Peritoneal Mesothelioma

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What Is Peritoneal Mesothelioma?

Peritoneal mesothelioma, also known as mesothelioma of the peritoneum, is a rare asbestos-related cancer that forms on the abdominal lining. About 600 cases are diagnosed each year in the United States. A rarer form of this cancer develops in the omentum, a layer of the abdominal membrane that covers the stomach and other organs.
The beginning symptoms of peritoneal mesothelioma include abdominal distension, abdominal pain, swelling or tenderness around the abdomen and constipation or diarrhea.
A peritoneal mesothelioma diagnosis is confirmed only through a biopsy. The cancer is often misdiagnosed as less serious abdominal conditions. Previous asbestos exposure and the presence of ascites can help doctors determine an accurate diagnosis.

Important Facts About Peritoneal Mesothelioma

  • It accounts for less than 20% of all mesothelioma cases.
  • Surgery with heated chemotherapy is the most effective treatment.
  • Immunotherapy for this type is available through clinical trials.
  • Surgical peritoneal patients live four times longer than the average pleural mesothelioma patient.

What Causes Peritoneal Mesothelioma?

Ingesting asbestos fibers causes malignant peritoneal mesothelioma. Researchers do not fully understand how, but they have developed theories about how asbestos fibers reach the abdomen and result in cancer.
Diagram showing the development of peritoneal mesothelioma

Development of Peritoneal Mesothelioma

  • Swallowed asbestos fibers travel from digestive system to the peritoneum.
  • Inhaled asbestos fibers reach the lymphatic system and travel to the peritoneum.
  • Once fibers are in the peritoneum, they irritate the cells and damage DNA.
  • The irritated cells begin to thicken the peritoneal lining.
  • Excess abdominal fluid builds.
  • Over time, tumors begin to form on the damaged peritoneum.
Research on other causes of peritoneal mesothelioma is scarce. Evidence shows other fibrous minerals, such as erionite, and radiation to the abdomen trigger some cases of this disease.


What Are the Symptoms of Peritoneal Mesothelioma Cancer?

The initial symptoms of peritoneal mesothelioma may mimic less serious gastrointestinal conditions. Anyone with a history of asbestos exposure should monitor their health and make a doctor appointment if they develop any of these symptoms.
Peritoneal mesothelioma symptoms include:
  • Abdominal pain or swelling
  • Diarrhea or constipation
  • Changes in bowel habits
  • A feeling of fullness
  • Night sweats or fever
  • Unexplained weight loss
  • Nausea or vomiting
  • Fatigue
  • Anemia Mesothelioma Guide

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Peritoneal Mesothelioma Staging and Life Expectancy

For decades, peritoneal mesothelioma experts developed their own staging system because an official one didn’t exist.
In 2011, researchers proposed three stages based on surgical cases. This staging system hasn’t been officially adopted because more data is required to confirm it, but many specialists use this system already.

3 Stages of Peritoneal Mesothelioma

  • Stage 1: Cancerous tissue is minimal, and tumors are contained within the abdominal lining, and lymph nodes are free of cancer.
  • Stage 2: Cancerous tissue is moderate, and tumors have not spread outside the lining or to lymph nodes.
  • Stage 3: Cancerous tissue is more extensive, and tumors may have spread outside the peritoneal lining, to lymph nodes or both.
A fourth stage is not yet clearly defined. It is generally accepted that patients with extensive tumor spreading are classified as stage 4.


Peritoneal Mesothelioma Treatment Options

Peritoneal mesothelioma is treated with chemotherapy or a combination of surgery with heated chemotherapy, also known as HIPEC (hyperthermic intraperitoneal chemotherapy).
Dr. Conway, a peritoneal mesothelioma surgeon, explains the best treatment options for long-term survival.
Dr. Conway discusses the best treatment for peritoneal mesothelioma and the potential side effects.
More than 60% patients are diagnosed too late to qualify for surgery with heated chemotherapy, which is the most effective treatment option. Chemotherapy alone is the most commonly received treatment for this type of mesothelioma.
  • Cytoreductive Surgery with Heated Chemotherapy: Cytoreductive surgery, also known as a peritonectomy, attempts to remove as much cancer as possible, then heated chemotherapy is applied locally to the abdomen before the surgery ends. Doctors only perform this procedure on a case-by-case basis. Around half of patients who undergo the procedure live five years or longer.
  • Chemotherapy: Patients who don’t qualify for surgery with heated chemotherapy can receive systemic chemotherapy alone. Chemotherapy drugs can shrink peritoneal mesothelioma tumors and slow the growth and spread of cancer. Chemotherapy drugs considered effective against peritoneal mesothelioma include pemetrexed, cisplatin, carboplatin and gemcitabine.

Palliative Treatment Options

In addition to anti-cancer treatments, many peritoneal patients receive palliative care to control symptoms and improve quality of life.
A palliative care specialist prescribes medications to control pain and side effects. They may refer patients to physical or occupational therapy or recommend complementary therapies. For example, a paracentesis procedure may be recommended to certain peritoneal patients to drain excess fluid from the abdomen.