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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. The type of mesothelioma diagnosed 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 is the second most common type of this rare cancer. Approximately 20 percent of diagnosed mesothelioma cases are of this form. This accounts for just 250 to 500 diagnoses per year in the U.S. Symptoms of peritoneal mesothelioma are similar to and often mistaken for more common digestive conditions. This leads to delayed diagnoses and an often poor prognosis.

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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 thin layers called the visceral peritoneum and the parietal peritoneum.

Mesothelioma is an aggressive type of cancer. In the peritoneum it spreads rapidly from one layer of tissue to the other. It then spreads to other types of tissue and to abdominal organs.

Peritoneal tumors can also spread to the omentum, a layer of fat over the abdominal organs. Although very rare, it is possible for peritoneal mesothelioma to actually start in the omentum. From there it spreads to the peritoneum.

Causes and Risk Factors

The main cause of 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.

Genetics may be important, bu the biggest factor in causing mesothelioma is exposure to asbestos. The longer and more frequent the exposure, the bigger the risk is.

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 from inhalation of the fibers.

Disturbed fibers of asbestos may also be ingested from the air or as they build up on surfaces. This may trigger damage and cancer in abdominal tissue, including the peritoneum. Fibers that have been inhaled may also migrate through the lymphatic system and end up in the abdomen where they cause damage.

The Development of Peritoneal Mesothelioma

The latency period, the time from first exposure to asbestos and cancer diagnosis, is long for peritoneal mesothelioma. It can take a few decades to get a correct diagnosis, even though the fibers of asbestos begin to do damage as soon as they enter the body.

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 that may spread further.

Symptoms

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

  • A feeling of fullness in the abdomen
  • Abdominal pain
  • Unintentional and unexplained weight loss
  • Diarrhea
  • Constipation
  • Bowel obstruction
  • Anemia
  • Fever
  • Fatigue
  • Nausea
  • Vomiting

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, so doctors are more likely to diagnose these first. This is especially true if they are unaware of any asbestos exposure a patient may have experienced.

If you know or even think you were exposed to asbestos and you have troubling symptoms, talk to your doctor right away. Your doctor can rule out other causes of symptoms. Exposure to asbestos is an important clue to screen for cancer.

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. The scans provide a picture of any abnormal tissue in the abdomen that might be cancerous.

If there tissue abnormalities 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 and 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 the patient’s overall health.

Oncologists, especially those who specifically work with mesothelioma patients, are best suited to plan your treatments. In addition to typical treatments, they can offer a special type of chemotherapy designed to treat peritoneal mesothelioma.

Called heated intraperitoneal chemotherapy, or HIPEC, the first step in this procedure is surgery 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. It is usually better than the outlook for pleural mesothelioma, though.

Factors such as the 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.

The best chance you have of a good prognosis for peritoneal mesothelioma is with an early diagnosis. Finding out about it in the early stages gives you more treatment options. Aggressive, early treatments can be a little risky but give the best chance of survival.

Getting a diagnosis for peritoneal mesothelioma may be devastating, but you have options and hope. 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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