Peritoneal Mesothelioma

Peritoneal mesothelioma is a form of cancer that develops in the lining of the abdomen (the peritoneum). It is caused by the ingestion of asbestos fibers.

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Key Points

1
Peritoneal mesothelioma is the second-most common form of the disease.
2
Asbestos likely reaches the abdomen through ingestion or via the lymphatic system.
3
The median survival of a peritoneal mesothelioma patient is about 31 months.
4
Surgery with a heated chemotherapy wash (HIPEC) is the most effective treatment.

Peritoneal mesothelioma is a form of mesothelioma that develops in the lining of the abdomen (known as the peritoneum). Because of its location, it is sometimes referred to as abdominal mesothelioma. There are approximately 500 cases diagnosed in the U.S. each year.

Peritoneal mesothelioma develops after asbestos fibers become lodged in the peritoneum. This can cause symptoms like abdominal pain and swelling. The median survival is about 31 months. This means about half of peritoneal mesothelioma patients survive longer than 31 months.

However, new treatments have extended survival times. Cytoreductive surgery and HIPEC, a heated chemotherapy wash, has been successful in extending patient life expectancy.

Cause // Asbestos inhalation or ingestion
Location // Abdominal lining (peritoneum)
Common Symptoms // Abdominal pain
Ascites/swelling
Anorexia/weight loss
Treatment // Surgery
Chemotherapy
HIPEC Radiation
Prognosis // 6 – 12 months

What Causes Peritoneal Mesothelioma?

As with all types of mesothelioma, the peritoneal form is caused by exposure to asbestos. When asbestos materials are disturbed, an individual may inhale or ingest them.

Asbestos fibers may become lodged in the peritoneum and cause inflammation. Over time, the inflammation and scarring can lead to tumors.

How Asbestos Reaches the Abdomen

It’s unclear exactly how asbestos gets into the abdomen, but the two most common theories are lymphatic transport and ingestion.

How Asbestos Reaches the Abdomen

Lymphatic Transport

The lymphatic system is a network of connected tissue and organs that help fight disease. Some experts believe asbestos fibers initially enter through the lungs. The fibers are then transported through the lymphatic system to the abdominal cavity, where they can become stuck in the peritoneum.

Ingestion

An individual may swallow airborne asbestos fibers. This may happen either directly or after being trapped in mucus during inhalation. As the fibers move through the digestive system, they may become embedded in the lining of the abdomen.

Symptoms of Peritoneal Mesothelioma

Peritoneal mesothelioma can take anywhere from 10 to 50 years after asbestos exposure to begin to show symptoms. When the cancer first presents, peritoneal mesothelioma symptoms can easily be confused for other illnesses or diseases because they are nonspecific.

Common Peritoneal Mesothelioma Symptoms

Abdominal pain
Abdominal swelling
Anemia
Bowel obstruction
Breathing difficulties
Fever
Loss of appetite
Nausea
Vomiting
Weakness
Weight loss

Patients experiencing any of these symptoms should inform their doctor of any potential past asbestos exposure, even if it occurred many years ago.

Peritoneal Mesothelioma Diagnosis

A diagnosis will typically begin with a variety of tests to rule out other illnesses and types of cancer, including imaging scans and blood tests. These tests can help avoid misdiagnosis. Peritoneal mesothelioma is most commonly mistaken for other abdominal cancers, irritable bowel syndrome (IBS) or ovarian cancer.

Currently, a biopsy or tissue sample is the only definitive method to diagnose mesothelioma. The doctor will perform a laparoscopy or laparotomy to take a sample of the tissue from the abdominal lining.

Once the biopsy is taken, a pathologist will analyze the sample tissue under a microscope to determine if the cells are cancerous. A pathologist can further categorize the cell type and the severity of the abdominal mesothelioma’s progression.

Diagnosing Rare Forms of Peritoneal Mesothelioma

There are also two rare forms of peritoneal mesothelioma.

Rare Forms of Peritoneal Mesothelioma

Papillary Mesothelioma

This type is also known as well-differentiated papillary mesothelioma (WDPM).
This form most often develops in the peritoneum.
Papillary mesothelioma is often benign and can be surgically removed.
Prognosis is favorable, with some documentation of patients surviving 12 years or longer.

Omental Mesothelioma

This form develops in the omentum, a layer of the abdominal membrane that covers organs like the intestines and stomach.
This rare type may be a result of peritoneal mesothelioma spreading (metastasis).
There is no standard treatment, but case reports document chemotherapy as an option.
Prognosis may be poor.

Peritoneal Mesothelioma Staging

Because of its rarity, there is no set staging system for peritoneal mesothelioma. However, doctors may still be able to identify how advanced the disease is and its progression for an individual case.

Doctors may use the general mesothelioma staging system to determine the cancer’s progression. Commonly, in stage 1 and stage 2 the tumor is localized. In later stages, tumors are more likely to have spread to nearby organs and lymph nodes.

Peritoneal cancers also have another system that helps identify the severity of tumor progression and helps determine what treatments a patient is eligible for.

What Is the Peritoneal Cancer Index?

The Peritoneal Cancer Index (PCI) is a notable tool used by oncologists for several decades. The PCI works by segmenting the abdominal region into 13 distinct sections.

Oncologists will then “score” the region based on the number and size of the tumors present through imaging scans. This is known as a lesion score.

The overall PCI is calculated by adding the scores for each region together, with the highest PCI being 39. The regional scores and overall PCI will help oncologists determine how far the cancer has advanced.

Peritoneal Cancer Index

Lesion Size (LS) Score and Tumor Size

0: No tumors
1: Up to 0.5 cm
2: Up to 5 cm
3: Larger than 5 cm or multiple tumors

PCI Score and Proposed Mesothelioma Stages

1-10 : Stage 1
11-20: Stage 2
21-30: Stage 3
31-39: Stage 4

In general, a higher score indicates a more advanced stage. A patient’s stage of peritoneal mesothelioma is an important factor in determining their prognosis.

Peritoneal Mesothelioma Prognosis

Peritoneal mesothelioma life expectancy has been improving. Compared to other forms of mesothelioma, peritoneal mesothelioma has the most favorable prognosis. Median survival for peritoneal mesothelioma is about 31 months.

Prognosis may vary based on several factors:

Location: The origin of the cancer may determine how it will impact the rest of the body.
Stage: Generally, lower stages experience better prognosis.
Cell type: The three main cell types are epithelioid, sarcomatoid and biphasic. Epithelioid has the best prognosis.

Peritoneal Mesothelioma Prognosis Based on Cell Type

Epithelioid mesothelioma: 16 months
Sarcomatoid mesothelioma: 4 months
Biphasic mesothelioma: 9 months

These factors also impact a patient’s treatment plan. Treatment is the best way for patients to improve their prognosis.

Thanks to advancements in treatment, peritoneal mesothelioma patients have started to see an improved life expectancy. Studies indicate more than 50% of patients treated with surgery and heated chemotherapy survive 5 years or longer.

Peritoneal Mesothelioma Survival Rate

Peritoneal mesothelioma survival rates have continuously improved over the past decade. Breakthroughs in treatment and improved diagnostic technology have allowed patients to improve life expectancy.

Peritoneal Mesothelioma Survival Rates by Stage

1-year Survival Rates

Stage 1: 92%
Stage 2: 86%
Stage 3: 84%
Stage 4: 63%

3-year Survival Rates

Stage 1: 85%
Stage 2: 65%
Stage 3: 57%
Stage 4: 40%

5-year Survival Rates

Stage 1: 85%
Stage 2: 52%
Stage 3: 48%
Stage 4: 30%

*This data is according to stages based on the Peritoneal Cancer Index (PCI)

Learn More About Factors That Impact Mesothelioma Life Expectancy

Peritoneal Mesothelioma Specialists

Peritoneal mesothelioma doctors have experience treating this rare form of cancer. A peritoneal specialist will work with patients to create a treatment plan for their unique case.

Many peritoneal specialists are connected to top hospitals and cancer centers. These facilities have the most up-to-date technology and allow patients to get top quality treatment.

Dr. H. Richard Alexander, Jr.

Surgical oncologist at University of Maryland Marlene and Stewart Greenebaum Cancer Center

Dr. Paul H. Sugarbaker

Gastrointestinal surgical oncologist at Washington Cancer Institute

Dr. James Pingpank

Surgical oncologist UPMC Hillman Cancer Center

Find a Mesothelioma Specialist Near You

Peritoneal Mesothelioma Treatment

Peritoneal mesothelioma specialists often rely on three standard treatments for any type of mesothelioma: surgery, chemotherapy and radiation. Most often, two or more treatments are combined to have the best effect on a patient’s prognosis. This is called multimodal treatment.

These treatments may be administered with therapeutic or palliative intent. When administered with therapeutic intent, treatments like surgery aim to potentially extend survival. Palliative treatments help improve quality of life and relieve a patient’s symptoms.

Palliative Treatment for Peritoneal Mesothelioma

One common palliative surgery is called paracentesis. It may be administered for patients experiencing peritoneal effusion, or excess abdominal fluid. The operation removes the fluid build up in the peritoneum to relieve pressure in the abdomen and alleviate symptoms.

If peritoneal mesothelioma patients do not respond to common treatments, they may enroll in a clinical trial. Promising experimental treatments that may extend survival are tested in clinical trials. Each clinical trial has its own eligibility criteria, so patients should talk to their doctor about their options.

Cytoreductive Surgery and HIPEC

Many studies have shown the positive effects of treating abdominal mesothelioma with cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). HIPEC is a heated chemotherapy wash that circulates through the abdominal cavity immediately after surgery.

With the surgery, doctors aim to remove all visible tumors in the abdominal cavity. Doctors then administer HIPEC throughout the abdomen to kill any remaining cancer cells.

Some studies have found this combination therapy successful in extending patient life expectancy. In one study, 45% of patients survived 10 years or longer.

Although HIPEC can’t cure peritoneal mesothelioma, it may be one of the most effective treatment options for eligible patients.

Is Peritoneal Mesothelioma Curable?

There is no cure for peritoneal mesothelioma. Seeking treatment is the best way for mesothelioma patients to improve their prognosis.

Thanks to the work of doctors and researchers, mesothelioma treatment has come a long way. They continue to develop new treatments and treatment combinations to further improve mesothelioma survival.