Malignant Peritoneal Mesothelioma
What Is Malignant Peritoneal Mesothelioma?
Peritoneal mesothelioma is a cancer of the peritoneum.
The peritoneum is a thin membrane that creates the lining of the abdominal cavity, arising from mesothelial cells. It consists of 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.
Known asbestos exposure is present in about half of peritoneal mesothelioma cases.
What Causes This Type of Mesothelioma?
The main cause of any type of mesothelioma is asbestos exposure. The longer and more frequent the exposure, the greater the risk of developing mesothelioma.
Experts believe other risk factors, like genetics and family history, also play a role because not everyone exposed to asbestos develops cancer. Also, some patients with peritoneal mesothelioma have no known history of asbestos exposure.
Prolonged asbestos exposure is most often associated with pleural mesothelioma because exposure is usually through inhalation of the fibers, but it can also trigger the peritoneal form in the abdomen.
There are two possible ways that asbestos fibers may travel to the abdominal cavity and cause peritoneal cancer:
Asbestos fibers may also be ingested and may be present in the sputum. Over time, these fibers reach the peritoneal surface by penetrating the wall of the intestine. This process can ultimately lead to the development of cancerous cells.
Fibers that have been inhaled may also migrate through the lymphatic system and end up in the abdomen where they cause damage.
How Peritoneal Mesothelioma Develops
Whether they get there through inhalation or ingestion, asbestos fibers in the abdomen become embedded in the cells of the peritoneum. There they trigger inflammation and damage.
Cellular damage can lead to those cells becoming cancerous, growing and dividing out of control. They then develop into tumors that may spread further, through the peritoneum and to other tissues and organs.
What Are the Symptoms of Peritoneal Mesothelioma?
The symptoms of peritoneal mesothelioma may not be obvious, or they may be mild and not show until many years, even decades, 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 (from fluid accumulation)
- Abdominal pain
- Unintentional and unexplained weight loss
- Diarrhea
- Constipation
- Bowel obstruction
- Anemia
- Fever
- Fatigue
- Nausea
- Vomiting
How Is Peritoneal Mesothelioma Diagnosed?
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 more common gastrointestinal disorders.
Doctors are more likely to diagnose these first, leading to a misdiagnosis. This is especially likely if they are unaware of any asbestos exposure a patient may have experienced.
The first step in getting an accurate diagnosis is a physical exam and a thorough history. Tell your healthcare provider if you have or think you may have experienced asbestos exposure. A physical exam will be followed by these steps in most cases:
After reviewing your symptoms and performing a physical exam, your doctor may start ordering imaging studies, usually beginning with a simple X-ray or CT scan. These studies can help identify peritoneal changes, such as thickening of the lining, or a tumor mass to suggest the presence of cancer. Other specialized imaging such as MRI or PET/CT scans are usually ordered by specialty providers and may take place after a biopsy.
A blood test may also be used to determine if you have any tumor markers, any substances that are associated with cancer.
If there are visible abnormalities on a scan, a biopsy is used to determine a diagnosis. This is usually done by an interventional radiologist, a specialist trained in both reading imaging scans and performing minimally invasive biopsies. Most biopsies can be performed at a local hospital with patients going home the same day.
In some cases, a more invasive surgical biopsy may be necessary. This happens when the tissue in question is difficult to reach or the routine biopsy could not gather enough cells to give your medical team a firm diagnosis.
At this point, a surgeon will usually recommend a laparoscopy in the operating room under general anesthesia. This allows the surgeon to use a camera to look inside the abdominal cavity looking for any signs of cancer and also choose the best location to biopsy.
Laparoscopy is an excellent instrument by which the surgeon can directly visualize tumors within the abdomen and pelvis and also facilitate a biopsy of a cancerous nodule. However, it has been associated with mesothelioma growing out of the insertion site for the telescope. This is referred to as port site metastases.
In order to avoid this very serious dissemination of mesothelioma to the abdominal wall, laparoscopy for mesothelioma must only be performed through the absolute midline of the abdomen. Usually, the telescopy is placed just above or below the umbilicus. If cancer grows out at a midline port site it can be excised without excessive damage to the muscles, nerves, and fascia that make up the abdominal wall.
How Is Peritoneal Mesothelioma Treated?
Treatment options for peritoneal mesothelioma include the standard therapies of surgery; chemotherapy; radiation is seldom indicated. There are, as well, some new and experimental therapies.
Oncologists, especially those who specifically work with mesothelioma patients, are best suited to plan your treatments. They will most likely recommend a combination of therapies based on your cancer’s stage, your health and age, and your preferences.
Cytoreductive Surgery and HIPEC
A newer, innovative treatment has been used with more success in patients with peritoneal mesothelioma and is now the standard therapy. It is called cytoreductive surgery plus HIPEC, or heated intraperitoneal chemotherapy:
Cytoreductive surgery. The first step in this procedure is a radical surgery to remove as much cancerous tissue as possible. Completer removal gives the best results.
Heated chemotherapy. Then heated chemotherapy drugs are administered directly into the abdomen at the end of surgery.
A potential cure. Only certain patients meet the requirements for this cutting edge treatment, but it has helped many live longer than otherwise expected. Some patients are cured.
What Is the Prognosis for Peritoneal Mesothelioma?
The prognosis for peritoneal mesothelioma is generally poor given the aggressive nature of the disease. However, it is usually much better than the outlook for pleural mesothelioma. Overall prognosis improves if you are a candidate for cytoreductive surgery plus HIPEC.
Several factors determine each individual patient’s prognosis:
- Age and health
- Gender
- Stage of the cancer at diagnosis
- Treatments chosen
- Concerning radiological features on CT identified by an experienced radiologist.
For peritoneal mesothelioma, the median survival time without disease progression–that is the time a patient lives from diagnosis with no further worsening of the disease–is just 13.9 months.
How to Improve Prognosis
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 increase the amount of time patients spend without visible cancer and allow patients to feel good longer.
It is important to discuss the potential risks and complications with your medical care team to ensure you are making the right decision. Choosing a team that has experience with mesothelioma can be very helpful.
The best survival rates are seen with patients who undergo cytoreductive surgery plus HIPEC. A 2017 study involved twenty-nine mesothelioma patients who received surgery followed by heated chemotherapy. Nearly three-quarters of the patients lived longer than five years after treatment, a big improvement in overall survival times.
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 Peritoneal Surface Oncology 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.
Frequently Asked Questions
What Causes Peritoneal Mesothelioma?
The leading cause of any type of mesothelioma is asbestos exposure. Ingested fibers of asbestos cause irritation and damage that may lead to tumor growth in the peritoneum. Not everyone exposed to the mineral will develop cancer. Other risk factors involved include family history and genetics and radiation therapy to the abdomen.
What Are the Symptoms of Peritoneal Mesothelioma?
The common symptoms of peritoneal mesothelioma are abdominal swelling and distension from ascites and abdominal pain. Other symptoms include nausea, a feeling of fullness, and unintended weight loss. Rare symptoms may include hernia, fever, and night sweats.
How Long Can You Live with Peritoneal Mesothelioma?
Survival time varies based on cancer stage, patient health and age, and treatment chosen. Life expectancy is generally longer than for pleural mesothelioma. If treatments are not available to you, survival may be less than a year. Survival rate for peritoneal mesothelioma after one year is 50%, after two years 35%, and after five years, just 18%.
Is Peritoneal Mesothelioma Curable?
Most cases of mesothelioma are considered incurable, but often manageable. Patients with the best hope of being cured of peritoneal mesothelioma receive a diagnosis in an early stage, are younger and in good health, and are able to undergo aggressive treatment. Even with remission, the cancer may return later.
How Quickly Does Peritoneal Mesothelioma Spread?
The low survival rates for mesothelioma indicate how rapidly it spreads. This is an aggressive type of cancer that metastasizes readily within the peritoneal cavity. How fast it spreads depends on the cell type. In one study, patients with the epithelioid type of peritoneal mesothelioma had a median survival time of fifty-five months, while those with a biphasic type saw a median survival time of just thirteen months.
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