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Peritoneal Mesothelioma

Mesothelioma is a rare and aggressive type of cancer caused by asbestos exposure. It begins with a tumor in the tissue that lines organs in the body, called the mesothelium. Types of mesothelioma are distinguished by the part of the mesothelium in which the primary tumor has grown. Peritoneal mesothelioma starts in the peritoneum, the lining of the abdominal organs.

Peritoneal mesothelioma is the second most common type of this asbestos-related cancer and accounts for about 20 percent of all cases. There are only between 250 and 500 cases off diagnosed peritoneal mesothelioma each year in the U.S. It causes symptoms that are often mistaken for conditions like irritable bowel syndrome. Treatment may include chemotherapy, radiation, and surgery, but the outlook is not generally positive.

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Cancer of the Peritoneum

The peritoneum is the part of the mesothelium that surrounds and protects abdominal organs like the stomach,  intestines, and liver. It consists of a double layer of tissue. One layer is called the visceral and the other the parietal peritoneum.

Mesothelioma spreads readily and quickly. It often spreads first from one layer of the peritoneum to the other. It typically then grows into organs within the abdominal cavity, like the liver, stomach and intestines.

Peritoneal cancer may also spread to the omentum, a layer of fatty tissue that covers the abdominal organs. In extremely rare cases—only about five have ever been reported—the cancer may begin in the omentum and then spread to the peritoneum.

Causes and Risk Factors

There main cause for any type of mesothelioma is asbestos exposure. Other risk factors may also be important because not everyone exposed to asbestos will develop cancer. Other factors include genetics and a family history of mesothelioma.

The strongest risk factor remains exposure to asbestos. The more prolonged the exposure, the greater the risk is, and people who worked around asbestos for the longest periods of time have the greatest risk.

Prolonged asbestos exposure is most often associated with pleural mesothelioma, the more common form of this cancer affecting tissue around the lungs. This is because the typical way people are exposed to asbestos fibers is by inhalation. But, asbestos exposure is also associated with the peritoneal form of the cancer.

It is also possible that loose asbestos fibers will be accidentally ingested. This can trigger cancer that begins in abdominal tissues. In some cases, though, it may be that the inhaled fibers of asbestos migrate to the abdomen, likely through the lymphatic system. Regardless of how it occurs, asbestos fibers in the abdominal cavity can lead to peritoneal mesothelioma.

The Development of Peritoneal Mesothelioma

Peritoneal mesothelioma has long latency period of several decades. This means that in the majority of cases, symptoms of the disease do not become obvious until decades after the initial exposure to asbestos. Though the asbestos fibers begin to do damage as soon as they enter the body, it takes a long time for their impact to be felt and noticed.

Asbestos fibers get embedded in the cells of the body and trigger inflammation and damage. This damage can cause cells to eventually become cancerous, growing and dividing out of control and developing into one or more tumors.

Symptoms

The symptoms of peritoneal mesothelioma often don’t become obvious or severe until decades after the initial exposure to asbestos. It can take decades to receive a proper diagnosis. Some of the common symptoms of peritoneal mesothelioma are:

  • Pain and Swelling in the Abdomen
  • A Feeling of Fullness in the Abdomen
  • Unexplained Weight Loss
  • Anemia
  • Fever
  • Diarrhea
  • Constipation
  • Bowel obstruction
  • Nausea
  • Vomiting
  • Fatigue

Diagnosing Peritoneal Mesothelioma

The early symptoms of peritoneal mesothelioma make it difficult to diagnose. They are often similar to symptoms of by irritable bowel syndrome, Crohn’s disease, colitis, and other gastrointestinal disorders, all of which are much more common than peritoneal mesothelioma. This make misdiagnosis fairly common.

It is important that patients tell their doctors about any asbestos exposure they know or suspect they may have experienced. After a physical exam, the next step in making a diagnosis is to image the abdomen with X-rays, a CT scan, an MRI, a PET scan, or some combination of these. These scans can give a doctor a good picture of any abnormal tissue in the abdomen that might be cancerous.

If there are tissue abnormalities visible in a scan, the next step is to perform a biopsy. This means removing a small amount of tissue for testing. If it is easy to access, a tumor may be biopsied with a needle, an easy outpatient procedure. If it is more difficult to get to, more invasive, surgical biopsies may be required. It is important that these samples be removed, though, as they often give the best final diagnosis.

Treatment

Treatment for peritoneal mesothelioma may include surgery, chemotherapy, radiation, and other strategies. The treatment plan depends on the patient, the stage of the cancer, and overall health. The use of more than one type of therapy provides the best results.

Peritoneal mesothelioma is rare, so there is no single accepted approach to treatment. Experts in this kind of cancer, often working at specialty cancer centers, are in the best position to plan the most effective treatment for each individual. Patients with peritoneal mesothelioma do have a unique type of treatment available that gives better results than standard chemotherapy.

Called heated intraperitoneal chemotherapy, or HIPEC, this procedure involves using surgery first to remove as much cancerous tissue as possible. Then, heated chemotherapy drugs are injected directly into the abdomen. Only certain patients meet the requirements for this cutting edge treatment, but it has helped a limited number of patients live longer than expected.

Prognosis for Peritoneal Mesothelioma

The prognosis for peritoneal mesothelioma is generally not very good. Factors such as extent and duration of the asbestos exposure, age and gender, and staging of the disease all contribute to a prognosis. Only about 25 percent of people with a diagnosis of peritoneal mesothelioma will live for three or more years.

An early diagnosis is crucial for a better survival time. The earlier the stage of the cancer is, the greater chance a patient has of living longer. Aggressive treatments can also help improve the prognosis for a patient. Not everyone can withstand the side effects of these treatments, but those who are able to will likely live longer.

Getting a diagnosis for peritoneal mesothelioma may be devastating, but you do have options, and getting the diagnosis means you can take action. You can get a second opinion, and you can choose from among treatments that are aggressive and those that will make you feel more comfortable in the time you have left. You may also be able to file a lawsuit to seek compensation if you were exposed to asbestos in the workplace.

Page edited by Dave Foster

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Dave has been a mesothelioma Patient Advocate for over 10 years. He consistently attends all major national and international mesothelioma meetings. In doing so, he is able to stay on top of the latest treatments, clinical trials, and research results. He also personally meets with mesothelioma patients and their families and connects them with the best medical specialists and legal representatives available. Connect with Patient Advocate Dave Foster
Sources
  1. American Cancer Society. (2018, November 16). Signs and Symptoms of Mesothelioma.
    Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/signs-symptoms.html
  2. Sugarbaker, P.H, Turaga, K.K., Alexander, H.R., Deraco, M. & Hesdorffer, M. (2016). Management of Malignant Peritoneal Mesothelioma Using Cytoreductive Surgery and Perioperative Chemotherapy. Journal of Oncology Practice, 12(10), 928-35.
    Retrieved from: http://ascopubs.org/doi/full/10.1200/jop.2016.011908
  3. Kim, J., Bhagwandin, S. & Labow, D.M. (2017). Malignant Peritoneal Mesothelioma: A Review. Annals of Translational Medicine, 5(11), 236.
    Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497105/
  4. Kanarek, M.S. & Mandich, M.K. (2016). Peritoneal Mesothelioma and Asbestos: Clarifying the Relationship by Epidemiology. Epidemiology: Open Access, 6:233.
    Retrieved from: https://www.omicsonline.org/open-access/peritoneal-mesothelioma-and-asbestos-clarifying-the-relationship-byepidemiology-2161-1165-1000233.php?aid=72695&view=mobile

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