Peritoneal mesothelioma affects the lining of the abdomen and is the second most common type of mesothelioma. It makes up about 20 percent of all mesothelioma cases.
Just like pleural mesothelioma, peritoneal mesothelioma is caused by exposure to asbestos. When someone ingests microscopic asbestos fibers, the tiny sharp particles get embedded in the lining of the abdomen (peritoneum). Over a course of 20 to 50 years, the fibers in the peritoneum cause mutations in the surrounding healthy mesothelial cells. Constant genetic damage makes these cells cancerous, forming tumors on the peritoneum.
What does your diagnosis mean? Once doctors obtain a diagnosis, they can determine a treatment plan based on the cell type and how advanced the disease is. Peritoneal mesothelioma doesn’t have a standard staging system, so doctors classify the disease as either localized or advanced. Those with localized mesothelioma can generally handle more aggressive treatments.
What treatments work? Surgery often offers the best chance for long-term survival. The cytoreduction with HIPEC has become the standard of care for peritoneal mesothelioma patients. The procedure removes tumors from the abdomen and treats the affected area with heated chemotherapy.
What’s the prognosis for this disease? Thanks in part to HIPEC, peritoneal mesothelioma patients have a higher survival rate than those diagnosed with either pleural or pericardial mesothelioma. The survival time of some patients treated with this procedure has reached beyond 5 years.
Treatments for Peritoneal Mesothelioma
Patients diagnosed with peritoneal mesothelioma most often receive the above-mentioned cytoreductive surgery with heated intraperitoneal chemotherapy (HIPEC). This combination of treatments is also generally known as a multimodal therapy. Dr. Paul Sugarbaker, one of the most respected mesothelioma specialists in the U.S., pioneered the addition of HIPEC to the procedure.
The addition of HIPEC to cytoreductive surgery has led to significant leaps in life expectancy for peritoneal mesothelioma patients.
Cytoreductive surgery is a procedure surgeons use to remove mesothelioma tumors that are in and around the abdominal cavity. A surgeon removes any visible signs of cancer. The surgeon may also remove nonessential organs affected by mesothelioma. The procedure itself is highly complex and can take up to 10 hours to complete.
Heated Intraperitoneal Chemotherapy (HIPEC)
HIPEC is a heated mixture of chemotherapy drugs introduced into the abdominal cavity shortly after the cytoreductive surgery is completed. The goal of HIPEC is to kill any microscopic traces of mesothelioma that may remain after surgery.
The mixture of drugs is typically heated to a temperature of 104 – 107 degrees and circulated inside the abdominal cavity for a maximum of 2 hours. This allows the chemotherapy enough time to be absorbed into the microscopic cancer cells and increases the cancer-killing effectiveness of the drugs.
HIPEC may be given once, shortly after the surgical procedure, or as many times as the surgeon sees fit in the weeks following the surgery. One recent study reported that patients who receive repeated HIPEC after a single cytoreductive surgery experienced a longer survival time (approximately 80 months) than those who only received it once (27.2 months).
A paracentesis involves the use of a needle or catheter to remove the buildup of fluid in the abdominal cavity. This procedure is mainly used to relieve any discomfort or pain caused by symptoms of peritoneal mesothelioma.
Symptoms of Peritoneal Mesothelioma
Peritoneal mesothelioma symptoms are often caused by the buildup of fluid in the abdominal cavity (ascites) and the thickening of the lining of the abdomen (peritoneal thickening). The more advanced a patient’s mesothelioma is, the more pressure ascites and peritoneal thickening put on the internal organs in the abdominal cavity.
Symptoms associated with peritoneal mesothelioma include:
- Buildup of fluid in the abdomen (ascites)
- Weight loss
- Loss of appetite
- Abdominal pain
- Seizures (less common)
- Buildup of gas
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Diagnosing Peritoneal Mesothelioma
The diagnosis of peritoneal mesothelioma typically begins with an x-ray. CT scans and MRIs aren’t used as often. The reason for this is that doctors can easily confuse mesothelioma on a CT scan or MRI with an abundance of gas and misdiagnose the disease as a result.
To confirm a peritoneal mesothelioma diagnosis, doctors will likely order a diagnostic procedure called a peritoneoscopy. During this procedure, a surgeon inserts a small camera through a small incision in the patient’s abdomen. The camera helps the surgeon find and extract a tissue sample from the mesothelioma tumor in the abdomen.
The surgeon sends the tissue sample to a lab where a pathologist tests the sample. Pathologists are doctors who specialize in the identification of different diseases. Sending the sample to a pathologist is necessary because peritoneal mesothelioma looks very similar to other cancers, even on a cellular level. Pathologists run several tests on the tumor sample to make sure that the suspected peritoneal mesothelioma diagnosis is correct.
The Prognosis of Peritoneal Mesothelioma
Patients diagnosed with peritoneal mesothelioma typically enjoy a more favorable prognosis than those with other forms of the disease. On average, the life expectancy of peritoneal mesothelioma patients is 12 months.
However, multiple studies have shown that patients who have cytoreduction with HIPEC experience significantly longer survival times.
Many patients now survive up to 5 years and some even live beyond 7 years. According to a study on its clinical results, most medical centers typically report a median survival rate ranging from 30 to 90 months after a cytoreduction with HIPEC.
Ultimately, a peritoneal mesothelioma patient’s prognosis is always unique because it’s based on a number of factors that are individually specific.
If you’ve been diagnosed with peritoneal mesothelioma, there are steps you can take to beat your prognosis. Living a healthy lifestyle, including eating healthy foods and getting plenty of exercise, can improve your overall health. If you’re healthy, you have a stronger immune system that can help fight mesothelioma.
The most important step a patient can take, however, is getting treatment from an experienced mesothelioma specialist. A specialist can select the most effective course of treatment for your specific cancer stage and mesothelioma cell type.
Our Patient Help Team has access to a network of mesothelioma specialists and can help connect you to an experienced professional now.
Repeat Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy May Offer Survival Benefit for Intraperitoneal Mesothelioma: A Single Institution Experience. Retrieved on October 20, 2014 from http://link.springer.com/article/10.1245/s10434-013-3341-7#page-1.
Clinical Results of Cytoreduction and HIPEC for Malignant Peritoneal Mesothelioma. Retrieved on October 17, 2014 from http://link.springer.com/chapter/10.1007/978-0-387-48993-3_22.
Clinical Results of Cytoreduction and HIPEC for Malignant Peritoneal Mesothelioma. Retrieved on October 20, 2014 from http://jco.ascopubs.org/content/27/36/6237.short.
Peritoneal Mesothelioma Treatment. Retrieved on October 17, 2014 from http://www.cancerresearchuk.org/about-cancer/type/mesothelioma/treatment/types/peritoneal-mesothelioma-treatment.
Diseases and Conditions: Mesothelioma. Retrieved on October 17, 2014 from http://www.mayoclinic.org/diseases-conditions/mesothelioma/basics/definition/con-20026157.