attention immediately. And for those currently battling this disease, know that you are not alone, and there is always hope.

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