Peritoneal mesothelioma is a type of cancer that develops in the peritoneum, the lining of tissue in the abdominal cavity. It is caused by asbestos exposure and is the second most common type of mesothelioma. Peritoneal mesothelioma causes abdominal swelling, pain, and gastrointestinal symptoms.
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What Is Peritoneal Mesothelioma?
Peritoneal mesothelioma is a form of asbestos cancer that attacks the cell walls in the peritoneum, the thin membranes that lubricate and protect the abdominal cavity.
Only 500 people each year are diagnosed with peritoneal mesothelioma, which is around 20% of all cases of mesothelioma. It is the second most common form of mesothelioma and has the best prognosis.
What Is the Difference Between Peritoneal Mesothelioma and Pleural Mesothelioma?
Both peritoneal and pleural mesothelioma are cancers caused by asbestos that develop in the mesothelium. The mesothelium is a thin, double layer of tissue that surrounds organs and lines cavities in the body.
The pleura is the part of the mesothelium in the chest cavity and around the lungs. The peritoneum, where peritoneal mesothelioma develops, is the mesothelium in the abdomen.
Pleural mesothelioma is more common than peritoneal mesothelioma. Both are malignant, aggressive, and difficult to treat. The prognosis is poor for both types but better for peritoneal mesothelioma.
Who Is at Risk for Peritoneal Mesothelioma?
Anyone who worked with or around asbestos is at risk for peritoneal mesothelioma. Also at risk are family members or others who lived with people who worked with asbestos. Most people diagnosed with any type of mesothelioma are older men, but anyone can develop this cancer.
Women are more likely to have peritoneal mesothelioma than pleural mesothelioma. The peritoneal form is also more common in younger people. No one knows why women are at greater risk for peritoneal mesothelioma.
How Does Asbestos Cause Peritoneal Mesothelioma?
The leading cause of peritoneal mesothelioma is past asbestos exposure. Most people with any type of mesothelioma were exposed to asbestos at work. The most common route of exposure is inhalation of fibers, which is why pleural mesothelioma is more prevalent than other mesothelioma types.
Workers inhaled asbestos fibers, which lodged in the pleural tissue around the lungs. There, the fibers caused damage and led to pleural mesothelioma in some people. How asbestos fibers get to the peritoneum and cause mesothelioma is not perfectly understood.
The peritoneum has two layers, which include the parietal layer and the visceral layer. The visceral layer protects the abdominal organs.
The parietal layer protects and covers the abdominal cavity in the same manner. With so many layers, it isn’t easy to understand exactly how asbestos reaches the peritoneum in the first place. Scientists have theorized that this can happen in two different ways:
- Since asbestos fibers are so small, they can easily be swallowed. The fibers then lodge in the peritoneal tissue in the abdomen.
- Inhaled fibers may migrate to the lymphatic system, which circulates fluids through the body. This could be how asbestos fibers end up in the abdomen.
The human body cannot eliminate the small fibers from the system. They cause inflammation and damage that can lead to tumor growth and malignancy.
Symptoms of Peritoneal Mesothelioma
Not everyone will experience the same symptoms. In addition, most symptoms will not surface until decades after asbestos exposure. Possible symptoms of peritoneal mesothelioma are:
- Unusual and rapid weight loss
- Nausea with or without vomiting
- Abdominal pain
- Abdominal swelling
- Diarrhea and/or constipation
- Small lumps under the abdomen skin
- Night sweats
- Anemia
- Fever
- Inflamed, thickened peritoneum
- Breathing difficulties
- Fatigue and lethargy
- Energy loss and weakness
How Is Peritoneal Mesothelioma Diagnosed?
Diagnosis of peritoneal mesothelioma begins with a complete physical exam, description of symptoms, and review of medical history. A doctor will then do tests to look for a cause of the symptoms and to rule out more common illnesses:
- Imaging Scans. An MRI or CT scan helps doctors see soft tissues in the body. A scan of the abdomen can show masses, thickened tissues, or other signs of suspected tumors.
- Biopsy. If a doctor finds an area of tissue that looks abnormal, they will perform a biopsy to remove a small sample of tissue. They might also draw out some abdominal fluid for testing.
- Pathology. A pathologist examines the biopsied tissue to look for signs of malignancy. They also identify the cell type and subtype.
- Immunohistochemistry. Pathologists may also use this type of test that relies on antibodies to identify markers of specific cell and tumor types.
Staging Peritoneal Mesothelioma
When doctors diagnose peritoneal mesothelioma, they also include a stage designation. The stage describes the extent and spread of the cancer. It is useful for planning treatment and estimating a patient’s life expectancy.
Because it is so rare, there is no standard staging system for peritoneal mesothelioma. Doctors typically use a combination of the TNM system used for most other cancers and the Peritoneal Cancer Index, which is used to stage metastasis of gastric cancer.
There are four stages of peritoneal mesothelioma:
- Stage 1. In the earliest stage, the tumors are localized to the peritoneal tissue and possibly additional tissue near the primary tumor.
- Stage 2. By stage 2, the tumors have spread further and may have invaded nearby lymph nodes.
- Stage 3. In stage 3, tumors have spread to more lymph nodes and to other organs and tissues in the abdominal cavity.
- Stage 4. Stage 4 is metastatic cancer, which means the tumors have spread to distant areas of the body.
Misdiagnosis of Peritoneal Mesothelioma
Peritoneal mesothelioma is rare, which means that misdiagnosis is common. Another reason it is often misdiagnosed is because the symptoms are similar to those of more common illnesses. Some common early misdiagnoses for peritoneal mesothelioma are:
- Colitis
- Crohn’s disease
- Ovarian cysts
- Ovarian cancer
- Colon Cancer
- Tuberculous peritonitis
Being diagnosed early and starting treatment immediately is the best way to get a better outcome with peritoneal mesothelioma. Misdiagnosis delays treatment. Always push for a second opinion or more tests if they are unsatisfied with an initial diagnosis.
Treatments for Peritoneal Mesothelioma
Specialists treat peritoneal mesothelioma with a combination of surgery, chemotherapy, and other treatments. Some patients may not be good candidates for surgery, especially if the cancer is in later stages and has metastasized.
Unfortunately, catching the disease in its early stage is rare at this time, as it typically takes decades before the first symptoms start to show up.
Surgery may still be performed during the disease’s advanced stages, but physicians almost always remove only parts of the tumor instead of removing it in its entirety. Once the disease has progressed, it is too dangerous and poses too many risks to remove.
Surgery for Peritoneal Mesothelioma
Surgery is one of the most common treatment strategies for peritoneal mesothelioma. Not all patients qualify if the cancer is too widespread or if their health is too poor. Some of the surgical procedures used to treat peritoneal mesothelioma include:
- Peritonectomy: This form of surgery entails removing the lining of the abdomen in an attempt to eliminate as many cancerous cells as possible. Peritonectomy surgery is usually performed in conjunction with cytoreductive surgery.
- Cytoreductive Surgery: Cytoreductive surgery is an invasive and long procedure, usually lasting up to 12 hours. Cytoreductive and peritonectomy surgery is combined so that cancerous cells can be removed while providing the patient with as much relief as possible.
Paracentesis: Paracentesis is a form of surgery that involves removing fluid from the peritoneal area (the area around the abdomen). The fluid is withdrawn using a long, hollow needle inserted through the stomach. Once the fluid is collected, victims experience relief from pain and bloating. The bowels usually begin to work better, and patients find that breathing is not as difficult as before.
Chemotherapy
Surgery is rarely used alone to treat mesothelioma. It is commonly combined with chemotherapy. Types of chemotherapy used to treat peritoneal mesothelioma include:
- Systemic Chemotherapy: Systemic chemotherapy involves chemotherapy entering the bloodstream intravenously. It’s most often used on patients experiencing widespread cancers across the body. Almost all chemotherapy treatments utilize systemic chemotherapy for peritoneal patients.
- Heated Chemotherapy: With heated chemotherapy (HIPEC), drugs are dispensed into the patient’s abdominal area. The drug is typically heated just above the patient’s body temperature before administering it. This form of chemotherapy is almost always used after surgery, and the heat is used to kill off any cancerous cells that were left behind. Candidates for heated chemotherapy must be in good overall physical shape.
- Neoadjuvant Chemotherapy: Neoadjuvant chemotherapy is used as a prior treatment before another form of treatment is given to the patient. For example, a patient undergoing surgery may be given neoadjuvant chemotherapy beforehand to reduce the size of the cancerous tumors. Most patients start neoadjuvant chemotherapy around three months prior to surgery.
Cytoreductive Surgery and HIPEC
Cytoreductive surgery (CRS), followed by HIPEC, has become a standard treatment strategy for peritoneal mesothelioma. It has a high success rate and has been proven to significantly extend life expectancy in many patients.
One study compared CRS and HIPEC with a control group of patients who received surgery and more traditional chemotherapy. The three-year survival rate was 33% for the control group and 65% for the experimental group. CRS with HIPEC doubled survival time.
Immunotherapy for Peritoneal Mesothelioma
Another type of treatment gaining traction is immunotherapy. It uses drugs that harness the patient’s immune system to target and kill cancer cells. While it is more commonly used to treat pleural mesothelioma, some peritoneal mesothelioma patients might benefit from immunotherapy.
Additional Treatments for Peritoneal Mesothelioma
Surgery and chemotherapy are standard treatments for peritoneal mesothelioma, but every treatment plan is different and depends on individual factors. Some other types of treatment doctors may consider for peritoneal mesothelioma patients include:
- Targeted Therapies. Targeted therapies are drugs that use a specific strategy to kill cancer cells or target specific genetic mutations.
- Clinical Trials. Patients who qualify for a clinical trial get access to emerging treatments not yet widely available. There are risks but also potential benefits.
- Palliative Care. Palliative treatments are used to manage symptoms of cancer and the side effects of treatment. They help patients feel more comfortable and improve their quality of life.
What Is the Prognosis for Peritoneal Mesothelioma?
Recently, doctors have begun to catch peritoneal cancer in its early stages more often than ever before. However, the average life expectancy is still around a year. Remember, though, that every situation is unique, and patients may go on to live years longer.
In addition, new treatment methods are being introduced as researchers make breakthroughs, which can further expand patient lifespans in the future.
What Is the Survival Rate for Peritoneal Mesothelioma?
Survival rate measures the percentage of people still living at a specified point after their diagnosis. Five-year survival rates for peritoneal mesothelioma are higher than for pleural mesothelioma:
- Stage 1 – 87%
- Stage 2 – 53%
- Stage 3 – 29%
These are averages based on a large number of patients. Every case is different, but averages can be useful in estimating the prognosis for each individual patient.
How Long Can You Live With Peritoneal Mesothelioma?
Life expectancy is another measurement or estimate that describes a patient’s prognosis. In general, peritoneal mesothelioma patients live longer after diagnosis than those with other types of mesothelioma.
Again, this varies and depends on the individual factors in each patient’s case. Life expectancy for peritoneal mesothelioma can be anywhere from six months to several years. Six months is a typical prognosis for patients who do not receive any treatment.
Is Peritoneal Mesothelioma Always Fatal?
Experts consider all types of mesothelioma to be incurable. Specialists treat mesothelioma as a condition to be managed. They try to extend life expectancy and do not focus on curing it.
Remission is rare but possible with mesothelioma. Peritoneal mesothelioma patients who are in the early stages and undergo cytoreductive surgery with HIPEC have the best chance of remission. Even with remission, the cancer can always return.
Can I Improve My Prognosis?
Yes, you can improve your prognosis after being diagnosed with peritoneal mesothelioma. The best way to improve prognosis is to get treated immediately. Assemble a team of specialists and begin treatment as soon as possible.
Choose the most aggressive treatments you qualify for. These treatments are most likely to extend your life expectancy. Also important is staying in good overall health, following your doctors’ advice, and managing symptoms with palliative care.
How to Find a Peritoneal Mesothelioma Specialist
Peritoneal mesothelioma is very rare. Most oncologists never encounter a patient with this diagnosis. For the best care, seek out treatment from a physician who specializes in treating it. These are some of the most noteworthy peritoneal mesothelioma specialists across the U.S.:
- Dr. David Bartlett, Allegheny Health Network, Pittsburgh, PA
- Dr. John Chabot, Columbia University Medical Center, New York City, NY
- Dr. W. Charles Conway, Ridley-Tree Cancer Center, Santa Barbara, CA
- Dr. Sophie Dessureault, Moffitt Cancer Center, Tampa, FL
- Dr. Hedy Lee Kindler, University of Chicago, Chicago, IL
Getting Help
If you’ve been diagnosed with mesothelioma, asbestos-related lung cancer, or asbestosis, there is a good chance that you’ll be entitled to significant financial compensation for medical expenses, pain, suffering, and much more. Fill out our form to receive our free Financial Compensation Packet. Our packet is loaded with information on experienced mesothelioma attorneys in your area.
