Peritoneal mesothelioma is a type of malignant mesothelioma cancer that is caused by inhaled or ingested asbestos fibers. It develops in the abdomen or peritoneum. Common symptoms of peritoneal mesothelioma include abdominal pain, nausea, and abdominal swelling.
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Malignant peritoneal mesothelioma is a rare and aggressive cancer in the abdominal cavity. It is also known as abdominal mesothelioma or gastric mesothelioma.
The only proven cause of peritoneal is asbestos exposure. Asbestos fibers are inhaled or swallowed, and they settle in the abdomen.
Each year in the United States, approximately 300 to 500 cases of peritoneal mesothelioma are diagnosed.
The prognosis for thistype of mesotheliomais very poor, and most patients only survive 1-2 years. A new type of multimodal treatment, cytoreductive surgery and HIPEC, heated chemotherapy, have successfully extended patients’ life expectancy, with some living more than 5 years after diagnosis of peritoneal mesothelioma.
What Causes Peritoneal Mesothelioma?
As with all types of mesothelioma cancer, abdominal mesothelioma is caused by exposure to asbestos fibers. These fibers are eaten or inhaled and can even travel through the bloodstream to reach the abdomen and cause cancer years after exposure.
This delay in detecting cancer is known as the latency period. For most, the latency period for peritoneal ranges from 20 to 60 years. Asbestos fibers and tumors can be dormant for decades before they touch a patient.
How Does Peritoneal Mesothelioma Develop
Like other asbestos-related diseases, peritoneal mesothelioma takes a long time to develop, and it can take decades to appear. Asbestos fibers cause inflammation and irritation and damage the DNA of the cells they affect.
Damaged DNA will lead to abnormal cell growth. These errors result in the formation and uncontrolled growth of tumors. These tumors will often spread to other body parts over time.
Based on current research, scientists believe there are only two ways asbestos can enter the stomach: by swallowing it raw and through the lymphatic system, passing fibers through all organs.
How Asbestos Fibers Reach The Stomach
Lymphatic transport
A network of interconnected organs and tissues, the lymphatic system aids in disease prevention. According to some specialists, asbestos fibers first enter the body through the lungs. The fibers are subsequently carried through the lymphatic system to the abdominal cavity, where they might get lodged in the peritoneum.
Ingestion
A person may inhale or ingest airborne asbestos fibers. Fibers can pass through the bloodstream or digestive system and become deposited in the abdominal lining.
Symptoms Of Peritoneal Mesothelioma
Flatulence, stomach pain and tenderness, and digestive issues, including diarrhea or constipation, are typical signs of peritoneal mesothelioma. Due to the disease’s latency, many abdominal mesothelioma symptoms won’t appear for several years or until cancer has progressed to a more serious stage.
Symptoms of peritoneal mesothelioma
- Abdominal pain
- Swollen abdomen (ascites)
- Night sweats
- Nausea and vomiting
- Fever
- Unexplained weight loss
- Tiredness
- Diarrhea
- Constipation
- Loss of appetite
- Problems with the intestines or urine
Many of these symptoms are similar to other abdominal diseases or disorders. To diagnose mesothelioma, you will need a doctor to perform a biopsy to help make the diagnosis.
If you have been exposed to asbestos while using a known asbestos product or using asbestos at work and experience any of the symptoms, you should speak to your doctor and discuss your history. Your doctor may recommend annual mesothelioma screening tests, such as a scan, to monitor for new or worsening symptoms.
How Is Peritoneal Mesothelioma Diagnosed?
Diagnosis usually begins with various tests to rule out other diseases and types of cancer, including imaging scans and blood tests. These tests can help you avoid misdiagnosis. Peritoneal is most often confused with other tumors of the abdominal cavity, irritable bowel syndrome (IBS), or ovarian cancer.
A biopsy or tissue sample is the only definitive method of diagnosing mesothelioma. Your doctor will perform a laparoscopy or laparotomy to collect a tissue sample from your abdominal mucosa.
After the biopsy, the pathologist will analyze the tissue sample under a microscope to determine if the cells are cancerous. The pathologist can further categorize the cell type and severity of abdominal mesothelioma.
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.
- The prognosis is favorable, with records of patients who have survived 12 years or more.
Network mesothelioma
- This form develops in the web, the layer of the abdominal wall that covers organs such as the intestines and stomach.
- This rare type may result from the spread of peritoneal mesothelioma (metastasis).
- No standard treatment exists, but case reports document chemotherapy as an option.
- The prognosis may be poor.
Staging Peritoneal Mesothelioma
Due to its rarity, there is no established system for assessing peritoneal mesothelioma. However, doctors may still be able to determine howadvanced the disease isand how it progresses in an individual case.
Doctors can use an available mesothelioma staging system to help determine the progression of cancer. Most often, in stage 1 and stage 2, the tumor is localized. In the later stages, cancers are more likely to spread to nearby organs and lymph nodes.
Peritoneal cancers also have a different system that helps determine the severity of tumor progression and helps determines which treatments a patient is eligible for.
What Is The Peritoneal Cancer Rate?
The Peritoneal Cancer Index (PCI) is a remarkable tool used by oncologists for several decades. PCI works by segmenting the abdominal area into 13 distinct sections.
Oncologists then “judge” the region based on the number and size of tumors using imaging scans. This is called the scale of change.
Total PCI is calculated by summing the scores for each region, with the highest PCI being 39. Regional scores and overall PCI will help oncologists determine how far the cancer has advanced.
Peritoneal Cancer Index
Lesion size scale (LS) and tumor size
- 0: No tumors
- 1:do 0,5 cm
- 2:do 5 cm
- 3: Larger than 5 cm or multiple bumps
PCI Score and Proposed Stages of Mesothelioma
- 1-10: Etap 1
- 11-20: Etap 2
- 21-30: Etap 3
- 31-39: Etap 4
Overall, a higher score indicates a more advanced stage. The stage of peritoneal mesothelioma is an important factor in determining the prognosis.
Prognosis Of Peritoneal Mesothelioma
The life expectancy of peritoneal mesothelioma is improving. Compared to other forms of mesothelioma, peritoneal mesothelioma has the best prognosis. The median survival for peritoneal mesothelioma is approximately 31 months.
The prognosis may vary depending on several factors:
- Location: The origin of a tumor can determine how it will affect the rest of the body.
- Stage: Overall, the prognosis is better in the lower stages.
- Cell type: The three main types of cells are epithelial, sarcoma, and biphasic. The epithelium has the best prognosis.
Prognosis of peritoneal mesothelioma based on cell type
- Epithelial mesothelioma: 16 months
- Sarcoma mesothelioma: 4 months
- Two-phase mesothelioma: 9 months
These factors also influence the patient’s treatment plan. Treatment is the best way for patients to improve their prognosis.
With treatment advances, patients with peritoneal mesothelioma have improved life expectancy. Studies show that over 50% of patients treated with surgery and thermal chemotherapy survive 5 years or more.
The peritoneal mesothelioma survival rate
The survival rates of peritoneal mesothelioma have steadily improved over the past decade. Treatment breakthroughs and improved diagnostic techniques have allowed patients to increase life expectancy.
Peritoneal mesothelioma survival rates by stage
Annual survival rates
- Etap 1: 92%
- Etap 2: 86%
- Etap 3: 84%
- Etap 4: 63%
3-year survival rates
- Etap 1: 85%
- Etap 2: 65%
- Etap 3: 57%
- Etap 4: 40%
5-year survival rates
- Etap 1: 85%
- Etap 2: 52%
- Etap 3: 48%
- Etap 4: 30%
*This data is for steps based on the Peritoneal Cancer Index (PCI)
Peritoneal Mesothelioma Specialists
Doctors specializing in treating peritoneal mesothelioma are skilled in handling this uncommon malignancy. Patients and a peritoneal specialist will collaborate to develop a customized treatment plan for each patient’s condition.
Many peritoneal specialists are connected to the best hospitals and cancer centers. These facilities have the most modern technology and allow patients to receive treatment at the highest level.
Treatment Of Peritoneal Mesothelioma
Peritoneal mesothelioma specialists often rely on the three standard treatments for each type of mesothelioma: surgery, chemotherapy, and radiation therapy. Two or more treatments are often combined to obtain the best effect on a patient’s prognosis. This is called multimodal treatment.
These therapies may be administered with therapeutic or palliative intent. Surgery procedures are designed to extend survival when potentially administered with a therapeutic intention. Palliative treatments help to improve the quality of life and relieve the patient’s symptoms.
Palliative Treatment Of Peritoneal Mesothelioma
One of the common palliative operations is paracentesis. It can be given to patients with peritoneal exudate or excess fluid in the abdomen. Surgery removes the build-up of fluid in the peritoneum to reduce abdominal pressure and ease symptoms.
If patients with peritoneal mesothelioma do not respond to conventional therapies, they can enroll in a clinical trial. Promising experimental therapies that can prolong survival are being tested in clinical trials. Each clinical trial has its eligibility criteria, so patients should talk to their doctor about available options.
Cytoreductive Surgery And Hipec
Multiple studies have shown the positive effects of treating abdominal mesothelioma with cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). HIPEC is a heated chemotherapy fluid that circulates in the abdominal cavity immediately after the procedure.
During the procedure, doctors aim to remove all visible tumors in the abdomen. Doctors then administer HIPEC in the abdominal cavity to kill any remaining cancer cells.
Some studies have shown that this combination therapy effectively extends the patient’s life expectancy. In one study, 45% of patients lived 10 years or more.
Although HIPEC cannot cure peritoneal mesothelioma, it may be one of the most effective treatment options for eligible patients.
Is Peritoneal Mesothelioma Curable?
Peritoneal mesothelioma is incurable. The greatest method for mesothelioma patients to enhance their prognosis is to seek therapy.
Thanks to the work of doctors and researchers, the treatment of mesothelioma has come a long way. They continue developing new treatments and combinations to improve mesothelioma survival further.