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Peritoneal Mesothelioma

Mesothelioma is a rare and deadly cancer caused by asbestos exposure. It affects the tissue that lines organs in the body. This double tissue layer is called the mesothelium. Classifying mesothelioma by type depends on 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 mesothelioma. It accounts for about 20 percent of all cases. There are only between 250 and 500 cases of 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 organs in the abdominal cavity. It consists two layers called the visceral peritoneum and the parietal peritoneum.

Mesothelioma spreads easily and quickly compared to many other cancers. It typically spreads first from one layer of the peritoneum to the other. It may then grow into organs within the abdominal cavity, like the liver, stomach and intestines.

The cancer also may spread to the omentum, a layer of fatty tissue covering 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. This is still considered to be peritoneal mesothelioma.

Causes and Risk Factors

The main cause for any type of mesothelioma is asbestos exposure. Experts believe other risk factors, like genetics and family history, also play a role because not everyone exposed to asbestos develop cancer.

Even with genetics the strongest risk factor remains exposure to asbestos. The more prolonged the exposure, the greater the risk. People who worked with or around asbestos for years are at the highest risk of all.

Prolonged asbestos exposure is most often associated with pleural mesothelioma, but asbestos also causes the peritoneal type. Pleural mesothelioma, which affects lung tissue, is more common because asbestos exposure usually occurs when someone inhales the fibers.

Loose asbestos fibers can also be ingested, though. This can trigger cancer that begins in abdominal tissues. Another way asbestos may cause cancer in the abdomen is through migration of inhaled fibers. The lymphatic system may carry the fibers to the abdomen.

The Development of Peritoneal Mesothelioma

Peritoneal mesothelioma has a long latency period. Several decades long, this is the time between exposure to asbestos and diagnosis of cancer. Though the asbestos fibers begin to do damage as soon as they enter the body, it takes many years for their impact to be felt and noticed.

Asbestos fibers embed in the cells of the body and trigger inflammation and damage. This damage can cause cells to become cancerous, growing and dividing out of control. They then develop into tumors.

Symptoms

The symptoms of peritoneal mesothelioma may not obvious or severe until many years after asbestos exposure. Significant and harmful delays in diagnosis often occur for this reason. Peritoneal mesothelioma may cause:

  • 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 challenging to diagnose. They are similar to symptoms of irritable bowel syndrome, Crohn’s disease, colitis, and other gastrointestinal disorders. All of these are much more common than peritoneal mesothelioma. Doctors are more likely to diagnose these first, especially if they are unaware of any asbestos exposure.

For this reason it is crucial that patients tell their doctors about any asbestos exposure they know or suspect they  experienced. This gives doctors an important clue to look for any signs of cancer, and especially for signs of mesothelioma.

After a physical exam, the next step in making a diagnosis is to take images of the abdomen with X-rays, a CT scan, an MRI, a PET scan, or some combination of these. These scans provide a picture of any abnormal tissue in the abdomen that might be cancerous.

If there tissue abnormalities are visible in a scan, doctors will then perform a biopsy. A biopsy is a procedure that removes a small amount of tissue or fluid for testing. If it is easy to access, a tumor may be biopsied with a needle in an easy outpatient procedure.

In some cases, a more invasive surgical biopsy may be necessary. This happens when the tissue in question is difficult to reach.

Treatment

Treatment options for peritoneal mesothelioma include surgery, chemotherapy, radiation, or more often a combination of multiple therapies. The treatment plan depends on the patient, the stage of the cancer, and overall health.

Experts, often working at specialty cancer centers, are in the best position to plan the effective treatment for a mesothelioma patient. Those with peritoneal mesothelioma do have a unique type of treatment available that gives better results than standard chemotherapy.

Called heated intraperitoneal chemotherapy, or HIPEC, the first step in this procedure is a surgical procedure 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 some patients live longer than otherwise expected.

Prognosis for Peritoneal Mesothelioma

The prognosis for peritoneal mesothelioma is unfortunately not very good, although it is usually better than the outlook for pleural mesothelioma.

Factors such as extent and duration of the asbestos exposure, age and health, and staging of the disease all contribute to an individualized prognosis. Only about one quarter of people with a diagnosis of peritoneal mesothelioma will live for three years or longer.

An early diagnosis is crucial for the best prognosis and any chance of remission. Aggressive treatments can also help improve the prognosis for a patient. Not everyone can withstand the side effects of these treatments, but those who can tolerate them will likely live longer.

Getting a diagnosis for peritoneal mesothelioma may be devastating, but you always have options. You may get a second opinion and then seek treatment at a specialty center. 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

Page Medically Reviewed and Edited by
Luis Argote-Greene, MD

Luis Marcelo Argote-Greene, MD
Luis Argote-Greene is an internationally recognized thoracic surgeon. He has trained and worked with some of the most prominently known thoracic surgeons in the United States and Mexico, including pioneering mesothelioma surgeon Dr. David Sugarbaker. He is professionally affiliated with University Hospitals (UH). His areas of interest and expertise are mesothelioma, mediastinal Tumors, thoracic malignancies, lung Cancer, lung transplantation, esophageal Cancer, experimental surgery, and lung volume reduction. Dr. Argote-Greene has also done pioneering work with video-assisted thoracoscopic surgery (VATS), as well as robotic assisted minimally invasive surgery. He has taught the procedures to other surgeons both nationally and internationally.
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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