Peritoneal mesothelioma develops in the lining of the abdomen (the peritoneum). It is the second most common form of cancer caused by asbestos, with approximately 500 cases diagnosed annually in the US.
Key Points about Peritoneal Mesothelioma
- Approximately 20 percent of all mesothelioma cases are peritoneal.
- Asbestos likely reaches the abdomen through ingestion or via the lymphatic system.
- Symptoms can take decades to appear after the initial asbestos exposure.
- Early diagnosis and aggressive treatment are the most effective options for surviving peritoneal mesothelioma.
Peritoneal mesothelioma, sometimes called abdominal mesothelioma, is one of several types of mesothelioma that develops in the lining of the abdominal cavity (known as the peritoneum). It accounts for about 15 – 20 percent of all mesothelioma cases diagnosed throughout the world, with approximately 500 cases in the U.S. diagnosed each year.
Peritoneal form is the second-most common form of the disease (after pleural mesothelioma), and while almost always fatal, it has a more favorable prognosis than other types of mesothelioma. New treatments have extended survival times, with many patients living with the disease for seven years or more.
- Cause // Asbestos inhalation or ingestion
- Location // Abdominal lining (peritoneum)
- Common Symptoms // Abdominal pain
- Treatment // Surgery
- Prognosis // 6 – 12 months
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How Is Peritoneal Different from Other Mesotheliomas?
As the second-most common type of the disease, peritoneal mesothelioma composes about 15 – 20 percent of new mesothelioma diagnoses. The primary ways that peritoneal mesothelioma can be contrasted from other types include the following:
Survival: Individuals with peritoneal mesothelioma typically have a longer life expectancy than patients with other types of mesothelioma.
Symptoms: The first place where symptoms of peritoneal mesothelioma develop is the abdomen and gastrointestinal system, because of where the cancer originates. Other types tend to develop symptoms in the chest and lungs first.
Location: Peritoneal mesothelioma develops in the lining of the abdomen, known as the peritoneum, a two-layer covering of tissue that encompasses the kidneys, gall bladder, liver, stomach, and other organs. The parietal layer on the outside protects the abdominal cavity, while the visceral layer on the inside protects the various organs.
Treatment: Like other types, peritoneal mesothelioma treatment includes surgery, chemotherapy, and radiation, as well as emerging treatments. Increased success has been seen with a specific operation known as cytoreductive surgery with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), in which the surgeon uses a warm chemotherapy “wash” to kill cancer cells in the abdomen.
What Causes Peritoneal Mesothelioma?
As with all types of mesothelioma, the peritoneal form is caused by exposure to asbestos. A very small number of people with a specific genetic predisposition may also develop peritoneal mesothelioma after prolonged exposure to erionite, a naturally occurring mineral similar to asbestos.
It’s unclear exactly how asbestos gets into the abdomen, but the two most common theories are lymphatic transport and ingestion.
Lymphatic Transport: A network of connected tissues and organs carries a fluid called lymph, which contains white blood cells, throughout the body. This lymphatic system is critical for helping to fight viruses, infection, and disease. Some experts believe that asbestos fibers enter initially through the lungs, and then are transported through the lymphatic system to the abdominal cavity, where they can become stuck in the mesothelial cells of the peritoneum.
Ingestion: Asbestos fibers may be swallowed, either directly or after being trapped in mucus during inhalation. The body cannot digest asbestos, and as the fibers move through the digestive system, they may work themselves into the peritoneal cavity and, eventually, into the lining of the abdomen.
Asbestos fibers in the peritoneum can cause inflammation that ultimately leads to cancer. As the tumors grow, they will spread throughout the abdomen and eventually to other parts of the body.
What Are the Symptoms of Peritoneal Mesothelioma?
Like all forms of asbestos-related cancer, peritoneal mesothelioma can lie dormant for up to fifty years, and the cancer’s symptoms may be easily confused with those of other, more common diseases. Many patients go undiagnosed or receive an improper diagnosis for months before the proper conclusion is determined. For many patients, an accurate cancer diagnosis is made only after it has already developed to a late stage, which is harder to treat.
- Abdominal pain (acute to severe)
- Swelling of the abdominal region due to fluid accumulation
- Breathing difficulties
- Loss of appetite and/or weight loss
- Bowel obstruction
A patient’s Symptoms may vary depending on a number of factors, including:
- Tumor location and size
- Extent of the cancer’s spread
- Patient’s age
- General health of the individual
When presenting symptoms for diagnosis, it’s important for patients to tell their doctor about any exposure to asbestos, even if it occurred many years ago. This could help the doctor narrow down the diagnosis, sparing the patient from unnecessary tests and a long wait before starting treatment.
How is Peritoneal Mesothelioma Diagnosed?
As with the more common pleural mesothelioma, a peritoneal diagnosis begins with imaging tests, such as an X-ray, MRI, CT scan, or PET scan. However, these tests can only show where malignant tumors may be formed and how the cancer may have spread.
After the imaging tests, a doctor will perform additional procedures to rule out other potential diseases. A tissue biopsy is the only test that can make a conclusive diagnosis of peritoneal mesothelioma. The doctor will perform a peritoneoscopy or laparotomy, which is a procedure to take a sample of the tissue from around the abdomen. The biopsy can be uncomfortable, but it is usually over in just a few minutes.
Once the biopsy is taken, a pathologist will scrutinize the sample tissue under a microscope to determine if the cells are cancerous. The doctor will further categorize a mesothelioma tumor according to its cell type.
How is Peritoneal Mesothelioma Treated?
Treating this deadly cancer usually requires a multimodal approach – that is, a combination of different techniques, usually surgery, radiation therapy, and chemotherapy. Multimodal treatment has shown a significant improvement in survival rates. If the disease is diagnosed at a late stage, then some of these treatments may be palliative (designed to relieve pain) rather than curative.
- Most often successful in early stages of mesothelioma
- Peritonectomy: tumor removed by cutting portion of lining and tissue from abdominal area
- Large tumors may require removal of a lung or section of the diaphragm
- Most peritoneal cases are too advanced for surgery
- Most common treatment for peritoneal mesothelioma
- Hyperthermic intraperitoneal chemotherapy (HIPEC): new treatment that involves delivering chemotherapy drugs directly to the abdominal cavity
- HIPEC most effective when combined with cytoreductive surgery
- Pemetrexed (Alimta) and cisplatin are the most common chemotherapy drugs
- Traditional radiation therapy bombards abdomen with radiation from an external source
- Brachytherapy: radiation delivered through an internal source
- Can enhance the effectiveness of other treatments and relieve symptoms
- Applied as palliative treatment during late-stage peritoneal mesothelioma
Experimental cancer treatments such as immunotherapy are riskier than traditional therapies, but they may offer hope to patients who respond poorly to chemotherapy, surgery, and radiation. Because of the low number of peritoneal cases each year, the number of clinical trials available for this cancer are limited.
- Uses the immune system to start or enhance the body’s natural immune responses to mesothelioma
- Can be used to target specific types of cells
- Usually employed in combination with conventional treatments
- Still only an option in clinical trials
- Cancer research funding has increased as mesothelioma cases have risen
- Test new treatments and combinations of therapies
- Outcomes uncertain, but may offer patients hope beyond conventional treatments
Peritoneal Mesothelioma Treatment Costs
The costs associated with peritoneal mesothelioma can be large, as is the case with any life-threatening disease. The expenses many patients find they need to pay include:
- Diagnosis expenses
- Therapy costs
- Hospital and at-home recovery expenses
- Follow-up visit payments
How much a peritoneal patient spends will be determined by a number of different factors, such as the stage of the disease at diagnosis, the location and cell type, what treatment options are available, how much medical insurance is willing to pay, and even what state they live in.
Since asbestos is the only known cause of mesothelioma, people diagnosed with peritoneal mesothelioma could receive a settlement or other compensation to use towards medical costs, as well as lost income. In some cases, they might also receive remuneration for pain and suffering caused by the cancer.
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