Peritoneal mesothelioma is a form of cancer that affects the lining of the abdomen (the peritoneum). It is caused by the ingestion of asbestos fibers.
What is Peritoneal Mesothelioma?
Peritoneal mesothelioma accounts for 20 to 25 percent of all mesothelioma cases. It is the most common diagnosis after pleural mesothelioma. Peritoneal patients have longer life expectancies than those with other types of mesothelioma. Some studies report patients living upwards of 5 years after cytoreductive surgery.
How Is Peritoneal Mesothelioma Treated?
This is the only surgical option available to those with a peritoneal diagnosis. This surgery has high success rates when it is combined with chemotherapy.
This is the most common treatment for peritoneal mesothelioma. It is sometimes administered directly to the abdomen during surgery.
This is the least invasive treatment option for peritoneal mesothelioma patients. Radiation may be delivered during surgery as well.
A patient with peritoneal mesothelioma may not experience symptoms early on. If symptoms are evident, they may be mistaken for other illnesses. One common symptom in many peritoneal mesothelioma patients is fluid pockets called ascites, which often cause the stomach region to bulge outward. Other symptoms include:
- Abdominal Pain
- Loss of Appetite
- Blood Clots
- Fluid Buildup (Ascites)
- Abdominal Swelling
- Fever or Sweating
- Tissue Lumps in the Abdomen
- Bowel Problems
In most cases, peritoneal mesothelioma does not spread to the lungs. It has been shown to spread to the other abdominal areas, such as ovaries, liver, or intestines. This metastasis often causes it to become discovered and sometimes misdiagnosed. Symptoms of stomach pains or ascites sometimes results in a misdiagnosis of hernias or a simple stomachache.
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Unlike pleural mesothelioma, peritoneal mesothelioma is most common in females between the ages of 51-59 years old. Men who are diagnosed with peritoneal mesothelioma are often veterans and those with occupational exposure to asbestos. Research suggests that peritoneal mesothelioma patients aged 60 and younger have a better survival rate.
Peritoneal mesothelioma does not usually spread to the lymphatic system (lymph nodes) or blood stream. It usually metastasizes in large masses in the same areas where it originated.
How Does Peritoneal Mesothelioma Develop?
- 1Asbestos fibers are ingested. This can happen after being inhaled, coughed up, and then swallowed.
- 2The body attempts to filter and remove them, but the sharp fibers can lodge into the lining of the abdomen (peritoneum). The fibers irritate the peritoneum and can cause genetic damage to cells.
- 3Genetic damage can keep cells from receiving important signals about when to stop replicating. This causes unchecked cell division and the formation of a malignant tumor. It can take decades for this process to happen.
Diagnosing malignant peritoneal mesothelioma is difficult due to non specific signs and symptoms. It is often confused with abdominal distension (gas) and irritable bowel syndrome. Most patients do not experience symptoms until the disease has progressed. CT scans are the most useful imaging tool to initially test for peritoneal mesothelioma.
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 small camera to explore the abdomen. There is also a tool on the camera that helps to extract tissue on the peritoneum to test for mesothelioma. These tissue biopsies are needed for confirmation of a diagnosis.
Doctors do not use a standard staging system when diagnosing peritoneal mesothelioma. Generally, before the tumors start to spread, the disease is centralized to the abdomen. As it progresses to stage 2, the mesothelioma may spread more but is still contained in the peritoneum. In the final stage, stage 4, the mesothelioma has spread to other organs, such as the liver and colon.
Treatment options are dependent on the stage a peritoneal mesothelioma patient is diagnosed with. There are more curative treatment options, like cytoreduction surgery, for patients with earlier stages.
Patients in the later stages may receive palliative treatments, like radiation or chemotherapy. Another palliative treatment option may be a paracentesis to drain the fluid buildup in the abdomen.
The most successful treatment of peritoneal mesothelioma has been the combination of cytoreduction surgery and HIPEC (heated intraperitoneal chemotherapy). The cytoreduction removes most of the cancerous tumor, and HIPEC is used to kill the remaining cells.
A study involving Dr. James Pingpank analyzed 211 patients with malignant peritoneal mesothelioma between the years of 1992 and 2010. All of the participants were treated with cytoreduction surgery and HIPEC. Patients that underwent both procedures had a 5-year survival rate of 41% and a 10-year survival rate of 26%. Researchers discovered that the median overall survival of the patients was 38.4 months.
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Cytoreduction is also referred to as “debulking.” The goal of cytoreduction is to remove as much of the tumor as possible, though it is often not possible to remove the entire tumor. The peritoneum (lining of the abdomen) and/or some other organs may need to be removed.
Since cytoreduction surgery is such an extensive procedure, it can take a surgeon up to 10 to 12 hours to complete. It is usually performed in patients with stage 1 or 2 peritoneal mesothelioma.
Recovery can take anywhere from 7 to 13 days. One study showed a majority of patients experiencing nausea up to 13 days after their surgery. Regular activities (such as eating, drinking, and mobility) are typically reestablished within 11 days after the cytoreduction and HIPEC.
Heated Intraperitoneal Chemotherapy (HIPEC)
Heated intraperitoneal chemotherapy (HIPEC) is used in patients who have cancers of the abdomen. High doses of chemotherapy are intended to kill any remaining mesothelioma cells left after a cytoreduction surgery. HIPEC is a heated and sterilized chemotherapy treatment.
Dr. Paul Sugarbaker led the way in innovating cytoreduction with HIPEC for patients with peritoneal mesothelioma.
The side effects of this chemotherapy are less than those of regularly administered chemotherapy. At the end of the 60-90 minutes, the chemotherapy is washed out of the body.
- Also referred to as “hyperthermic intraperitoneal chemo” or simply “hot chemo”
- Usually done after cytoreduction
- Administered both during surgery (most effective) and after using an abdominal catheter
A study conducted by Dr. Sugarbaker revealed success in using cytoreductive surgery and HIPEC to treat patients with diffuse malignant peritoneal mesothelioma. 401 patients were followed up with after experiencing treatment. 60% of the patients had a 5-year survival rate, and 47% had a 10-year survival rate. Overall, the participants had a median survival of 53 months.