Written By: Devin Golden

Malignant Peritoneal Mesothelioma

Peritoneal mesothelioma is a rare cancer that forms in the thin lining of the abdomen (the peritoneum). It is caused by ingesting (swallowing) sharp asbestos fibers.

Karen Ritter, RN BSN

Medically Reviewed By

Karen Ritter, RN BSN

Registered Nurse


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peritoneal intro

Important Facts About Malignant Peritoneal Mesothelioma

  • Peritoneal mesothelioma is a cancer of the peritoneum, which is a sheet-like membrane surrounding your abdominal cavity.
  • Peritoneal mesothelioma accounts for between 10% and 15% of all mesothelioma cases, making it the second most common form of mesothelioma.
  • Peritoneal mesothelioma patients have longer life expectancies than those with other types of mesothelioma.
  • The average age for patients with malignant peritoneal mesothelioma 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.

Peritoneal mesothelioma causes abnormal mesothelial cells to divide uncontrollably. These fast growing cells attack your body tissue and form clumps of cells called tumors.

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

Causes of Peritoneal Mesothelioma

Exposure to asbestos is the only known cause of malignant mesothelioma. The main types of mesothelioma include pleural and peritoneal mesothelioma. This type of cancer is associated with inhaling (breathing in) or 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 a history of asbestos exposure. Asbestos fibers enter the body and ends with genetic changes to cells:


Asbestos fibers are inhaled or 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.

Malignant pleural mesothelioma spreads to lymph nodes in the thoracic cavity, but malignant peritoneal mesothelioma usually remains in the abdomen. Organs in this area are at risk.

Treatment of Peritoneal Mesothelioma

The standard treatment options for peritoneal mesothelioma include surgery and chemotherapy. There are additional treatments that are available to patients through clinical trials. Finding cancer treatment from a specialist is a crucial step after receiving a diagnosis of peritoneal mesothelioma.



Cytoreduction surgery is the primary treatment option for peritoneal mesothelioma. This involves debulking, or removing all visible tumors and any diseased tissue. Surgeons also often remove the patient’s peritoneum, where peritoneal mesothelioma forms.



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

Symptoms of Peritoneal Mesothelioma

Symptoms of peritoneal mesothelioma may not occur right away. The cancer is often undetectable until it has developed large tumors or the cancer has spread throughout the peritoneal cavity. One common symptom is the buildup of fluid in the abdomen, called ascites.

Other symptoms may include:

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

Peritoneal Mesothelioma Diagnosis

Diagnosing peritoneal mesothelioma can be difficult since symptoms are often similar to other health conditions. Mesothelioma of the peritoneum can be confused with abdominal distension (gas) and irritable bowel syndrome.

To obtain an accurate diagnosis of peritoneal mesothelioma doctors rely on abdominal X-rays, CT Scans (computed tomography), MRI’s and PET scans.

Peritoneal mesothelioma is diagnosed with a tissue biopsy. Doctors may choose to use a laparoscopy, or peritonoscopy, to perform the biopsy. Surgeons make small incisions in the patient’s abdomen and then use a camera to explore the abdominal cavity. There are small instruments that can be inserted through the small incisions to help extract tissue samples to test for peritoneal 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 staging system for peritoneal mesothelioma: they use 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 help specialists determine the treatment. Curative treatment options, like cytoreduction surgery, are typically for patients in an early stage.

Patients with 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 Surgery

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 hyperthermic intraperitoneal chemotherapy for peritoneal cancers, or cancer of the abdomen. High doses of chemotherapy are used to help kill cancer cells remaining 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, the intraperitoneal chemotherapy for peritoneal mesothelioma, 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

Patients with peritoneal mesothelioma may receive a combination of pemetrexed and cisplatin. These two chemotherapy drugs are approved by the U.S. Food and Drug Administration for peritoneal mesothelioma treatment.

A combination of both chemotherapy drugs is usually best. In one study, 41% of patients who were given the combination experienced improved survival. 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 Survival Rates

Although there isn’t a cure for peritoneal mesothelioma, many patients have a hopeful 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.

If you would like more information about mesothelioma and your treatment options contact one of our patient advocates. You can email our registered nurse, Karen Ritter, at karen@mesotheliomaguide.com.

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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How is a patient diagnosed with peritoneal mesothelioma?

Peritoneal mesothelioma symptoms are often nonspecific and can be similar to other health conditions. Peritoneal mesothelioma is a rare cancer so it is important to identify your symptoms and seek a medical evaluation and testing.

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What is the prognosis for peritoneal mesothelioma patients?

The average life expectancy for peritoneal mesothelioma is around one year, but early detection and aggressive treatment can lead to survival lengths of five or more years. Women and younger patients tend to live for longer. There is currently no cure for peritoneal mesothelioma.

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How does peritoneal mesothelioma form?

Asbestos exposure is the only known link to peritoneal mesothelioma. Loose, sharp fibers pierce into cell linings and irritate tissue, which can cause genetic mutations. When asbestos particles are inhaled or swallowed, they can reach the peritoneum. This thin membrane, which lines the abdominal cavity, is where peritoneal mesothelioma forms.

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Who is most likely to get peritoneal mesothelioma?

Males make up a little more than half of the people with peritoneal mesothelioma. The average age of patients is around 52. People who worked with asbestos — or the loved ones of exposed to asbestos — are most at risk of this cancer.

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How is peritoneal mesothelioma treated?

Doctors use a combination of surgery and chemotherapy to achieve the best overall survival for people with peritoneal mesothelioma. The method is cytoreduction with hyperthermic intraperitoneal chemotherapy. Most cancer centers do not use radiation to treat peritoneal mesothelioma because of the potential harm to vital organs.

Sources & Author

    1. Malignant peritoneal mesothelioma: Epidemiology, risk factors, clinical presentation, diagnosis, and staging. UpToDate. Retrieved from: https://www.uptodate.com/contents/malignant-peritoneal-mesothelioma-epidemiology-risk-factors-clinical-presentation-diagnosis-and-staging?search=mesothelioma%20statistics&source=search_result&selectedTitle=1~74&usage_type=default&display_rank=1. Accessed: 03/19/19.
    2. Signs and Symptoms of Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/signs-symptoms.html. Accessed: 04/10/19.
    3. Mesothelioma: Symptoms and Signs. American Society of Clinical Oncology. Retrieved from: https://www.cancer.net/cancer-types/mesothelioma/symptoms-and-signs. Accessed: 04/10/19.
    4. Tests for Malignant Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/how-diagnosed.html. Accessed: 04/10/19.
    5. Determining the Peritoneal Cancer Index. HIPEC.com. Retrieved from: http://www.hipec.com/knowledge-base/determining-the-peritoneal-cancer-index/. Accessed: 04/12/19.
    6. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma: patient selection and special considerations. Cancer Management and Research. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6511620/#CIT0023. Accessed: 02/4/20.
    7. HIPEC Surgery – What to Expect. Tufts Medical Center. Retrieved from: https://www.tuftsmedicalcenter.org/patient-care-services/Departments-and-Services/Cancer-Center/Clinical-Care-Services/Peritoneal-Surface-Malignancy-Program/What-to-Expect-After-HIPEC-Surgery. Accessed: 05/15/19.
    8. Hyperthermic Intraperitoneal Chemotherapy. MD Anderson Cancer Center. Retrieved from: https://www.mdanderson.org/treatment-options/hyperthermic-intraperitoneal-chemotherapy.html. Accessed: 03/13/18.
    9. Malignant peritoneal mesothelioma: Treatment. UpToDate. Retrieved from: https://www.uptodate.com/contents/malignant-peritoneal-mesothelioma-treatment?source=bookmarks_widget. Accessed: 03/13/18.
    10. Life Expectancy in Pleural and Peritoneal Mesothelioma. Lung Cancer International. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292397/. Accessed: 03/19/19.
    11. Molecular Pathways and Diagnosis in Malignant Mesothelioma: A Review of the 14th International Conference of the International Mesothelioma Interest Group. Lung Cancer. Retrieved from: https://www.researchgate.net/publication/329200715_Molecular_Pathways_and_Diagnosis_in_Malignant_Mesothelioma. Accessed: 03/19/19.
    12. Predictors and Outcomes of Surgery in Peritoneal Mesothelioma: An Analysis of 2000 Patients From the National Cancer Database. Annals of Surgical Oncology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/32006127/. Accessed: 02/04/20.
Devin Golden

About the Writer, Devin Golden

Devin Golden is a content writer for Mesothelioma Guide. He produces mesothelioma-related content on various mediums, including the Mesothelioma Guide website and social media channels. Devin's objective is to translate complex information regarding mesothelioma into informative, easily absorbable content to help patients and their loved ones.