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Peritoneal Mesothelioma | Mesothelioma Master

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Peritoneal mesothelioma is a form of cancer that forms in the peritoneum (abdominal tissue). It is caused by inhalation or ingestion of asbestos fibers. Patients with this condition can survive several years after diagnosis. The peritoneal mesothelioma is the second most common type of mesothelioma.

Tumors of this rare cancer related to asbestos form in the abdomen.

The initial symptoms of peritoneal mesothelioma are abdominal distension, abdominal pain, swelling or tenderness around the abdomen and constipation or diarrhea.

What is Peritoneal Mesothelioma?

Peritoneal mesothelioma accounts for 20 to 25 percent of all cases of mesothelioma. This is the most common diagnosis after pleural mesothelioma. Peritoneal mesothelioma patients have a longer life expectancy than patients with other types of mesothelioma. Some studies report on patients older than 5 years after cytoreductive surgery.

Location: Peritoneal mesothelioma occurs in the abdominal wall (peritoneum), a bilayer membrane that surrounds the stomach and other abdominal organs. The visceral layer protects organs such as the liver and gallbladder in the abdomen, while the parietal layer covers the outside of the abdomen.

Peritoneal Mesothelioma

Important Facts About Peritoneal Mesothelioma

  • It accounts the less than 20 percent of all the cases of mesothelioma.
  • Surgery and hot chemotherapy are the most effective treatments.
  • Immunotherapy for this type is available in clinical trials.
  • Peritoneal mesothelioma patients generally live four times longer than pleural mesothelioma patients.
The survival rate of a person diagnosed with peritoneal mesothelioma depends on the stage of the cancer, the types of treatments the patient undergoes, and the quality of the treating specialist.
Surgery plays an important role in long-term survival. Patients who do not qualify for surgery live for about a year. About half of the patients undergoing surgery and hot chemotherapy live more than five years later.

Although clinical studies on peritoneal mesothelioma are not as rich as on pleural mesothelioma, the researchers are investigating whether chemotherapy-based immunotherapy could play a greater role in fighting cancer by strengthening the body's immune system.

Mesothelioma in the Peritoneum

Peritoneum is protective of the membrane with two layers surrounding the abdomen. Peritoneal mesothelioma can develop in both layers.
  • Parietal layer: covers the abdominal cavity.
  • Visceral layer: surrounds the abdomen, liver and other abdominal organs.
Together, the layers strengthen the abdomen and its organs.

What Causes Peritoneal Mesothelioma?

In contrast to pleural mesothelioma, peritoneal mesothelioma is most common in women between the ages of 51 and 59 years. Men who are diagnosed with peritoneal mesothelioma are often veterans and those who are exposed to asbestos. Research indicates that peritoneal mesothelioma patients under the age of 60 have a better survival rate.

Peritoneal mesothelioma usually does not spread in the lymphatic system (lymph nodes) or bloodstream. It normally metastasizes in large quantities in the same areas where it originated.

Asbestos exposure is the leading cause of peritoneal mesothelioma, also known as abdominal mesothelioma.

Development of Peritoneal Mesothelioma

  • Swollen asbestos fibers enter the peritoneum from the digestive system.
  • Inhaled asbestos fibers pass from the lymphatic system into the peritoneum.
  • Once fibers are in the peritoneum, they irritate the cells.
  • In irritated cells begin to thicken the peritoneal lining.
  • Superfluous abdominal fluid builds up.
  • Over time, tumors develop on the damaged peritoneum.

The study of other causes of abdominal mesothelioma is rare. Evidence shows that other fibrous minerals such as erionite and abdominal irradiation trigger some cases of this disease.

Peritoneal Mesothelioma Symptoms

Due to the location of the disease, the symptoms of peritoneal mesothelioma develop mostly in the abdomen and/or gastrointestinal system and not in the chest and lung area.

Patients with peritoneal mesothelioma may not experience early symptoms. When symptoms are obvious, they can be confused with other diseases. A common symptom in many peritoneal mesothelioma patients is fluid pockets, called ascites, which often cause the stomach to bulge outward.

The symptoms of peritoneal mesothelioma may take decades after inhalation or ingestion of asbestos fibers. When symptoms occur, they usually develop first in the abdominal and/or gastrointestinal system, although some symptoms (such as weight loss or fever) may be systemic.

The symptoms of peritoneal mesothelioma range from those associated with the localization of tumors near the abdominal cavity to symptoms similar to other less severe conditions, such as the flu.

Peritoneal Mesothelioma

Common peritoneal mesothelioma symptoms:

  • Abdominal pain or swelling
  • Diarrhea or constipation
  • Changes in bowel habits
  • A feeling of fullness
  • Night sweat or fever
  • Unexplained weight loss
  • Nausea or vomiting
  • Fatigue
  • Anemia

In the most cases, the peritoneal mesothelioma does not spread to the lungs. It has been shown to spread to other areas of the abdomen, such as the ovaries, liver, or intestine. This metastasis often causes it to be discovered and sometimes misdiagnosed. Symptoms of abdominal pain or ascites can sometimes lead to misdiagnosis of hernias or to simple abdominal pain.

Diagnosis of Mesothelioma

The latest advances in the medical technology allow the doctors to diagnose this disease earlier than ever. Experienced cancer doctors, however, have difficulty in accurately diagnosing them. In fact, the process can take months.

Diagnosis of malignant peritoneal mesothelioma is difficult due to nonspecific signs and symptoms. It is often confused with abdominal cramps (gas) and irritable bowel syndrome. Most patients experience no symptoms until the disease has progressed. CT scans are the most useful imaging tool to test for peritoneal mesothelioma.

Doctors can also use a technique called peritoneoscopy. During this procedure, a surgeon makes a small incision on the abdomen of the patient and uses a small camera to examine the abdomen. There is also a tool on the camera that can be used to remove tissue from the peritoneum to test for mesothelioma. These tissue biopsies are needed to confirm a diagnosis.

Since the symptoms of peritoneal mesothelioma are often similar to those of other diseases, the diagnosis can be difficult. Usually, diagnostic tests focus on excluding more common diseases and other cancers.

As part of the mesothelioma diagnosis, the doctor determines the stage of the cancer. Although there is no staging system for peritoneal mesothelioma, physicians may try to determine how far advanced the disease is on the basis of relevant criteria, for example, if the cancer has spread the lymph nodes or other organs.

Ascites occur in 60-100% of newly diagnosed patients.
When diagnosing peritoneal mesothelioma, physicians do not use a standard staging system. Generally, the abdominal disease is centralized before the tumors begin to spread. During progression to stage 2, the mesothelioma can spread more but is still contained in the peritoneum. In the terminal stage, stage 4, the mesothelioma has spread to other organs such as the liver and the colon.

The process of diagnosis of peritoneal mesothelioma is similar to other types of mesothelioma. It begins with a thorough examination of your medical history, your professional history, and your general physical condition. Usually follows a series of tests, including image scans and biopsies.

Make sure you mention a history of asbestos exposure, even if your doctors forget to ask. It is important to communicate every detail that you can remember. These include dates for the incidents and the duration and duration of the claims.

This information alerts your doctors to the possibility of asbestos disease and helps them to determine the next steps. Vague abdominal discomfort is very nonspecific, so the history of asbestos exposure is important for conducting diagnostic tests.

Misdiagnosis

Since this cancer is so rare, doctors who have no experience with the disease often diagnose mesothelioma patients with more common diseases that have similar symptoms. This is the serious misstep that delays the proper treatment.

Symptoms of peritoneal mesotheliomas, such as abdominal swelling, weight loss, and hernias, also occur in other types of abdominal cancers and many less severe conditions. This overlap of symptoms increases the likelihood of misdiagnosis.

If you have been exposed to asbestos in the past, it is best to make an appointment with a specialist to ensure an accurate diagnosis. Doctors specializing in mesothelioma have the knowledge and tools to make a quick diagnosis. You can explain all the mesothelioma treatments available to you.

Imaging Scans

When a patient experiences symptoms, doctors will likely ask for a chest x-ray, CT scan, or other types of imaging. These tests will uncover potential tumors and show cancer spread. They also help doctors choose the best biopsy sites.

It is important to know that a CT scan can diagnose ascites (fluid in the abdomen). In the absence of liver disease, it is extremely important to track the cause of ascites.

Biopsies

Biopsies are smaller procedures in which fluid and tissue samples are taken under a microscope for examination. This is an essential step in the diagnostic process as only one biopsy confirms a peritoneal mesothelioma diagnosis.

Sometimes, doctors need to perform a laparoscopic surgical biopsy that is more invasive. In both cases, pathologists will check if laboratory results show cancer cells in your peritoneal fluid or tissue.

Testing biopsy specimens with antibodies called antibodies is important for confirming mesothelioma diagnosis. The antibodies used to confirm peritoneal mesothelioma include calretinin and podoplanin.

Peritoneal Mesothelioma Cell Types

Mesothelioma tumors consist of cells that are classified according to their structure and composition. The three major cell types of the peritoneal mesothelioma include epithelioids, sarcomatoids and biphasic.

Epitheloid mesotheliomas are the most common and most responsive to the treatment. Sarcomo cells are the rarest and poorly respond to treatment. Biphasic tumors consist of epithelial and sarcomoid cells. The response of the biphasic mesothelioma to the treatment depends on the ratio of epithelioid to sarcoma cells.

Because there are rare subtypes of these cells, pathologists face challenges in the diagnosis of abdominal cancer.

Other histological deviations of the peritoneal mesothelioma include adenoid cystic, tubulopapillary, microcystic, signet ring, diffuse, not otherwise specified (NOS), pleomorphic and well-differentiated papillaries.

The cell type of a patient can have a significant impact on the prognosis. Mesothelioma patients with epithelioid tumors live on average 200 days longer than patients with sarcomatous tumors.

Examples of rare cell subtypes include:

Lymphohistiocytoid mesothelioma

An often misdiagnosed form of sarcomatous mesothelioma. If it develops alongside epithelial cells, a two-phase peritoneal mesothelioma diagnosis is made.

Desmoplastic mesothelioma

A type of sarcomatous cells that occurs in peritoneal and pleural mesothelioma. The cells are made up of more than 50 percent fibrous tissue that produces collagen.

Deciduoid mesothelioma

A rare variant of epithelioid mesothelioma. It was diagnosed in around 45 mesothelioma cases. About half of the cases of decided occur in the abdomen.

How Is Peritoneal Mesothelioma Staged?

Imaging scans help physicians estimate the stage of mesothelioma. These tumors first form on the abdominal wall. The tumors grow and spread, by they migrate outside the lining to lymph nodes and distant organs.

For decades, peritoneal mesothelioma experts have developed their own staging system because there was no official system. Since then researchers have proposed three stages. A fourth phase is not yet clearly defined.

It is generally accepted that patients with severe tumor spread are classified as stage IV.

3 Stages of Peritoneal Mesothelioma

Peritoneal Mesothelioma

Stage 1

Cancer tissue is minimal and tumors are contained in the abdominal wall, and lymph nodes are cancer-free.

Stage 2

Cancerous tissue is moderate and tumors have not spread outside the lining or to the lymph nodes.

Stage 3

Cancerous tissue is more extensive and tumors may have spread outside the peritoneal lining, to lymph nodes, or both.

Treatment Options for Peritoneal Mesothelioma

The most effective treatment for peritoneal mesothelioma is cytoreductive surgery, followed by hyperthermic intraperitoneal chemotherapy (HIPEC) - a hot chemotherapy wash that kills cancer cells in the abdomen.

Although an increasing number of specialists have developed as treatment providers for stomach cancer in recent years, the total number of peritoneal mesothelioma specialists is still low.

If there are no malignant mesothelioma specialists for peritoneal in the area, you can consider one in a neighboring country.

The treatment of this type of mesothelioma includes surgery, chemotherapy and experimental therapies such as immunotherapy.

Doctors believe that the combination of traditional treatments often works better than any single treatment. A combination of one or more treatments is referred to as multimodal therapy. Research shows that a multimodal approach usually provides the best survival benefits.

The most promising treatment for peritoneal mesothelioma is cytoreductive surgery in combination with heated intraperitoneal chemotherapy (HIPEC).

While doctors only perform HIPEC surgery on a case-by-case basis, this has increased survival and improved quality of life. In studies with small groups of patients, about half lived for five years or more.

The treatment options depend on the stage in which a peritoneal mesothelioma patient is diagnosed. For patients with earlier stages, there are more curative treatment options, such as: B. cytoreduction.

Patients in later stages may receive palliative treatments such as radiation or chemotherapy. Another palliative treatment option may be paracentesis to drain abdominal fluid.

The most successful treatment of peritoneal mesothelioma was the combination of cytoreduction surgery and HIPEC (heated intraperitoneal chemotherapy). The cytoreduction removes the most of cancerous tumor and HIPEC is used to kill the remaining cells.

In a study with Dr. med. James Pingpank analyzed 211 patients with malignant peritoneal mesothelioma between 1992 and 2010. All participants were treated with cytoreduction and HIPEC. Patients on both procedures had a 5-year survival rate of 41% and a 10-year survival rate of 26%. The researchers found that patients' median overall survival was 38.4 months.

This treatment was successful in patients with good general health. Some patients have lived for 7 years after this operation.

Find a mesothelioma specialist who offers this treatment option with our free Doctor Match program.

In order to qualify for surgery with HIPEC, a patient's cancer must be so limited that doctors can remove it completely and not spread over the abdominal area.

Qualified patients must also be physically fit to tolerate the stress of anesthesia and surgery.

Surgery

Cytoreduction Surgery

Cytoreduction is also known as debulking. The goal of cytoreduction is to remove as much tumor as possible, although often the entire tumor can not be removed. The peritoneum and/or some other organs may need to be removed.

Since the cytoreduction surgery is so extensive, it can take up to 10 to 12 hours for a surgeon. It is usually performed in the patients with stage 1 or 2 peritoneal mesothelioma.

The recovery can take between 7 and 13 days. One study showed that the majority of patients had nausea for up to 13 days after their operation. Regular activities (such as eating, drinking, and mobility) are usually restored within 11 days of cytoreduction and HIPEC.
Peritonal Mesothelioma
Surgery is the most promising traditional treatment option for peritoneal abdominal mesothelioma, but it is only effective in early cancer. Since doctors most often diagnose asbestos-related diseases after the cancer has spread, most operations only attempt to remove tumor segments.

Surgery can be curative or palliative. The curative operation aims to remove as much tumor as possible to cure the cancer. Otherwise, physicians may perform a palliative surgery that removes parts of the tumor to alleviate symptoms, including bowel obstruction, survival, and quality of life. Palliative therapies do not stop the cancer.

The tumor spread is usually too large when it reaches over the abdomen to be operated on to completely remove cancer. A curative operation is not recommended after the cancer has spread. However, surgery can be performed to remove most tumors to relieve pain and improve symptoms such as abdominal distension and pain.

Typical operations include peritonectomy and cytoreductive surgery, bowel resection and removal of some organs.

Another small surgical procedure known as paracentesis is commonly used in patients with peritoneal mesothelioma. A small abdominal incision is made to remove excess peritoneal fluid (ascites). This procedure reduces abdominal swelling and pain.

Chemotherapy

Chemotherapeutics can shrink peritoneal mesothelioma tumors and slow down the growth and spread of cancer. It can be administered before, during or after surgery. In the some cases, the doctors offer chemotherapy as the only treatment option. Chemotherapeutic agents that are effective against peritoneal mesotheliomas include pemetrexed, cisplatin, carboplatin and gemcitabine.

In recent years, cancer ablation chemotherapy - including peritoneal mesothelioma, colon cancer, and ovarian cancer - has been carried out in a new way by using a heated chemotherapy wash that flushes out the abdominal cavity and hopefully kills all cancer cells left after cytoreductive surgery. This technique is called hyperthermic intraperitoneal chemotherapy (HIPEC).

Although HIPEC is performed in only a few cancer centers around the world, it has proven to be more effective than the more common multimodal treatment option for surgery, followed by systemic chemotherapy. This may be because the chemotherapeutic agents used in heated intraperitoneal chemotherapy treatments are stronger than those used for systemic treatments such as cisplatin.

According to a 2015 study presented at the American Society of Clinical Oncology (ASCO), about two thirds of peritoneal mesothelioma patients who received HIPEC treatment survived 3.4 years - much longer than those Standard survival time for peritoneal mesothelioma.

In 2017, Dr. Paul Sugarbaker of improved survival in patients who received early postoperative chemotherapy and long-term chemotherapy after cytoreductive surgery with HIPEC. All chemotherapy was intraperitoneal chemotherapy, ie it was only applied to the peritoneum. No systemic chemotherapy was used in the study. Of the 29 patients who underwent surgery with HIPEC, postoperative chemotherapy, and long-term chemotherapy, 75 percent lived longer than five years.

In the appropriate patients, the main treatment will be cytoreductive surgery with HIPEC. The surgical part removes all gross tumors with residual deposits of less than 2 mm. The HIPEC treats the remaining tumor and microscopic cancer cells that the surgeon can not see.

Patients with peritoneal mesothelioma can receive a combination of Alimta and cisplatin, the same treatment that is also administered to pleural patients.

In 2009, a patient went into an unrelated procedure and signs of peritoneal mesothelioma were found. The patient was given the combination of Alimta (500 mg) and cisplatin (80 mg).

After six cycles of chemotherapy, all signs and markers of the peritoneal mesothelioma had disappeared. Six months later, CT scans showed no change or recurrence in mesothelioma. After 4 years, the patient lived without signs of disease progression.

Studies show that the normal survival of patients with peritoneal mesothelioma is about 7.6 months if they do not receive chemotherapy. 41% of the patients receiving the combination showed improvement, while 17% with cisplatin alone showed satisfactory results.

On average, patients taking the combination of Alimta and cisplatin lived 12.1 months longer than just 9.3 months with cisplatin.

Studies are also testing the efficacy of vinorelbine and gemcitabine in combination with cisplatin.

Radiation Therapy

In many peritoneal mesothelioma patients, radiation is usually not effective. Radiation may shrink tumors before or after cytoreduction, but no cases of eradicated mesothelioma have been reported by radiation alone. A mesothelioma specialist can determine if radiation is appropriate based on the patient's specific diagnosis.

Some studies show that radiation therapy can slightly improve the survival of peritoneal mesothelioma in combination with surgery and chemotherapy. Doctors, however, tend not to recommend radiation to these patients.

Although targeted irradiation can shrink tumors and slow cancer growth, the procedure is risky because of the location of these tumors. The peritoneum envelops the stomach, liver, and intestine. Exposure to nearby tumors could damage these organs and cause life-threatening damage.

Alternative Treatments

Alternative treatments and new therapies are available, but these treatments have less predictable results. The immunotherapy strengthens the body's immune system to fight cancer. The research on this emerging therapy focuses mainly on the treatment of pleural mesothelioma, which develops in the lining of the lung.

Many patients find hope in clinical trials, which are medical studies testing new and experimental treatments. Research from clinical trials helps improve outcomes for future patients.

Finding Peritoneal Mesothelioma Clinical Trials

The number of new cases of peritoneal mesothelioma is low. In the US, about 500 patients are diagnosed each year. The number of people in clinical trials for this cancer is even lower.

At The Mesothelioma Center, you can speak with your doctor or a patient advocate about whether a clinical mesothelioma study is right for you.

A current example of a peritoneal mesothelioma study is the drug tremelimumab. The study recruited patients to test the efficacy of tremelimumab against mesothelioma. It is an immunotherapeutic that signals to the immune system to attack malignant mesothelioma cells. Tremelimumab was combined with chemotherapy to increase efficacy in the trial.

In 2017, the Ochsner Medical Center in New Orleans opened a clinical trial to investigate the effects of a new immunotherapeutic in combination with chemotherapy for peritoneal mesothelioma.

Prognosis for Peritoneal Mesothelioma

While the prognosis for all forms of mesothelioma is generally poor, the life expectancy for peritoneal mesothelioma is slightly better than for other types of malignant mesothelioma. The median survival for abdominal mesothelioma is 1 year and the longest known survival time was 19 years.

Patients who have undergone cytoreductive surgery with HIPEC have significantly better survival rates. According to one study, about half of peritoneal mesothelioma patients undergoing this form of treatment lived more than five years.

The prognosis for peritoneal mesothelioma depends on:

  • Stage at diagnosis
  • Tumor grade (how fast it grows)
  • gender
  • Genetic mutations
  • Treatments selected

The rate of cancer development is highly variable in this type of mesothelioma. The individual prognosis is difficult to predict.

In the 80s and 90s, the average survival time was about one year. Today, more people with this disease live longer. Survival is significantly longer in patients who qualify for surgery with heated chemotherapy. Almost half of these patients live longer than five years.

More than the 60 percent of the patients are diagnosed too late to qualify for surgery. These patients often choose chemotherapy. The systemic combination of cisplatin and pemetrexed has a response rate of approximately 30 percent, mean progression-free survival of 11.5 months and median survival of 13 months.


Chemotherapy, which is initiated directly, not systemically, without surgery in the peritoneum, has a higher response rate of 47 percent. In the meantime, the heated chemo administered during the operation has a response rate of 84.6 percent.

Women tend to live longer with menopausal mesothelioma than men. If average and short-term survival is averaged, women live on average 13 months and men six months.

In the median survival of untreated the peritoneal mesothelioma is six months.

Patients with tumors containing epithelial cells live longer than patients with sarcomatous or biphasic cells. The tumor grade also influences the prognosis. Tumor grade is based on how abnormal the cells look, indicating how fast they are likely to grow and spread.

Although there is currently no cure for peritoneal mesothelioma, many patients have a hopeful prognosis. The median survival for patients without cytoreductive surgery is about one year. In patients who have undergone surgery, however, the survival time increases by up to five years. There have been the cases of long-term survivors who have been in remission for over fifteen years. The most successful cases are those in which mesothelioma is detected at an early stage and treatment begins immediately. Most of these cases involve cytoreductive surgery and HIPEC.

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Mesothelioma Master: Peritoneal Mesothelioma | Mesothelioma Master
Peritoneal Mesothelioma | Mesothelioma Master
Peritoneal mesothelioma is a cancer found in the peritoneum.Surgery and chemotherapy are the most successful treatments to extend life expectancy.
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