Peritoneal Mesothelioma

What Is Peritoneal Mesothelioma?

Peritoneal mesothelioma is a rare cancer of the peritoneum, the thin layer of tissue that lines the abdominal cavity. As tumors develop and grow on the peritoneum, they put pressure on vital organs and can spread to form new tumors.

Peritoneal mesothelioma is the second-most common type of mesothelioma. The most common type of mesothelioma is pleural mesothelioma, which affects the tissue lining the lungs. Other types of mesothelioma include pericardial (heart lining) and testicular (testes). Omental mesothelioma is extremely rare and forms in the omentum, which is the lining covering the stomach and other organs.

All forms of mesothelioma are cancers of the mesothelium, a type of tissue found only in the lining around organs. Malignant mesothelioma is an aggressive cancer that requires prompt diagnosis and treatment.

Peritoneal mesothelioma comes from mesothelial cells in the lining of the abdominal cavity.

Dr. W. Charles Conway

Peritoneal mesothelioma surgical oncologist

What Causes Peritoneal Mesothelioma?

Asbestos exposure is the primary cause of peritoneal mesothelioma. When someone ingests the thin asbestos fibers, they can travel through the bloodstream and into the abdomen. These asbestos fibers can become trapped and cause inflammation and irritation, damaging DNA and causing excess abdominal fluid buildup. This can lead to abnormal cell growth, causing tumors to form.

Mesothelioma takes decades to develop after initial asbestos exposure. Symptoms typically appear about 40 years after exposure.

Risk factors for mesothelioma include different types of asbestos exposure, including occupational, environmental and secondary exposure. Many mesothelioma survivors were exposed while serving in the U.S. armed forces.

Asbestos exposure is the primary cause of other types of mesothelioma as well. Inhaled asbestos fibers, for example, cause pleural mesothelioma. 

Symptoms of Peritoneal Mesothelioma

Peritoneal mesothelioma symptoms can include stomach pain, swelling, fever and unexplained weight loss. Symptoms often appear after the cancer has already progressed.

If you or a loved one has a history of asbestos exposure, it’s important to discuss this with your doctor. They may recommend regular screenings for mesothelioma and other asbestos-related conditions to help identify disease early.

Peritoneal mesothelioma shares common symptoms with many other abdominal disorders. An accurate diagnosis often requires a mesothelioma specialist with experience diagnosing and treating mesothelioma. 

Rare Symptoms of Peritoneal Mesothelioma

Peritoneal mesothelioma can spread or metastasize when it progresses, leading to rare and serious symptoms in other areas of the body. People may develop other symptoms if tumors spread to organs in the abdominal cavity, including the liver or intestines. 

Peritoneal metastasis typically remains local or near where it originally formed. Distant metastases are more rare, occurring in 10% to 50% of stage 4 mesothelioma cases. When distant metastasis does occur, it can cause symptoms in far away organs including the chest cavity and brain.

Serious but less common symptoms of peritoneal mesothelioma can be mistaken for other diseases and conditions. There are no symptoms that are unique to mesothelioma, making it difficult sometimes to determine why a patient is experiencing them. Communicating your known history of asbestos exposure with your doctor can help raise suspicion of possible mesothelioma.

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How Is Peritoneal Mesothelioma Diagnosed?

Peritoneal mesothelioma is diagnosed with a core needle biopsy or laparoscopic biopsy. A biopsy, or tissue sample, is the only way to confirm the presence of malignant mesothelioma cells. 

A core needle biopsy uses a long needle inserted through the skin to collect a sample of cells from a suspected tumor. A laparoscopic biopsy involves inserting a camera and surgical instruments into the abdomen through small incisions to see inside the body and collect a tissue sample.

Collecting a sample of mesothelioma cells is essential for a proper diagnosis. Pathologists examine biopsies in a lab to identify types of cancer cells, including epithelioid, sarcomatoid and biphasic mesothelioma cell types. This information helps doctors select appropriate treatment options.

Blood tests and imaging scans are also used to help diagnose peritoneal mesothelioma. Scans are especially useful to identify tumors that have spread to nearby or distant locations in the body. The size, location and spread of tumors are all important for determining the stage of cancer.

Why Peritoneal Mesothelioma Is Frequently Misdiagnosed

Because peritoneal mesothelioma is so rare, most doctors and even oncologists have never seen patients with mesothelioma. As peritoneal mesothelioma survivor Sara B. told The Mesothelioma Center, “My primary care doctor told me he had never seen anyone with this disease before in his career.”

Sharing common symptoms with other diseases such as the flu and forms of cancer also increases the risk of an initial misdiagnosis. As peritoneal cancer survivor Tamron Little told The Mesothelioma Center, “I was nauseous. I was tired all the time. It was the same symptoms I had when I was pregnant.”

Peritoneal mesothelioma misdiagnosis can delay treatment. The best way to get a proper diagnosis is to schedule an appointment with a mesothelioma specialist. Peritoneal specialists have the experience to ensure you get an accurate diagnosis.

The diagnostic process may seem overwhelming because of the number of tests, unfamiliar terms and procedures. A mesothelioma specialist understands this and will guide you and your loved ones through the diagnostic experience.

Staging Peritoneal Mesothelioma

There is no official staging system for peritoneal mesothelioma. Doctors often use the tumor, node, metastasis system to define three peritoneal mesothelioma stages. The TNM system is the most widely used cancer staging system.

Using the TNM system, the stages of mesothelioma describe the size and location of tumors and how far they have spread in the body. The stage affects treatment options and helps assess a patient’s prognosis.

Stage 4 peritoneal mesothelioma isn’t clearly defined. Many doctors consider mesothelioma progression stage 4 when tumor spread is extensive and to distant sites throughout the body. Most peritoneal patients are diagnosed at a later stage.

The peritoneal cancer index is another tool doctors sometimes use to assess tumor location and spread in the abdomen using imaging scans. This helps them determine the approximate mesothelioma stage and appropriate treatments. PCI scores range from 1 to 39. Lower index scores mean the patient may qualify for surgery, while index scores above 20 indicate that cancer has spread too far and the patient likely won’t respond well to surgery.

Survivor Story

Karen Frantz Mesothelioma Survivor

Peritoneal Mesothelioma Survivor Tackles Adversity with Faith

Survivor Story

Karen Frantz was originally misdiagnosed with stage III ovarian cancer. After her second surgery, specialists accurately diagnosed her with peritoneal mesothelioma in 2015. Doctors suggested she return for more surgery and undergo a Heated Intraperitoneal Chemotherapy (HIPEC) procedure. Now, as a survivor of mesothelioma, Frantz strives to inspire others struggling with this rare cancer.

Read Karen’s Story

Peritoneal Mesothelioma Survival Rate and Prognosis

The prognosis for peritoneal mesothelioma is generally poor for patients who don’t qualify for surgery, which can significantly improve survival. For example, more than 50% of peritoneal patients who undergo surgery with HIPEC live more than 5 years. Those who undergo HIPEC, post-operative chemotherapy and long-term chemotherapy have a 5-year survival rate of 75%.

Everyone is different. No one can simply look at a diagnosis of mesothelioma and tell you what your life expectancy is.

Karen Selby, RN

Patient Advocate

Individual survival with peritoneal mesothelioma varies depending on several factors. These include that stage at which the cancer is detected, the specific mesothelioma cell type the person has, the treatments they choose in consultation with their doctor, any coexisting conditions they may have and their overall health. 

Peritoneal mesothelioma survivors are now living longer than ever before. Statistics do show, however, that the prognosis for patients without any treatment is only 6 months. People who don’t qualify for surgery live about 13 months with chemotherapy alone.

How Is Peritoneal Mesothelioma Treated?

Chemotherapy is the most-used treatment for peritoneal mesothelioma. The most effective treatment option is a multimodal therapy approach that incorporates cytoreductive surgery to remove tumors and hyperthermic intraperitoneal chemotherapy. 

HIPEC involves a multidisciplinary team of surgical oncologists, medical oncologists and other experts. Not all peritoneal mesothelioma patients qualify for this procedure. 

The chemotherapy did what it was intended to do and it killed the cancer. Since the HIPEC procedure, I have not had any cancer recurrences. I’m a 15-year and counting survivor.

Tamron Little

Peritoneal Mesothelioma Survivor

The treatment options your doctor recommends for you will depend on your stage, tumor cell type and overall health. Other treatment options for peritoneal mesothelioma include immunotherapy and surgery. Enrolling in a clinical trial can also give mesothelioma patients access to the latest treatment regimens and innovative new therapies. 

Chemotherapy for Peritoneal Mesothelioma

Patients who aren’t good candidates for HIPEC with surgery can undergo chemotherapy as a standalone therapy. Chemotherapy can be whole body (systemic) or localized (intraperitoneal, meaning in the abdominal cavity).

Chemotherapy drugs are effective for shrinking peritoneal mesothelioma tumors and slowing the growth and spread of cancer. The most common chemotherapy combination for mesothelioma is cisplatin and pemetrexed.

HIPEC Surgery

Doctors perform cytoreductive surgery, called a peritonectomy, to remove as much cancer as possible from the abdominal cavity. Then they infuse heated chemotherapy into the abdomen before the surgery ends. 

HIPEC surgery has shown significant promise in treating peritoneal mesothelioma patients. A recent study in the Journal of Clinical Haematology reported that more than 80% of the patients who underwent HIPEC lived 5 years or longer.

The HIPEC surgery involved a chemotherapy washout. They take the tumor out and then they wash the inside of your abdomen, making sure the chemotherapy is washing everything.

Tamron Little

Peritoneal Mesothelioma

Dr. Snehal Smart, a Patient Advocate at The Mesothelioma Center shared, “Peritoneal mesothelioma patients I speak with commonly ask about the HIPEC procedure. They ask about how doctors determine who will receive this treatment.” 

Doctors only perform this procedure on a case-by-case basis. HIPEC surgery is typically the recommendation only for younger patients in good enough overall health to tolerate the intensive 12-hour procedure and recovery.

Peritoneal Mesothelioma Immunotherapy and Emerging Treatments

Immunotherapy uses drugs that help the body’s immune system fight cancer. Patients can receive it as a standalone therapy or in combination with surgery and HIPEC. 

Because peritoneal mesothelioma is so rare, data from clinical trials is limited. Research has produced mixed results, but some studies indicate that immunotherapy may be useful in some cases of peritoneal mesothelioma. 

The U.S. Food and Drug Administration hasn’t yet approved immunotherapy for peritoneal mesothelioma. The agency has approved it to treat pleural mesothelioma.

Palliative Care for Peritoneal Mesothelioma

Many peritoneal mesothelioma patients receive palliative care to control symptoms and improve their quality of life. Palliative care can include procedures to reduce pain and other symptoms. This includes draining excess fluid from the abdomen (paracentesis), HIPEC and surgery designed to reduce symptoms.

Palliative care specialists can prescribe medications to control pain and mesothelioma complications. They may also refer patients to physical or occupational therapy or recommend complementary therapies to improve quality of life.

Finding Top Peritoneal Mesothelioma Specialists

Peritoneal mesothelioma is rare and difficult to treat, so it’s important to find care from an experienced mesothelioma specialist. In selecting top mesothelioma doctors to feature, The Mesothelioma Center rigorously vets specialists. 

We look for doctors who practice at the top cancer centers in the U.S. and have experience in working in multidisciplinary teams. Their research and publications in medical journals are also reviewed.

Ideally, you want to find a doctor who has experience specifically with peritoneal mesothelioma. It’s also beneficial to find a specialist familiar with the unique challenges mesothelioma survivors, caregivers and their loved ones face. 

Top Treatment & Cancer Centers for Peritoneal Mesothelioma

When looking for mesothelioma treatment, consider a cancer center with a mesothelioma treatment center. These centers can give you access to mesothelioma specialists, an experienced multidisciplinary treatment team, mesothelioma clinical trials and a full range of support services for patients and their families.

Experience matters when treating mesothelioma. However, few doctors and hospitals have experience treating peritoneal mesothelioma. It’s important to try to find a top treatment center to ensure you have the best possible outcomes.

Common Questions About Peritoneal Mesothelioma

Is there a cure for peritoneal mesothelioma?

Unfortunately, there is currently no cure for peritoneal mesothelioma or any other type of mesothelioma yet. Research is ongoing to find better, more effective treatments.

Currently, HIPEC with cytoreductive surgery offers the best outcomes, increasing lifespan more than 5 years. Combining HIPEC, post-operative chemotherapy and long-term chemotherapy has been shown to work best. About 75% of these patients lived longer than 5 years.

Why is early detection of peritoneal mesothelioma important?

Early detection of mesothelioma has a significant impact on treatment outcomes and an increased chance of long-term survival. People with a history of asbestos exposure and show signs of the disease should seek an experienced peritoneal mesothelioma specialist.

How long can you live with peritoneal mesothelioma?

Life expectancy with peritoneal mesothelioma varies from person to person. Without treatment, median survival is 6 months. However, the overall 5-year survival rate for peritoneal mesothelioma is 65%. This percentage increases to 75% with surgery, HIPEC, post-operative chemotherapy and long-term chemotherapy.

Some peritoneal mesothelioma survivors have lived for decades after treatment — well beyond the average life expectancy. With ongoing research into new emerging treatments, experts predict the life expectancy for this cancer to increase.

Can peritoneal mesothelioma go into remission?

Yes. According to a 2020 study, about 12% of peritoneal mesothelioma patients who undergo aggressive treatment experience complete remission. Partial remission is also possible.

Remission isn’t the same as a cure. Doctors continue to monitor patients because cancer can return after entering partial or complete remission.

Are there tips for managing a peritoneal mesothelioma diagnosis?

Managing a cancer diagnosis is a challenging experience for patients and their loved ones. There is no one right way to cope with mesothelioma. Every individual experience is different.

• Learn About Your Diagnosis: Understanding the specifics of your diagnosis can help you make informed decisions.
• Get Emotional Support: Talking to a counselor or joining a support group can improve quality of life.
• Take Care of Yourself: Eating a healthy diet and managing mental health through relaxation or physical activity can maintain strength.
• Seek Financial Assistance: Compensation for peritoneal mesothelioma is available through trust funds, lawsuits and workers’ compensation.

It’s important for cancer patients to remember they’re not alone. Many resources are available. Cancer treatment is constantly evolving, and survival has significantly improved for peritoneal mesothelioma thanks to advances in treatment.

What questions should I ask my doctor about peritoneal mesothelioma?

There are several questions you should ask your doctor about peritoneal mesothelioma:

• Has my cancer spread out of my abdomen? How does that affect my prognosis?
• What are my treatment options? What are the benefits? What are the risks or side effects?
• How can I manage side effects and symptoms?
• Do I qualify for surgery? Do I qualify for HIPEC?
• Do I qualify for any emerging treatments or clinical trials? How can I access them?

Healthcare communication at these appointments often falls on caregivers. Be prepared ahead of medical appointments to ask questions and communicate clearly with doctors. This can help families feel informed and empowered.