Linda Molinari Editor in Chief
This page was medically reviewed by James Stevenson, M.D. on February 6, 2019. For information on our content creation and review process read our editorial guidelines. If you notice an error or have comments or questions on our content please contact us.
James Stevenson, M.D. Thoracic Medical Oncologist
Peritoneal mesothelioma is a malignant cancer caused by ingesting asbestos fibers. It is also known as abdominal mesothelioma because it develops in the peritoneum, or the tissue lining the abdomen. Symptoms of peritoneal mesothelioma include stomach pain, nausea and swelling of the abdomen.
Medical advisor Dr. F. Perry Wilson defines peritoneal mesothelioma, as well as discusses the prevalence, associated symptoms, therapeutic treatment options and prognosis for this type of mesothelioma.
Peritoneal mesothelioma is a form of cancer caused by asbestos. When asbestos fibers are ingested or inhaled, they can become embedded in the lining of the abdomen. The fibers may migrate to the abdominal lining through the digestive or lymphatic systems. However, experts have not agreed upon any one mechanism explaining how asbestos reaches the abdominal lining.
The life expectancy for peritoneal malignant mesothelioma cancer is more favorable than other types of malignant mesothelioma.
Peritoneal mesothelioma prognosis may vary depending on an individual’s case, with life expectancy ranging from two to six years. More patients are surviving five years or longer with advancements in treatment.
Several factors can influence an individual patient’s prognosis, including:
Epithelioid cell type is most common in peritoneal mesothelioma. It responds more favorably to treatment, with a median life expectancy of 79 months with treatment.
A small percentage of peritoneal malignant mesothelioma patients are diagnosed with sarcomatoid cell type. Peritoneal mesothelioma patients diagnosed with this cell type have an average survival of 10 months with treatment.
Ingestion of asbestos fibers causes malignant peritoneal mesothelioma. Experts have yet to determine how the mineral reaches the abdomen. However, tests have found asbestos fibers in parts of the abdomen and digestive tract.
Once in the abdomen, asbestos may cause mesothelioma through several mechanisms, including:
Research has also tied certain genetic factors to mesothelioma, such as BAP1 mutations. Still, asbestos exposure is the only known cause of mesothelioma. The best way to minimize mesothelioma risk is to avoid asbestos exposure.
Peritoneal mesothelioma symptoms can take 10 – 50 years to appear after an individual inhales or ingests asbestos fibers. The fibers become lodged in the peritoneum, the lining of the abdomen, which leads to irritation and scar-tissue buildup. These damaged cells can develop into tumors and cause symptoms.
For most patients, early peritoneal mesothelioma symptoms will typically present in the abdomen or gastrointestinal system. Patients may also experience systemic symptoms, such as weight loss, which can further complicate diagnosis.
A peritoneal mesothelioma diagnosis consists of a series of tests. Diagnosis often starts with imaging tests, like CT scans and X-rays. These tests can rule out more common diseases and other forms of cancer, like adenocarcinoma and ovarian cancer.
If a tumor is detected through imaging tests, a doctor may order blood tests to identify biomarkers that can further differentiate mesothelioma from other cancers.
Biopsies are the only way to confirm a peritoneal mesothelioma diagnosis. A doctor will take a fluid or tissue sample to confirm the cancer. The biopsy can also help identify cell type and mesothelioma progression.
When diagnosing peritoneal mesothelioma, a doctor will also determine the stage of the cancer. Although there is no well-defined staging system for peritoneal malignant mesothelioma, doctors may identify the advancement of the disease with relevant criteria. For example, doctors may identify if the cancer has metastasized to other organs or lymph nodes.
In some cases, doctors may rely on a tool called the Peritoneal Cancer Index (PCI), developed for abdominal cancers. With this method, the abdominal region is split into 13 distinct sections and scored on a scale of 0 – 3 based on the presence and size of tumors.
The 13 sections are then totaled for an overall PCI score, with 39 being the highest. Doctors suggest peritoneal mesothelioma stages equivalent to the scores. A higher PCI score indicates a more advanced stage of abdominal mesothelioma.
The TNM cancer staging system is commonly used for pleural mesothelioma but has been adapted for peritoneal mesothelioma. The adapted TNM system for peritoneal mesothelioma incorporates three components:
Based on these factors, patients may fall into one of three stages. In this system, stage 3 indicates the most advanced stage.
No matter which staging system doctors use, many factors affect prognosis. Patients can consult a mesothelioma doctor to determine the best treatment for their stage of peritoneal mesothelioma.
Peritoneal mesothelioma is often treated with a multimodal approach, which combines conventional treatments like surgery, chemotherapy and radiation therapy.
Traditional chemotherapy and radiation therapy have shown limited success in peritoneal mesothelioma patients, with some clinical trials showing a median survival time of one year. However, some studies indicate success when using chemotherapy during surgery to treat peritoneal mesothelioma.
For patients with advanced stage peritoneal malignant mesothelioma, standard treatments may be used as palliative care. Palliative treatments are used to improve quality of life and extend life expectancy.
Minimally invasive procedures, like paracentesis, are often used palliatively. This procedure removes buildup of fluid and relieves symptoms associated with peritoneal malignant mesothelioma.
Clinical trials are continually testing new treatments for peritoneal mesothelioma. Emerging treatment options include pressurized intraperitoneal aerosol chemotherapy (PIPAC), a chemotherapy applied in a pressurized form. Treating mesothelioma with PIPAC is in early phases and requires further testing. However, the treatment has shown a median life expectancy of approximately 27 months.
After a 26-year career in the HVAC industry, Jim Dykstra was diagnosed with peritoneal mesothelioma. Jim underwent cytoreductive surgery followed by HIPEC. After he recovered, he underwent multiple rounds of chemotherapy and radiation therapy to control the growth of his tumors. Though he is still battling malignant peritoneal mesothelioma, he is a survivor of more than five years.
For eligible patients, a combination treatment of debulking surgery combined with heated chemotherapy is becoming a standard of care. The heated chemotherapy, known as hyperthermic intraperitoneal chemotherapy (HIPEC), is applied to the abdomen during surgery.
Doctors perform debulking surgery, also known as cytoreductive surgery, prior to HIPEC to remove visible tumors and tissue that have been damaged by mesothelioma cells. This may involve removing the abdominal lining or other organs in order to remove as much of the tumor as possible.
HIPEC is then applied throughout the abdominal cavity to kill any remaining cancer cells. The heated chemotherapy is applied at 104°F – 109°F and consists of a stronger dosage than traditional chemotherapy.
Clinical trials have shown the effectiveness of the treatment, with life expectancy ranging from 53 to 92 months. Data suggests approximately 30% to 90% of patients survive five years or longer.
Because HIPEC is a specialized treatment, it is available at select cancer centers. Patients should also be aware of treatment costs as they make treatment decisions. Recent estimates show that surgery with HIPEC can average $40,000.
Finding a qualified mesothelioma doctor is one of the most important decisions someone diagnosed with peritoneal mesothelioma can make. Many of the best doctors work in dedicated cancer clinics across the country. Some of those doctors also conduct clinical trials to study new therapies and methods of treating and diagnosing mesothelioma.
H. Richard Alexander, Jr., M.D.
Brian W. Loggie, M.D.
James Pingpank, M.D.
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Editor in Chief
Linda Molinari has more than 15 years of experience as a writer and advocate for mesothelioma patients and a ban on asbestos.
Editor in Chief
Thoracic Medical Oncologist
Dr. James Stevenson is an experienced medical oncologist specializing in mesothelioma and lung cancer treatment, currently practicing at the Cleveland Clinic.
Thoracic Medical Oncologist
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