Peritoneal mesothelioma is a rare asbestos-related cancer of the peritoneum, the tissue lining the abdomen. Common treatments are cytoreductive surgery (tumor-removing) with HIPEC, chemo and immunotherapy. Cancer spread, cell type and overall health affect eligibility for surgery and outcomes.
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Quick Answers
What is peritoneal mesothelioma?
Peritoneal mesothelioma is a rare asbestos-related cancer that starts in the thin tissue lining the abdominal cavity and organs called the peritoneum.
What symptoms are most common?
Common symptoms include abdominal pain or swelling, fluid buildup in the belly, digestive changes, loss of appetite and unexplained weight loss.
How is peritoneal mesothelioma diagnosed?
A tissue biopsy is the only test that can confirm the diagnosis. Imaging and blood tests can suggest disease and help doctors plan next steps.
What treatments are used?
Treatment can include cytoreductive surgery with HIPEC, systemic chemotherapy, immunotherapy, radiation, targeted therapy and palliative care. Treatment plans are tailored to each person.
Our Take
“The best treatment for peritoneal mesothelioma is a combination of HIPEC and pressurized intraperitoneal aerosolized chemotherapy, also known as PIPAC, which differs from traditional chemo because it uses pressure to turn the chemo drugs into a mist to reach the abdominal area better.”
Expert Take
2:55
[MUSIC PLAYING] Peritoneal mesothelioma is different than pleural mesothelioma essentially because it’s just a different site in the body. It’s a cancer that comes from the same cell of origin, the mesothelium cell. You can get cancer from really any cell in your body. You can get cancer in bone cells, fat cells, muscle cells. But in this particular case, there’s a layer of cells both in the chest as well as in the abdomen that have a lining function that regulate the passage of fluid across the membrane into the cavity or out of the cavity. And then also allow tissues to slide easily without getting stuck, which is, of course, really important when you breathe or when the bowels move around. But you have these same cells in the lining of the abdominal cavity as you do have lining the chest cavity, so you can get mesothelioma in the abdomen as well as in the chest. [MUSIC PLAYING] Mesothelioma of the peritoneal cavity only makes up about 20% to 30% of all the mesothelioma cases in the US. That comes out to an incidence of about 400 new cases per year. Likely, it’s just that the peritoneal lining is less commonly exposed to asbestos than the lining of the thoracic cavity where the fibers are easily inhaled. [MUSIC PLAYING] I try to, first, tell them that they certainly have treatment options. A lot of folks in the medical community still are fairly nihilistic about this disease. So the first thing I like to tell them is that they certainly do have options. Essentially without treatment, the median survival is a year or maybe a little bit less. With good treatment that we use now, that median survival can actually be several years. [MUSIC PLAYING] First and foremost, you need to make sure the diagnosis is correct. So you need a pathologist that’s comfortable making that kind of a diagnosis. There are some other tumor types that sometimes are mistaken for mesothelioma. So a path review I think is important. The next thing certainly is need to be in a place that has a multidisciplinary treatment team that can discuss your case, look at the imaging, and then come up with a plan that would be best on an individual basis for someone with malignant peritoneal mesothelioma, good infrastructure to be able to make that possible, surgeons that are comfortable with difficult complex cases, a place where folks aren’t terribly pessimistic or nihilistic and are willing to try treatments for this difficult to treat disease. [MUSIC PLAYING]
Overview
Peritoneal mesothelioma, also called abdominal mesothelioma, forms tumors in the peritoneum. The peritoneum is the thin tissue lining the abdominal cavity and organs in your belly. Irritation from asbestos exposure is the primary cause.
The most common symptoms of peritoneal mesothelioma are stomach pain, swelling, digestive problems and weight loss. Patients can improve their symptoms and prognosis with treatments including chemotherapy, immunotherapy and surgery, particularly HIPEC, a combination of surgery and a heated chemo wash of the abdominal cavity.
Doctor’s Insights
“Peritoneal mesothelioma is different than pleural mesothelioma essentially because it’s just a different site in the body. It’s a cancer that comes from the same cell of origin, the mesothelium cell. You can get cancer from really any cell in your body. You can get cancer in bone cells, fat cells and muscle cells.”
Comparing Abdominal Cancers
Several cancers affect the abdominal cavity, but peritoneal mesothelioma isn’t the same as ovarian, colorectal and appendiceal cancer. Those cancers begin elsewhere and may spread to the peritoneum, while peritoneal mesothelioma starts in the peritoneal lining and requires a different treatment approach.
Ovarian
Ovarian cancer can develop in one or both ovaries and fallopian tubes. Most cases (85% to 90%) are epithelial ovarian carcinoma on the ovary’s surface.
Colorectal
Colorectal cancer can develop in the colon or rectum. Most cases are adenocarcinoma, a cancer that starts in the cells lining the large intestine.
Appendiceal
Appendiceal cancer starts in the appendix. Types include neuroendocrine tumors from hormone-producing cells and mucus-producing mucinous neoplasms.
Peritoneal mesothelioma shares many symptoms with other abdominal cancers including fluid buildup or ascites and abdominal pain. CT scans and imaging tests can look nearly identical across these diagnoses, contributing to why peritoneal mesothelioma is one of the most commonly misdiagnosed cancers.
Multiple peer-reviewed case reports confirm peritoneal mesothelioma initially presented as ovarian cancer, but tissue biopsy later corrected the diagnosis. In men, doctors sometimes mistake peritoneal mesothelioma for colorectal or appendiceal cancer that has spread to the peritoneum.
A tissue biopsy is the only reliable way to confirm a peritoneal mesothelioma diagnosis. Pathologists look at specific proteins in mesothelioma cells but not ovarian, colorectal and appendiceal cells. Doctors use a combination of positive mesothelioma markers and negative carcinoma markers to reach an accurate diagnosis.
A misdiagnosis can delay getting the right care for you. If you have a history of asbestos exposure and received an abdominal cancer diagnosis, seek a second opinion from a peritoneal mesothelioma specialist.
When to See a Doctor
See a doctor for persistent abdominal pain, bloating or unexplained digestive problems. If you have a history of asbestos exposure, talk to a mesothelioma specialist.
Symptoms
Common symptoms of peritoneal mesothelioma include abdominal pain, bloating and fluid buildup. Fluid in the belly puts pressure on internal organs, causing pain and discomfort. Early-stage mesothelioma can change digestion, including bowel habits. Other signs are weight loss and fever, with most mesothelioma symptoms appearing in later stages.
Epifanio Figueroa tells us his first sign of peritoneal mesothelioma was abdominal swelling. He shares, “It started with my stomach growing, and it didn’t stop getting bigger. It was liquid that was being accumulated. It was from mesothelioma, but we didn’t know that at the time.”
Early Symptoms (Most Common at Presentation)
Late-Stage Symptoms (Appear as Disease Progresses)
Late-stage mesothelioma usually includes significant abdominal pain, fluid buildup, weight loss, fatigue, nausea and vomiting. A 2023 report in Radiology Case Reports also discussed the risk of bowel obstruction. Rare and severe symptoms include blood clots and fluid buildup around the lungs (pleural effusion) or the sac around the heart (pericardial effusion).
Our 2025 State of Mesothelioma survey reported similar patterns among more than 200 survey participants. Fatigue and weight loss were among the most common peritoneal symptoms reported.
Common Peritoneal Symptoms by Gender
| Symptom | Percentage of Males | Percentage of Females |
|---|---|---|
| Abdominal pain | 68% | 74% |
| Fatigue | 75% | 80% |
| Weakness | 62% | 66% |
| Loss of appetite | 54% | 60% |
| Unexplained weight loss | 60% | 65% |
| Bowel obstruction | 38% | 42% |
| Fever | 27% | 33% |
Source: The Mesothelioma Center at Asbestos.com, 2025
Causes
The main cause of peritoneal mesothelioma is inhaling or swallowing asbestos fibers. These tiny fibers can travel into the belly and get stuck in the peritoneum. After 20 to 60 years, they can cause irritation and damage that may lead to cancer. This slow process is called the latency period, and it can take many years to happen.
If you have a history of asbestos exposure, let your doctor know, as you could be at a higher risk of developing peritoneal or pleural mesothelioma. Your doctor may recommend regular mesothelioma screenings for you.
Exposure to asbestos is the largest risk factor for peritoneal mesothelioma. Most people are exposed to asbestos at work. Duration and intensity of the exposure play a key role in the likelihood of the disease developing. There is no safe level of asbestos exposure.
Common Risk Factors for Peritoneal Mesothelioma
Asbestos exposure can also occur from contaminated talcum powder. Talc is often mined next to naturally occurring asbestos, which can lead to contaminated talc products such as baby powder, a cause of increased mesothelioma rates in women.
We spoke to mesothelioma survivor James D. about his peritoneal mesothelioma. He told us the exposure happened while working as a mechanic in Chicago. Many survivors also tell us they were exposed to asbestos while serving in the U.S. Armed Forces.
Secondary Exposure Matters
Family members of workers can face secondary asbestos exposure when fibers are carried home on clothing, hair or skin. Laundry, close contact or handling contaminated work gear can release fibers and increase risk.
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Diagnosis & Staging
A biopsy is the only test that can confirm a peritoneal mesothelioma diagnosis. Imaging and blood tests may suggest disease, but diagnosis always requires a pathologist to examine a tissue sample. The diagnostic process usually begins with a physical exam where your doctor will feel for abnormalities in your belly. Imaging tests and blood work may then be ordered.
A small sample of tissue from your biopsy is sent to a pathologist. The pathologist looks at the tissue under a microscope to see if mesothelioma cells are present. Your pathology report also identifies if your cell type is epithelioid, sarcomatoid or biphasic. Each cell type responds differently to treatment, so your care plan will account for your cell type.
Diagnostic Tests for Peritoneal Mesothelioma
Biopsy
A small sample of your tissue or fluid is collected to check for cancer cells.
Blood tests
Blood samples are studied for signs called biomarkers. For example, mesothelin, fibulin-3 and CA125 are proteins often found in higher amounts in people with mesothelioma.
Imaging tests
X-rays, CT scans, MRIs or PET scans can show if there are abnormalities or mesothelioma tumors and help determine how far they’ve spread in your body.
Dr. Anton Strocel, who treated Trina R., a 20-year survivor of peritoneal mesothelioma, tells us, “She presented to me with unexplained ascites.” Ascites is excess fluid in the abdomen. Trina later had an exploratory laparotomy and peritoneal biopsies before her diagnosis was confirmed.
Finding peritoneal mesothelioma early is important but often hard. Symptoms can take 20 to 60 years after exposure to appear and when they do, they can look like signs of other common illnesses.
In early-stage peritoneal mesothelioma, tumors are small and only within the abdominal lining. In mid-stage peritoneal mesothelioma, tumors haven’t spread outside the lining or into lymph nodes. The cancerous tissue spreads more widely in late-stage mesothelioma.
There’s no official mesothelioma staging system for peritoneal, but the Peritoneal Cancer Index is commonly used to measure the size and spread of tumors. Peritoneal surgeon Dr. Mohamed Abdelgadir Adam at the University of California San Francisco and other researchers announced in 2026 that they’re proposing a new peritoneal staging system that analyzes which tumor characteristic combinations most strongly predict survival. People in each stage have more similar outcomes, making it easier for doctors to explain what to expect and how to plan appropriate treatment.
In early-stage peritoneal mesothelioma or stage 1, cancerous tissue is minimal. Tumors are only within the abdominal lining and lymph nodes are free of cancer.
In mid-stage peritoneal mesothelioma or stage 2, cancerous tissue is moderate. Tumors haven’t spread outside the lining or into lymph nodes.
Survivor Story
1:37
My name is Epifanio Figueroa. In my days when I was a young kid, they didn’t tell us that asbestos was bad for you. I I knew it once I was sick. I think that’s one of the things that have caused a lot of damage to people, Not knowing, not having that information because the people that actually manufacture all those things don’t want us to know how dangerous it is. It started with my stomach growing, being getting bigger, and it didn’t stop getting bigger. We went to Brigham Young. There, I got six chemotherapies. The tumors in my body were diminishing to the point that, the last time that I went, the doctor says we can’t see almost anything there. And I feel great. I’m alive because of my wife. She was my mentor, my advisor. I owe her my life. That’s that’s what I can tell you. To all my buddies that have mesothelioma, once you get off the treatment, sweep that under the rug and keep on going forward.
Treatment
Common peritoneal mesothelioma treatment options include surgery, chemotherapy (often HIPEC) and immunotherapy, which is FDA-approved for pleural mesothelioma and clinical trials are studying these drugs for peritoneal patients. Your doctor might suggest a mesothelioma treatment plan that combines several therapies.
Common Peritoneal Mesothelioma Treatments
Talk to your doctor about which treatments fit your diagnosis and overall health. A peritoneal mesothelioma specialist can help you assess all of your options.
Cytoreductive surgery combined with HIPEC is the most effective treatment for eligible patients with peritoneal mesothelioma. The procedure works in 2 steps. First, surgeons remove as much visible tumor as possible. Then, they circulate heated chemo drugs directly inside the abdomen for 1 to 2 hours to destroy any remaining cancer cells.
Multiple studies show that patients who receive CRS+HIPEC live significantly longer than those who receive chemo alone. Patients who don’t qualify for surgery live an average of 13 months with chemo. Research consistently shows that patients who achieve complete tumor removal during CRS have significantly better outcomes.
Not every person with peritoneal mesothelioma qualifies for CRS+HIPEC. Doctors consider cell type, lymph-node involvement, overall health and tumor spread when evaluating eligibility. If you don’t qualify for surgery right away, neoadjuvant therapy (treatment before surgery) may help reduce tumor size enough to make CRS+HIPEC possible.
HIPEC Drug Regimens
The most common drugs doctors use during HIPEC for peritoneal mesothelioma are cisplatin, mitomycin C (MMC) or a combination of cisplatin and doxorubicin. Your doctor will recommend the best regimen for you.
Factors to Consider for CRS + HIPEC
Cell type
Epithelioid mesothelioma generally has better outcomes and is more likely to qualify for surgery.
Lymph nodes
No cancer in the lymph nodes or distant spread improves eligibility for CRS+HIPEC.
Overall health
Patients need to be healthy enough to tolerate a long, complex surgery.
Tumor spread (PCI score)
PCI scores of 20 or below are typically suitable for CRS+HIPEC, though some specialized centers may consider scores of 24 to 26.
Your treatment path depends on your health, stage and tumor characteristics. Your doctor and Patient Advocates can help you identify clinical trials that are actively enrolling and may fit your diagnosis.
All patients
Ask a Patient Advocate or your doctor about enrolling in open clinical trials for peritoneal mesothelioma.
Eligible for surgery
CRS+HIPEC is the gold-standard of care for peritoneal patients. Consult a specialist about your eligibility.
Not eligible for surgery
Systemic chemo and immunotherapy can help shrink and kill mesothelioma tumors.
Not yet eligible
Chemo or immunotherapy before surgery (neoadjuvant) may shrink tumors enough to make surgery possible for some patients.
Dr. Joseph Skitzki, a surgical oncologist at Roswell Park Comprehensive Cancer Center, regularly performs HIPEC for peritoneal mesothelioma. He tells us, “The results are quite impressive. About 80% of patients who are eligible for the treatment will be alive at 5 years, and about half of that number without any further evidence of disease.”
Choosing a mesothelioma treatment center with clinicians who regularly treat this rare cancer can offer expert care and access to clinical trials. Our Patient Advocates can also help connect you with specialists and schedule appointments for you at top cancer centers.
Tammy Frank was diagnosed with peritoneal mesothelioma in 1999. After surgery, radiation and chemo, she became a 20+ year survivor. Tammy credits her longevity to early treatment and a deep sense of purpose.
Clinical trials give people the ability to participate in research testing new treatment approaches. Peritoneal mesothelioma trials may test chemo, immunotherapy, surgery or combinations of treatments. Eligibility varies by study and can depend on your cell type, prior treatment and overall health.
Use the search tool to explore current peritoneal mesothelioma trials near you.
Important Note
Clinical trial availability, recruiting status and eligibility can change. Review current trial details with your doctor and the study team before making treatment decisions.
Find Active Trials
Exclusive Content
2:09
Mesothelioma is a cancer coming from mesothelial lining. We have mesothelial lining around our lungs and our chest called pleura. We have mesothelial lining around our abdomen, peritoneal mesothelioma, and we also have mesothelial lining around the testicles as well as the pericardium.
Mesothelioma, which is a cancer of the lining of the mesothelial cells, can occur around the heart, pericardial mesothelioma, quite rare, and occur around the lungs, the pleural cavity, that’s called pleural mesothelioma, the most common type.
And the second most common type is around the intestine, around the belly, that’s called peritoneal type, and extremely rarely around the testicles. Of the different locations, the treatment in terms of chemotherapy or immunotherapy does not differ.
What makes us decide to use chemotherapy versus immunotherapy is not the location of the mesothelioma, but rather the subtype, meaning how does it look like under a microscope, the histological subtype. Is it epithelial, or is it sarcomatoid, or is it mixed? Now in terms of surgery, the surgery differs obviously in terms of the location in the body. So if we have pleural mesothelioma, we usually have a tendency to remove the whole lining around the lung, the lining around the chest wall, the lining around the heart and the diaphragm. If it’s peritoneal mesothelioma, we make an incision on the belly, and then we remove the lining around the belly, on the intestines, the capsule, sometimes around the liver, and the rectum. So the type of surgery differs in terms of location, but the type of systemic therapy, chemo or immunotherapy, is the same irrespective of the location of the mesothelioma.
Life Expectancy & Survival
The average life expectancy for peritoneal mesothelioma is about 31 months from diagnosis with today’s treatments. People who don’t qualify for surgery live about 13 months with chemo alone. Patients without treatment have a life expectancy of 6 to 8 months. This is significantly longer than the average for pleural mesothelioma.
Early detection means treatment starts earlier and increases the likelihood of being eligible for surgery, which improves outcomes. Healthy nutrition and exercise can also extend survival. Age, gender, stage, cell type and tumor location all affect prognosis. Women, for example, often survive longer. But statistics are based on large groups and can’t predict individual outcomes.
Peritoneal Mesothelioma Survival Rates
| Treatment Approach | 5-Year Survival Rate | Avg. Life Expectancy |
|---|---|---|
| Cytoreductive surgery + chemotherapy | 75% | Varies by patient |
| Overall with treatment | 65% | 31 months |
| HIPEC surgery | More than 50% | Varies by patient |
| Chemo alone (nonsurgical candidate) | Lower than with surgery | 13 months |
| No treatment | Very low | 6 to 8 months |
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Living With Cancer
Living with peritoneal mesothelioma takes physical and emotional strength. A solid support system of family, friends and health care providers can make a big difference. Rest, proper nutrition and gentle movement can help you feel your best.
Peritoneal mesothelioma and its treatments can affect how your body absorbs nutrients. Working with an oncology dietitian can help you build a nutrition plan that fits your specific treatment. We offer a free Mesothelioma Nutrition Guide with tips from a registered nurse on what a survivor’s diet can include.
Day-to-Day Strategies
Balance activity with rest and listen to your body. Eat small, frequent meals with protein to help manage nausea or low appetite. Stay hydrated, especially if treatment affects digestion.
Good nutrition helps your body handle treatment and supports recovery. Protein helps preserve muscle and repair tissue after surgery, chemo or radiation. Aim for high-protein foods like chicken, fish, eggs, dairy and beans. Eat colorful fruits and vegetables to support immune function. Avoid processed meats, fried foods and alcohol, as these can increase inflammation and interfere with treatment.
Peritoneal mesothelioma patients who undergo CRS+HIPEC often face digestive challenges after surgery. Reintroduce foods slowly and work closely with your care team during recovery. Some patients need to adjust their fiber intake or follow a temporary modified diet until their digestive system heals. Always talk to your doctor before making major dietary changes.
Light activity like walking, gentle stretching or yoga can reduce fatigue, improve mood and support recovery. Start slowly and increase intensity only with your doctor’s guidance. Break exercise into shorter sessions if energy runs low.
If you’re traveling for treatment, bring a copy of your medical records and current medications list. Ask your care team about managing symptoms around travel. Our Patient Advocates can help you arrange care at a top cancer center near home.
Caregivers play a vital role but the physical and emotional demands of caregiving can feel overwhelming. It’s important to ask for support when possible. Our private Mesothelioma Facebook Support Group connects caregivers in a safe space to share experiences, ask questions and find practical support.
We also host a monthly online support group for patients and caregivers. A licensed mental health counselor and registered nurse lead each session.
Collaborating with your medical team helps you get the right care. Connecting with others who share your experience can be empowering. Volunteer groups can also provide meals and daily assistance, and your care team may know of local respite care resources.
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How Asbestos.com Helps
Our support resources include groups where patients and caregivers can share experiences and get practical support, plus guidance for caring for a loved one with mesothelioma.
Guidance for caring for a loved one with mesothelioma.
A private group for patients and caregivers to share experiences and practical support.
A monthly online group for peritoneal mesothelioma patients and caregivers led by a licensed mental health counselor and registered nurse.
Peritoneal Mesothelioma Support
Patient Advocates can help you find specialists, understand treatment and clinical-trial options and connect with support resources at no cost.
FAQs
There is no cure for malignant peritoneal mesothelioma. But it can go into remission. About 12% of peritoneal mesothelioma patients who get aggressive treatment have complete remission. Partial remission is also possible. Remission isn’t the same as a cure. Doctors watch patients closely. Cancer can return after remission.
Prepare questions before your appointment like: Has my cancer spread beyond my abdomen? What are my treatment options? How can I manage side effects and symptoms? Do I qualify for surgery or HIPEC? How can I access emerging treatments or clinical trials?
Costs differ depending on the hospital, surgeon and whether or not you get CRS-HIPEC which requires an extended hospital stay. Insurance, travel, missed days of work and follow up care make the cumulative total even higher. It’s best to request a written price expectation from your surgical team for insurance pre-authorization. Financial counselors and Patient Advocates can help with resources like grants and lodging or travel amenities.
It generally develops in the peritoneal cavity and can involve adjacent organs, the omentum and lymph nodes. In more advanced situations, it can extend into the chest or other distant areas, but this is less frequent. Early intervention from specialists can manage and stabilize the disease, reducing progression and increasing quality of life.
About 65% of patients with peritoneal mesothelioma live 5 years or more with treatment. Among patients who qualify for CRS+HIPEC surgery, about 80% are alive at 5 years. Without treatment, life expectancy is 6 to 8 months. Individual outcomes vary based on stage, cell type, age and overall health.
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Asbestos.com. (2026, August 27). Peritoneal Mesothelioma. Retrieved August 31, 2026, from https://www.asbestos.com/mesothelioma/peritoneal/
"Peritoneal Mesothelioma." Asbestos.com, 27 Aug 2026, https://www.asbestos.com/mesothelioma/peritoneal/.
Asbestos.com. "Peritoneal Mesothelioma." Last modified August 27, 2026. https://www.asbestos.com/mesothelioma/peritoneal/.
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Karen Selby is a registered nurse and Board Certified Patient Advocate at The Mesothelioma Center with more than 30 years of experience in oncology and thoracic surgery. She worked as an operating room nurse in thoracic surgery at the University of Maryland for 6 years, assisting with surgeries such as lung transplants, pneumonectomies and pleurectomies. She later served as regional director of the tissue procurement program at the University of Florida. Karen joined The Mesothelioma Center in 2009, providing patients with personalized support and resources.
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