Peritoneal mesothelioma is the second most common type of this cancer, accounting for 10% to 30% of all cases. Irritation from asbestos exposure can cause mesothelioma tumors to grow in the abdominal lining. Surgery and heated chemotherapy can improve outcomes and relieve symptoms.
Get the nation's most requested peritoneal mesothelioma guide.
Dr. Charles Conway: Differences Between Peritoneal & Pleural Mesothelioma
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.
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Dr. Charles Conway: Differences Between Peritoneal & Pleural Mesothelioma
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.
What Is Peritoneal Mesothelioma?
Peritoneal mesothelioma, also called abdominal mesothelioma, is a rare asbestos-related cancer that forms in the peritoneum. The peritoneum is the thin tissue lining the cavity and organs in your belly.
Key Facts About Peritoneal Mesothelioma
About 65% of patients with peritoneal mesothelioma live for 5 years or more.
Approximately 300 to 900 new cases are diagnosed annually.
Patients often have a better prognosis than pleural mesothelioma.
The average life expectancy without any treatment is 6 months.
Irritation from asbestos exposure is the primary cause. Patients can improve their symptoms and prognosis with treatments like HIPEC, a combination of surgery and heated chemotherapy.
Insight From a Mesothelioma Specialist
First and foremost, you need to make sure the diagnosis is correct. A pathology review is important. The next thing is you need to be in a place that has a multidisciplinary treatment team.
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.
Peritoneal Mesothelioma Symptoms
Abdominal pain
Abdominal swelling or bulging
Altered bowel movements
Anemia
Blockage in the small intestine
Bowel obstruction
Chest pain
Difficulty breathing
Fatigue and weakness
Fluid buildup in the abdomen (ascites)
Loss of appetite
Nausea and vomiting
Night sweats
Unexplained fever
Unexplained weight loss
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-stage mesothelioma affects the digestive system, including changes in bowel habits. Other signs of mesothelioma are weight loss or fever. Most symptoms appear in later stages of the disease.
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 with peritoneal mesothelioma. Rare and severe symptoms include, blood clots and fluid buildup in other places such as around the lungs (pleural effusion) or sac around the heart (pericardial effusion).
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
When to See a Doctor
See a doctor if you have persistent abdominal pain, bloating or unexplained digestive issues. If you have a history of asbestos exposure, consider seeing a mesothelioma specialist for evaluation.
Causes of Peritoneal Mesothelioma
Diagram shows how asbestos fibers cause peritoneal mesothelioma.
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.
Risk Factors for Peritoneal Mesothelioma
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. Even short-term exposure isn’t safe.
Common Risk Factors for Peritoneal Mesothelioma
Age
Duration of asbestos exposure
Exposure to radiation
Family history
Gender
Genetics
Occupation
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.
Family members of workers can face secondary asbestos exposure when fibers are brought home on clothing, hair, or skin. Everyday activities such as doing laundry, hugging a loved one, or handling contaminated gear can release asbestos fibers and increase risk.
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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 tissue sample examined by a pathologist.
Diagnostic Tests for Peritoneal Mesothelioma
Biopsy: A small sample of your tissue or fluid is collected to check for cancer cells.
Blood tests: Samples of your blood are studied for signs, called “biomarkers,” of specific diseases. 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 Reif, a 20-year survivor of peritoneal mesothelioma, tells us, “She presented to me with unexplained ascites.” Ascites is the buildup of excess fluid in the belly. Trina then had an exploratory laparotomy and peritoneal biopsies before her diagnosis was confirmed.
Survivor Story
Epifanio Figueroa: Walk us through your peritoneal mesothelioma diagnosis and treatment
It started with my stomach growing.
Being getting bigger, and it didn’t stop getting bigger.
So then we went to the doctor, and it It was always liquid that was being, accumulated. It’s not in the stomach. It’s in between It’s in between the stomach and the skin.
It’s a layer in between.
And that is actually caused by mesothelioma, but we didn’t know that at that at the time. So we went to a hospital called Memorial West in Florida.
And from there, they they told us, we can’t we we’re not sure. So We went to Cleveland Clinic, and they, diagnosed us with that, with that.
That was in nineteen- 2016.
And, from 2016, We went to Brigham.
And, there I got six chemo there.
When I was in my six chemotherapy, I felt that Actually, I was dying because of the chemo, and I stopped.
I told him I didn’t want any more home.
And, actually, they weren’t that happy with it, that I stopped and I told him that I didn’t want any more chemo.
But from then on, I started feeling better.
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.
Staging Peritoneal Mesothelioma
Peritoneal mesothelioma staging shows how far the disease has spread. The Peritoneal Cancer Index is the system most used to stage peritoneal mesothelioma. PCI measures the size and spread of tumors in the abdomen. This information can help determine treatment options.
In stage 1, or early-stage peritoneal mesothelioma, the cancerous tissue is small. Tumors are only within the abdominal lining, and lymph nodes are free of cancer. In stage 2, or mid-stage peritoneal mesothelioma, cancerous tissue is moderate. Tumors haven’t spread outside the lining or into lymph nodes. The cancerous tissue spreads more widely during stages 3 and 4, or late-stage mesothelioma.
Early-Stage
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.
Mid-Stage
In mid-stage peritoneal mesothelioma or stage 2, cancerous tissue is moderate. Tumors haven’t spread outside the lining or into lymph nodes.
Late-Stage
In late-stage mesothelioma, also known as stage 3 or stage 4, cancerous tissue is more extensive.
Treatments for Peritoneal Mesothelioma
Common peritoneal mesothelioma treatment options include surgery, chemotherapy (often HIPEC) and emerging therapies like immunotherapy. Your doctor might suggest a mesothelioma treatment plan that combines several therapies.
Common Peritoneal Mesothelioma Treatments
Chemotherapy: Chemo drugs target peritoneal mesothelioma cells. They enter these cells, kill them and stop their spread. This is the most common treatment for peritoneal mesothelioma.
HIPEC: Hyperthermic Intraperitoneal Chemotherapy drugs are applied directly to the abdomen during surgery. Doctors infuse and circulate the drugs throughout your belly to treat any remaining cancer cells.
Immunotherapy: Drugs such as Opdivo and Yervoy are used to boost the immune system to find and fight cancer cells. Immunotherapy uses your own body’s defenses against disease.
Palliative care: This includes less invasive versions of treatments such as chemo, immunotherapy and surgery along with curative treatments to control symptoms. These options help manage pain and improve a patient’s quality of life.
Radiation: This uses high-energy particles or X-rays to kill cancer cells. This can be given with chemo or immunotherapy. It helps improve survival and relieve symptoms of peritoneal mesothelioma.
Surgery: Cytoreductive surgery is performed to remove as much tumor as possible prior to HIPEC. A surgical peritonectomy is done to remove the peritoneal lining and often an omentectomy removes the fatty apron of the abdomen.
Targeted therapy: These treatments focus on specific genetic changes in cancer cells. Your doctor can perform genetic testing to determine which treatment may work the best for your disease.
For peritoneal mesothelioma, this may include HIPEC. This warm chemo wash after surgery is part of a 2-step procedure to remove and kill cancer cells. It’s considered a gold-standard treatment for peritoneal mesothelioma.
If surgery isn’t an option, your doctor may recommend immunotherapy or targeted therapy. You may also choose to participate in a clinical trial to try new treatments or approaches. Your doctor and Patient Advocates can help share more information about trials that are actively looking for people to participate and could be helpful for you.
The diagram shows the 3 steps of HIPEC procedure.
Insight From a Mesothelioma Specialist
The results are quite impressive. About 80% of patients who are eligible for the treatment [HIPEC] will be alive at 5 years, and about half of that number without any further evidence of disease.
Dr. Joseph Skitzki, surgical oncologist at Roswell Park Comprehensive Cancer Center
Finding a Peritoneal Mesothelioma Specialist
Choosing a top mesothelioma treatment center can help you get better results. These centers often offer clinical trials and understand the unique challenges of this rare cancer to provide support for you and your family. These specialists. Our team of Patient Advocates can also connect you with the right specialist and cancer center.
Peritoneal Mesothelioma Life Expectancy & Survival Rate
The average life expectancy for peritoneal mesothelioma is about 31 months from diagnosis with today’s treatments. Patients without treatment have a life expectancy of 6 to 8 months.
This is significantly longer than the average for pleural mesothelioma, which is the most common type of this cancer and develops in the lining of the lungs. Treatment options and prompt treatment of peritoneal mesothelioma can affect your outlook or prognosis. Early detection and HIPEC surgery boost survival rates.
Peritoneal Mesothelioma Survival Rates
About 75% of patients who undergo successful cytoreductive surgery and then chemo live longer than 5 years.
More than 50% of peritoneal cancer patients who had HIPEC surgery live more than 5 years.
The overall peritoneal mesothelioma 5-year survival rate with treatment is 65%, but the average life expectancy without treatment is 6 months.
Aggressive treatments such as surgery help about 50% of patients live 5 years or more.
People with peritoneal mesothelioma who don’t qualify for surgery live about 13 months with chemo alone. Adopting healthy habits and new treatments may extend life expectancy.
Age, gender, genetics, stage, cell type and tumor location all affect prognosis. Women, for example, often have longer survival rates. However, statistics are based on large groups and can’t predict individual outcomes. Many factors affect your prognosis, and new breakthroughs continue to improve survival. Always discuss your specific case with a mesothelioma specialist.
Tammy Frank
Verified Asbestos.com Survivor
20-Year Peritoneal Mesothelioma Survivor Celebrates Life
20-Year Peritoneal Mesothelioma Survivor Celebrates Life
Tammy Frank was diagnosed with peritoneal mesothelioma in 1999. After undergoing surgery, radiation and chemo, she has become a 20+ year survivor. Tammy credits her longevity to early treatment and a deep sense of purpose.
Living With Peritoneal Mesothelioma
Living with peritoneal mesothelioma can be difficult. But a solid support system of family, friends and health care providers can make a big difference. Both patients and caregivers may face physical and emotional issues. Rest, proper nutrition and gentle movement can help you feel your best.
Day-to-Day Strategies
Balance activity with rest and listen to your body.
Stay hydrated, especially if treatment affects digestion.
Eat small, frequent meals with protein to manage nausea or low appetite.
Track symptoms and medications to help doctors adjust care.
Take short walks or stretch to reduce stiffness and boost energy.
Emotional & Social Support
Join a support group to connect with others.
Practice relaxation through meditation or deep breathing.
Accept help from family or friends with meals and errands.
Stay connected through calls or visits to ease isolation.
Talk with a counselor or social worker about coping with stress.
Collaborating with your medical team helps you get the right care. This support is key to managing symptoms and enjoying a better quality of life. Meeting and talking to others who are on a similar journey as yourself can also help. Joining a support group is a great way to find relief when dealing with your diagnosis.
Get Help Paying for Mesothelioma Treatment
You shouldn’t have to choose between getting care and paying for it. Get the financial support you deserve.
Updated 2025 ASCO guidelines for treating peritoneal mesothelioma recommend using a combination of chemotherapy drugs gemcitabine with either cisplatin or carboplatin.
Newer peritoneal mesothelioma treatment guidelines also show the diagnostic process should include a CT of the chest with contrast plus a CT or MRI of the abdomen or pelvis with contrast.
“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.”
Common Questions Our Patient Advocates Are Asked
Is there a cure for peritoneal mesothelioma?
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.
What questions should I ask my doctor about peritoneal mesothelioma?
Effective communication with your doctor is key. Preparing questions ahead of time helps you make the most of your appointment.
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?
Writing down your questions also ensures you don’t forget important topics during the appointment. This approach helps you communicate effectively with care providers and gives you more control over your diagnosis and treatment.
Is peritoneal mesothelioma hereditary?
Inherited genetics don’t account for the majority of cases. Some gene changes, like BAP1, are uncommon but increase risk in certain families. If you notice BAP1 in multiple family members with mesothelioma or related cancers, consult your doctor about genetic counseling and testing. Results may help your doctors in treatment planning.
What’s the cost of peritoneal mesothelioma treatment?
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.
Can peritoneal mesothelioma spread to other parts of the body?
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. Report new onset abdominal pain, abdominal swelling, respiratory difficulty and unintended weight changes to your provider as soon as possible.
Recommended Reading
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Surgical oncologist and peritoneal specialist Dr. W. Charles Conway is director of surgical oncology at the Ridley-Tree Cancer Center in Santa Barbara, California. He specializes in gastrointestinal cancers and peritoneal surface malignancies, including mesothelioma.
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