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Peritoneal Mesothelioma
Table Of Contents
Peritoneal mesothelioma is a rare cancer that affects the peritoneum, the lining of the abdomen. This is the second most common form of mesothelioma, and it’s caused by asbestos exposure. As tumors grow, they put pressure on internal organs such as your intestines, stomach and liver.
Written by Dr. W. Charles Conway | Medically Reviewed By Dr. Jacques Fontaine | Edited By Walter Pacheco | Last Update: July 25, 2024
Written by Dr. W. Charles Conway | Medically Reviewed By Dr. Jacques Fontaine | Edited By Walter Pacheco | Last Update: July 25, 2024
Symptoms of Peritoneal Mesothelioma
The most common initial symptoms of peritoneal mesothelioma are fluid buildup (ascites), abdominal pain and bloating. Fluid within the abdominal cavity puts pressure on internal organs, causing pain and discomfort. Other early signs include changes in bowel movements and unexplained weight loss or fever.
Peritoneal Mesothelioma Symptoms
- Abdominal pain and swelling
- Anemia
- Bowel obstruction
- Chest pain
- Difficulty breathing
- Fatigue and weakness
- Fluid buildup in the abdomen
- Loss of appetite
- Nausea and vomiting
- Night sweats
Mesothelioma symptoms may not present for decades after initial asbestos exposure. For peritoneal mesothelioma, the latency period is 20 to 40 years. Many people don’t experience symptoms until more advanced stages. For others, symptoms are vague or intermittent, making it difficult to get a correct diagnosis.
It’s important to talk to your health care provider about the possibility of mesothelioma if you have a history of asbestos exposure, even if you’re not yet experiencing symptoms. Screenings and diagnostic tests can help you obtain an early diagnosis, which can offer you the most treatment options.
Rare Symptoms of Peritoneal Mesothelioma
Peritoneal metastasis can cause rare and serious symptoms as tumors spread to other organs, including the liver or intestines. Distant metastases are rarer than local spread, occurring in only 10% to 50% of stage 4 mesothelioma cases. It can cause symptoms in distant organs including the chest cavity and brain.
Rare Peritoneal Mesothelioma Symptoms
- Abnormal liver function tests
- Anemia
- Blood clotting disorders
- Bowel obstruction
- Fluid buildup around the lungs (pleural effusions)
- Fluid buildup in the sac surrounding the heart (pericardial effusions)
- Hernias
- High platelet count
- Jaundice
- Low blood sugar
- Neurological symptoms such as seizures or paralysis
In our exclusive mesothelioma survey in 2023, peritoneal respondents cited anemia and bowel obstruction as serious symptoms. A case report in Radiology Case Reports the same year highlights the risk of bowel obstruction with peritoneal mesothelioma. Some cancer treatments, such as chemotherapy and radiation therapy, can also cause anemia.
What Causes Peritoneal Mesothelioma?
Asbestos exposure is the primary risk factor for peritoneal mesothelioma. Inhaled asbestos fibers can enter the abdomen through your bloodstream. Once there, the fibers can become trapped, causing inflammation, irritation and DNA damage. This can lead to abnormal cell growth and tumors.
Many mesothelioma survivors were exposed to asbestos at work or while serving in the U.S. armed forces. Secondary exposure can occur through contact with a loved one who inadvertently brought home asbestos on work clothes or gear. People living near asbestos manufacturing sites or mines also experienced environmental exposure.
How Is Peritoneal Mesothelioma Diagnosed?
Peritoneal mesothelioma is diagnosed with a biopsy or tissue sample. This is the only way to confirm the presence of malignant mesothelioma cells.
If you have a known history of asbestos exposure, your mesothelioma diagnostic process may begin with mesothelioma screenings involving X-rays or CT scans. For others, the appearance of symptoms leads to physical exams, blood tests and imaging scans. Doctors may also order MRIs for clearer images of any abnormal growths found in other scans.
23%
Percentage of peritoneal mesothelioma diagnoses among respondents to The Mesothelioma Center’s 2023 mesothelioma patient survey.
After your care provider orders a biopsy to confirm your diagnosis, a pathologist will examine the sample to identify epithelioid, sarcomatoid or biphasic mesothelioma cell types. Your doctor will use this information to recommend therapies that best treat your specific mesothelioma cell type.
Why Peritoneal Mesothelioma Is Frequently Misdiagnosed
Mesothelioma misdiagnosis is common because most doctors and even oncologists have never seen patients with mesothelioma and peritoneal mesothelioma is even rarer. As peritoneal mesothelioma survivor Sara B. told us, “My primary care doctor told me he had never seen anyone with this disease before in his career.”
Most symptoms aren’t unique to peritoneal mesothelioma, so doctors may initially mistake them for signs of other, more common conditions, such as the flu or other forms of cancer. As peritoneal cancer survivor Tamron Little shared with us, “I was nauseous. I was tired all the time. It was the same symptoms I had when I was pregnant.”
Survivor Story
Survivor Story
Tammy Frank
Peritoneal mesothelioma
20-Year Peritoneal Mesothelioma Survivor Was First Misdiagnosed With an Ovarian Cyst
Tammy Frank was told an ovarian cyst was causing her abdominal pain. Surgery uncovered a much more serious problem. At the time, not many doctors could identify peritoneal mesothelioma. It took months and multiple tests to confirm. Her prognosis was grim. “I spend most of my time now helping others,” Tammy says. “I never, ever thought I’d still be here 20 years later.”
Staging Peritoneal Mesothelioma
There is no official staging system for peritoneal mesothelioma. Doctors often use a general cancer staging method, the tumor, node and metastasis system, to stage tumors. TNM takes into account the size of the tumor, whether it has spread to nearby lymph nodes and how many are affected and whether it has metastasized to other parts of the body.
Stage 4 peritoneal mesothelioma isn’t clearly defined. Many doctors consider widespread metastasis to distant sites throughout the body a defining stage 4 characteristic.
Peritoneal Mesothelioma Treatment
The most common treatment for peritoneal mesothelioma is chemotherapy. While a multimodal therapy approach incorporating tumor-removing surgery and heated intraperitoneal chemotherapy or HIPEC, may be considered the most effective treatment, not all patients qualify for surgery.
Treatment Options
- Chemotherapy: Systemic and intraperitoneal chemotherapy may slow the progression of peritoneal mesothelioma.
- Immunotherapy: While more widely studied in pleural mesothelioma than the peritoneal type, immunotherapies show promise in some patients. An MD Anderson Cancer Center study showed a meaningful response to a combination of atezolizumab and bevacizumab in 40% of patients.
- Radiation: Although not common, some doctors may recommend palliative radiation.
- Surgery: Cytoreductive surgery, often combined with HIPEC, can remove tumors in eligible patients.
The exact nature of your mesothelioma, including tumor size and disease progression, will factor significantly into your treatment. Overall health and any underlying medical conditions may also play a role. Enrolling in a clinical trial can provide access to new and experimental therapies.
“The first thing I like to tell [patients] is that they certainly do have [treatment] options,” Dr. Dr. W. Charles Conway of the the Ridley-Tree Cancer Center told The Mesothelioma Center. “Essentially, without treatment, the median survival is a year or maybe a little less. With good treatment that we use now, that median survival can be several years.”
Chemotherapy for Peritoneal Mesothelioma
Patients who aren’t good candidates for HIPEC with surgery can undergo chemotherapy as a standalone therapy. Chemotherapy delivered throughout the bloodstream is called systemic, while delivery to the abdominal cavity is called localized.
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Systemic chemotherapy has a response rate of about 30%. Chemotherapy delivered directly to the peritoneum without surgery has a higher response rate of 47%.
Chemotherapy drugs are effective for shrinking peritoneal mesothelioma tumors and slowing the growth and spread of cancer. Effective chemotherapy drugs for peritoneal mesothelioma include carboplatin, cisplatin, gemcitabine, paclitaxel 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. Heating chemotherapy and applying it after surgery increases the chemotherapy response rate to 84.6%.
HIPEC surgery has shown significant promise in treating peritoneal mesothelioma patients. A recent study in the Journal of Clinical Haematology reported more than 80% of patients who underwent HIPEC and continued localized chemotherapy lived 5 years or longer.
Doctors only perform this procedure on a case-by-case basis. HIPEC surgery is typically recommended only for younger patients in good enough overall health to tolerate the intensive 12-hour procedure and recovery. About 54% of peritoneal mesothelioma patients who responded to The Mesothelioma Center at Asbestos.com’s survey were eligible for HIPEC surgery.
Peritoneal mesothelioma patients I speak with commonly ask about the HIPEC procedure. We can help answer their questions and match them to specialists who can assess if it’s the right treatment for them.
Peritoneal Mesothelioma Immunotherapy
Immunotherapy uses drugs that help the body’s own immune system to fight cancer. Because peritoneal mesothelioma is so rare, data from clinical trials is limited. Research has produced mixed results, but some studies indicate 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 you to physical or occupational therapy or recommend complementary therapies to improve your quality of life.
Peritoneal Mesothelioma Survival Rate and Prognosis
Individual peritoneal mesothelioma prognosis and survival vary depending on factors such as the stage at which your cancer is detected, the specific mesothelioma cell type you have and the treatments you choose. Your overall health and any coexisting conditions you may have can also play a role. Importantly, peritoneal mesothelioma survivors are now living longer than ever before.
Survival Rates for Peritoneal Mesothelioma
- The 5-year survival rate for all cases of peritoneal mesothelioma is 65%.
- More than 50% of peritoneal patients who undergo surgery with HIPEC live more than 5 years.
- About 75% of patients who undergo surgery with post-operative and long-term chemotherapy live longer than 5 years.
- The average life expectancy of peritoneal mesothelioma without any treatment is only 6 months.
- People who don’t qualify for surgery live about 13 months with chemotherapy alone.
Karen Selby, RN and Patient Advocate at The Mesothelioma Center, explains,“Everyone is different. No one can simply look at a diagnosis of mesothelioma and tell you what your life expectancy is.”
Finding Top Peritoneal Mesothelioma Specialists
Peritoneal mesothelioma is rare and difficult to treat, so it’s important you 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 working in multidisciplinary teams. Their research and publications in medical journals are also reviewed.
Santa Barbara, California
W. Charles Conway
Peritoneal Specialist | Surgical Oncology
Expertise: Peritoneal Mesothelioma, Thoracic Diseases, Cytoreductive Surgery and HIPEC
Languages: English
Pittsburgh, Pennsylvania
J.F. Pingpank Jr.
Peritoneal Specialist | Surgical Oncology
Expertise: HIPEC Research
Languages: English
Chicago, Illinois
Hedy Lee Kindler
Peritoneal Specialist | Gastrointestinal Oncology
Expertise: Immunotherapy Research
Languages: English
Tampa, Florida
Sophie Dessureault
Peritoneal Specialist | Surgery
Expertise: Cytoreductive Surgery HIPEC
Languages: English, French
Chicago, Illinois
Mecker Moller
Peritoneal Specialist | Surgical Oncology
Expertise: Cytoreductive Surgery HIPEC
Languages: English, Spanish
Danbury, Connecticut
Daniel M. Labow
Peritoneal Specialist | Surgical Oncology
Expertise: Cytoreductive Surgery HIPEC
Languages: English
Cancer hospitals with mesothelioma treatment centers offer mesothelioma specialists and an experienced multidisciplinary treatment team. They also offer 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 find a top treatment center to help ensure you have the best possible outcomes.
Common Questions About Peritoneal Mesothelioma
- Is there a cure for peritoneal mesothelioma?
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Unfortunately, there is 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. Research shows combining HIPEC, post-operative chemotherapy and long-term chemotherapy works best. About 75% of patients receiving these treatments lived longer than 5 years.
- Why is early detection of peritoneal mesothelioma important?
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Early detection of mesothelioma has a significant impact on treatment outcomes and increases the chance of long-term survival. People with a history of asbestos exposure who show signs of the disease should seek an experienced peritoneal mesothelioma specialist.
- How long can you live with peritoneal mesothelioma?
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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?
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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?
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Managing a cancer diagnosis is challenging for patients and their loved ones. There is no one right way to cope with mesothelioma. Every individual experience is different. Understanding the specifics of your diagnosis can help you make informed decisions. Talking to a counselor, joining a support group, eating a healthy diet and managing your mental health through relaxation or physical activity are all helpful.
It’s important to remember you’re not alone. Many resources are available. For example, compensation for peritoneal mesothelioma from trust funds, lawsuits and workers’ compensation can help ease the financial strain of treatment.
- What questions should I ask my doctor about peritoneal mesothelioma?
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Asking questions at doctor appointments can inform and empower mesothelioma patients and their families. Health care communication at these appointments often falls on caregivers.
Peritoneal Mesothelioma Questions
- 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?
Prepare questions before medical appointments to communicate clearly with care providers. This helps you maintain more control over your diagnosis and treatment.
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