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Important Facts About Peritoneal Mesothelioma

  • The peritoneum is a sheet-like membrane surrounding your abdominal cavity.
  • Peritoneal mesothelioma accounts for between 10% and 15% of all mesothelioma cases. It is the second most common type of mesothelioma.
  • Peritoneal mesothelioma patients have longer life expectancies than those with other types of mesothelioma.
  • The average age for patients is 57, and 56% are male.

What Is Malignant Peritoneal Mesothelioma?

Malignant peritoneal mesothelioma is a cancerous, fast-spreading disease. It will likely spread throughout the abdomen if not treated quickly.

Malignant peritoneal mesothelioma causes abnormal mesothelial cells to divide uncontrollably. They then attack your body tissue and form cell clumps called tumors.

Tumors can be malignant (cancerous) or benign (not cancerous). Benign mesothelioma is not actively spreading.

Causes of Peritoneal Mesothelioma

Asbestos exposure is the only proven cause of peritoneal mesothelioma. The cancer is associated with ingesting (swallowing) asbestos.

Dr. Shanel Bhagwandin, a peritoneal mesothelioma specialist, explained how fibers reach the abdomen.

“As far as how (asbestos fibers) might reach the abdomen and result in cancer, it could be anything from swallowing the fibers and they travel through the digestive track and reach the peritoneum.”

— Dr. Shanel Bhagwandin

The average age for peritoneal mesothelioma patients is 57, and approximately 56% are male. Peritoneal mesothelioma affects females more than pleural mesothelioma does.

How Does Peritoneal Mesothelioma Develop?

Peritoneal mesothelioma develops through a multi-step process. It starts with asbestos fibers entering the body and ends with genetic changes to cells:


Asbestos fibers are inhaled or ingested (most often ingested).


The sharp fibers lodge into tissue along either side of your peritoneum.


Genetic damage prevents cells from regulating their replication, which causes tumors to form.

Pleural mesothelioma spreads to lymph nodes in the chest, but malignant peritoneal mesothelioma usually remains in the abdomen. Organs in this area are at risk.

How Is Peritoneal Mesothelioma Treated?

There are two primary treatment options for peritoneal mesothelioma: surgery and chemotherapy. Immunotherapy for peritoneal mesothelioma has not yet been approved by the FDA, but many specialists support this treatment method.



Cytoreduction is the primary surgical option for peritoneal mesothelioma. This involves debulking, or removing macroscopic tumors. Surgeons also remove the patient’s peritoneum.



Chemotherapy is a common treatment for peritoneal mesothelioma. There are two methods: intravenous or intraperitoneal.

Peritoneal Mesothelioma Symptoms

The symptoms of peritoneal mesothelioma are associated with the abdomen. However, patients may not experience symptoms right away. This is called peritoneal ascites and causes swelling of the stomach. Patients may not experience symptoms right away. The cancer is often undetectable until it has spread.One common symptom is the buildup of fluid in the abdomen. This is called ascites and causes swelling of the stomach.

Other symptoms include:

  • Abdominal pain
  • Constipation
  • Bowel issues
  • Nausea
  • Vomiting
  • Fever or sweating
  • Tissue lumps

Since the peritoneal cancer forms close to the abdomen, it often metastasizes to organs within this cavity, such as the liver or intestines.

Peritoneal Mesothelioma Diagnosis

Diagnosing peritoneal mesothelioma is difficult since symptoms are shared by other health concerns. Peritoneal mesothelioma can be confused with abdominal distension (gas) and irritable bowel syndrome.

X-rays and computed tomography (CT) scans help detect peritoneal mesothelioma. A PET scan or MRI may follow.

Doctors may use a technique called peritoneoscopy as a biopsy. Surgeons make a small incision on the patient’s abdomen and use a camera to explore the abdominal area. There is also a tool on the camera that helps to extract tissue to test for peritoneal mesothelioma.

Removing tissue for a biopsy is the most surefire way to diagnose mesothelioma.

Peritoneal Cancer Index

Mesothelioma staging differs based on the type of the disease. For pleural mesothelioma, doctors assign a number between 1 and 4. Stage 1 is the least severe and stage 4 is the most severe.

Specialists use a separate system for peritoneal mesothelioma: the peritoneal cancer index, which scores the disease spread within the abdominal cavity.

13 Sections of the Abominal Cavity

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There are 13 sections of the cavity and each one receives a score between 0 and 3. The score depends on the size and amount of tumors in that space. A score of 0 means no cancer exists in that section, and a score of 3 means cancer has overtaken it. The scores are added up to a total, which is assigned to a stage:

PCI Score


1 - 10

11 - 20

21 - 30

31 and higher

Stage 1

Stage 2

Stage 3

Stage 4

Sample PCI Score Chart

sample stages

PCI Score


1 - 10

11 - 20

21 - 30

31 and higher

Stage 1

Stage 2

Stage 3

Stage 4

PCI Score: 8

Stage 1

The score and equivalent stage helps specialists determine the treatment. Curative treatment options, like cytoreduction surgery, are typically for patients in an early stage.

Patients with a more advanced disease receive palliative treatments. An example of palliative treatment is paracentesis, which drains fluid from the abdomen.

Surgery for Peritoneal Mesothelioma

The primary surgery option for peritoneal mesothelioma is cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.



Cytoreduction is often combined with heated intraperitoneal chemotherapy (HIPEC).

The goal of cytoreduction is to remove as many of the tumors as possible. This operation also involves removing the peritoneum and possibly part of the intestines and more organs.

Cytoreduction is a laborious procedure, taking surgeons up to 12 hours to complete.

Inpatient recovery can take anywhere from 1-2 weeks. Once patients return home, they may need a few more weeks for full recovery. Post-surgery effects such as bowel issues and fatigue could last for months.

Heated Intraperitoneal Chemotherapy (HIPEC)

HIPEC is used in patients who have cancers of the abdomen. High doses of chemotherapy are used to kill any remaining malignant peritoneal mesothelioma cells left after cytoreduction. HIPEC is a heated and sterilized treatment.

Dr. Paul Sugarbaker innovated cytoreduction with HIPEC for malignant peritoneal mesothelioma.

The side effects are less damaging to the patient than regularly administered chemotherapy. The drugs are delivered directly into the abdomen and don't travel through the bloodstream. Due to this, the drugs attack the cells in the area where cancer resides, not in healthy body parts.

HIPEC Treatment in Action

HIPEC treatment may vary depending on the facility. The MD Anderson Cancer Center website says surgeons heat cisplatin to 103 degrees Fahrenheit. They then rock the patient back and forth to ensure the drug washes the entire abdomen.

According to the cancer center, around 90% of the liquid cisplatin stays within the abdominal cavity. This reduces the negative effects on other body areas.

A study conducted by Dr. Sugarbaker proved cytoreduction and HIPEC is successful for treating malignant peritoneal mesothelioma. Of 405 patients in the study, 60% had a three-year survival rate, and 47% had a five-year survival rate. The overall median survival was 53 months.

Chemotherapy for Peritoneal Mesothelioma

Peritoneal mesothelioma chemotherapy is a common treatment method for this cancer. Peritoneal patients may receive a combination of pemetrexed and cisplatin. These two chemotherapy drugs are approved by the U.S. Food and Drug Administration for mesothelioma.

A combination of both chemotherapy drugs is usually best. In one study, 41% of patients who were given the combination experienced improvement. Only 17% showed satisfactory results after receiving just cisplatin.

On average, the combination of pemetrexed and cisplatin helped patients live 12.1 months longer compared to no chemotherapy.

Studies are also testing other chemotherapy drugs — such as vinorelbine and gemcitabine — with cisplatin.

Peritoneal Mesothelioma Prognosis

Although there isn't a cure for malignant mesothelioma, many patients have a hopeful peritoneal mesothelioma prognosis.

There are cases of long-term survivors in remission for more than 15 years. Kendra Ferreira, for instance, was diagnosed in 2001 and has far outlived her mesothelioma prognosis.

The most successful cases involve detection in the earlier stages. Early diagnosis means treatment begins immediately. According to a study, the five-year survival for patients diagnosed with stage 1 (PCI score of 1-10) was 87%.

In an analysis of 2,000 peritoneal mesothelioma patients registered in the National Cancer Database, radical surgery plus systemic chemotherapy led to median survival of 41 months. Patients who didn’t receive surgery often survived for less than one year.

Learn how mesothelioma survivors beat the odds in our free Mesothelioma Survivors Guide. You’ll read the stories of multiple people who have outlasted their mesothelioma prognosis and continue to live enriching lives.

Veterans With Peritoneal Mesothelioma

Veterans comprise the largest group of people who have mesothelioma. Approximately one-third of U.S. mesothelioma cases are former military members.

The U.S. Department of Veterans Affairs (VA) offers numerous benefits to veterans who have peritoneal mesothelioma. If the disease formed due to service-related asbestos exposure, then the veteran could receive Disability Compensation.

If you are a veteran with peritoneal mesothelioma — or a survivor of a veteran who passed away due to this cancer — our VA Accredited Claims Agent can help you. Contact us today or request our free Veterans Support Guide.

Frequently Asked Questions About Peritoneal Mesothelioma

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What are the symptoms of peritoneal mesothelioma?

The symptoms of peritoneal mesothelioma include fluid buildup in the peritoneum (ascites), abdominal pain, fever, night sweats, loss of appetite, abdominal swelling, fatigue, nausea and risk of seizures.

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Is peritoneal mesothelioma curable?

Peritoneal mesothelioma is not curable currently, but experts continue to look for a permanent solution to this cancer. Patients can live long past their prognosis with help from a mesothelioma specialist.

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How long do peritoneal mesothelioma patients live?

Peritoneal mesothelioma patients usually live for around one year. However, there are stories of patients living for 5, 10 or even 15 years after their diagnosis.

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How can you treat peritoneal mesothelioma?

You can treat peritoneal mesothelioma with a combination of cytoreductive surgery with heated intraperitoneal chemotherapy. The survival rates for this approach are around five years.

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What causes peritoneal mesothelioma?

Exposure to asbestos causes peritoneal mesothelioma. If inhaled or swallowed, asbestos can irritate cells in the peritoneum, which is located near your abdomen.

Last Edited: June 1, 2023.

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