Peritoneal Mesothelioma

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

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Written by Jenna Campagna, RN

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Facts About Peritoneal Mesothelioma

Peritoneal mesothelioma is a cancer of the peritoneum, which is a sheet-like membrane surrounding your abdominal cavity. This disease 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. Some studies report survival times up to five years after aggressive treatment.

What Is Malignant Peritoneal Mesothelioma?

Malignant peritoneal mesothelioma means the disease is cancerous and deadly. When a disease is described as “malignant,” it can and likely will spread throughout the body if not treated.

When malignant peritoneal mesothelioma forms, abnormal mesothelial cells divide uncontrollably and attack your body tissue. These cells form clumps, which are called tumors.

Tumors can be malignant (cancerous) or benign (not cancerous). Benign mesothelioma refers to a form of mesothelioma that is not actively spreading.

Causes of Peritoneal Mesothelioma

Asbestos exposure is the only scientifically proven cause of peritoneal mesothelioma. However, the other main type of mesothelioma (pleural mesothelioma) is most often linked to inhaling asbestos fibers while peritoneal mesothelioma is associated with ingesting (swallowing) asbestos.

Dr. Shanel Bhagwandin, a peritoneal mesothelioma specialist at Jupiter Medical Center, explained this contrast in an interview with Mesothelioma Guide.

“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% of cases involve males. Peritoneal mesothelioma has a much higher rate of female cases than pleural mesothelioma does.

How Does Peritoneal Mesothelioma Develop?

Peritoneal mesothelioma develops through a multi-step process that starts with asbestos fibers entering the body and ends with genetic damaging of mesothelial cells:

1

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

2

The sharp fibers lodge into tissue along either side of your peritoneum and cause genetic damage to cells.

3

This genetic damage prevents cells from regulating their replication, which causes tumors to form along your peritoneum.

Unlike pleural mesothelioma, which spreads to lymph nodes in the thorax, malignant peritoneal mesothelioma usually remains in the abdominal space. Metastasis, which is the scientific term for a cancer spreading in the body, still puts nearby organs at risk.

How Is Peritoneal Mesothelioma Treated?

surgery

Surgery

There is one primary surgical option for peritoneal mesothelioma: cytoreduction. This operation involves debulking — defined as removing macroscopic tumors and taking out part of the patient’s peritoneum.

chemotherapy

Chemotherapy

Chemotherapy is a common treatment for peritoneal mesothelioma. There are two methods: intravenous or intraperitoneal. Chemotherapy is often heated as a combination with cytoreduction surgery.

Peritoneal Mesothelioma Symptoms

Patients may not experience symptoms immediately after the disease develops. One common symptom in many patients is the buildup of fluid in the abdomen, which is called ascites. This symptom often causes the stomach region to swell.

Other symptoms include:

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

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 any form of mesothelioma is difficult since many of the disease’s signs and 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 are often the first tests for detecting peritoneal mesothelioma. A PET scan or MRI may follow.

Doctors may also use a technique called peritoneoscopy. During this procedure, a surgeon makes a small incision on the patient’s abdomen and uses a camera to explore the abdominal area. There is also a tool on the camera that helps to extract tissue on the peritoneum to test for mesothelioma, which is called a biopsy.

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 the cancer a number between 1 and 4. Stage 1 is the least severe and stage 4 is the most progressed.

Specialists use a separate system for peritoneal mesothelioma. Many doctors rely on the peritoneal cancer index, which scores the extent of the disease 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 depending 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 then added up to a total, which can be assigned to a stage:

PCI Score

Stage

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

Stage

1 - 10

11 - 20

21 - 30

31 and higher

Stage 1

Stage 2

Stage 3

Stage 4

PCI Score: 8

Stage 1

Based on the score and stage, specialists either conduct surgery to remove the cancer, offer chemotherapy to extend life expectancy or focus on limiting patient discomfort.

Treatment options often are dependent on the patient’s disease progression. Curative treatment options, like cytoreduction surgery, are typically for patients with an early-stage diagnosis of peritoneal mesothelioma.

Patients with a more advanced disease receive palliative treatments. An example of palliative treatment is paracentesis, an operation used to drain the fluid buildup in the abdomen.

Surgery for Peritoneal Mesothelioma

cytoreduction

Cytoreduction

Cytoreduction is the most popular surgery for malignant peritoneal mesothelioma. It is often combined with heated intraperitoneal chemotherapy (HIPEC).

The goal of cytoreduction is to remove as many of the tumors as possible. This operation may also involve removing the peritoneum, part of the intestines and more organs near the disease’s point of origin.

Cytoreduction is a laborious procedure, taking surgeons up to 10 or 12 hours to complete. It is usually performed in patients with a less-advanced form of the cancer.

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

To improve your chances of living well after your prognosis, find a mesothelioma specialist offering this treatment option. You can use our free Doctor Match program to find the right fit.

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 led the way in innovating cytoreduction with HIPEC for patients with malignant peritoneal mesothelioma.

The side effects of this chemotherapy are less damaging to the patient than those of regularly administered chemotherapy. The chemotherapy is delivered directly into the abdomen and doesn’t have to 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 explains on its website how HIPEC treatment works at the institution. Surgeons heat cisplatin to 103 degrees Fahrenheit and rock the patient back and forth to ensure the drug reaches all areas of the abdomen.

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

A study conducted by Dr. Sugarbaker revealed the success of using cytoreduction and HIPEC to treat 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 for this study was 53 months.

Chemotherapy for Peritoneal Mesothelioma

Peritoneal patients may receive a combination of pemetrexed and cisplatin. These two chemotherapy drugs are the only two approved by the U.S. Food and Drug Administration for mesothelioma.

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

On average, patients who received the combination of pemetrexed and cisplatin lived 12.1 months longer than those who do not receive any chemotherapy.

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

Peritoneal Mesothelioma Prognosis

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

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

The most successful cases are those where mesothelioma is detected in the earlier stages and treatment begins immediately. According to a study, the five-year survival for patients diagnosed with Stage 1 (PCI score of 1-10) was 87%.

Surgery is also a pathway to long-term survival. In one study analyzing 2,000 peritoneal mesothelioma patients registered in the National Cancer Database, patients who underwent radical surgery plus systemic chemotherapy survived for a median 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 those in the U.S. with mesothelioma 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.

Common Questions About Peritoneal Mesothelioma

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.

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.

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.

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.

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: July 7, 2020.

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