Peritoneal mesothelioma is the second-most common type of
mesothelioma, accounting for 10 to 20 percent of all mesothelioma
cases. About 3,000 new cases of mesothelioma are diagnosed annually in
the United States and approximately 300 to 600 of these are peritoneal
mesothelioma. Asbestos exposure is its primary cause and most cases
take more than two decades to develop once asbestos fibers are inhaled
or ingested. X-rays and other tests are used to detect peritoneal
mesothelioma, but biopsies help confirm a diagnosis. Although the cancer
is usually diagnosed in the later stages of development, treatment
options are available to combat symptoms and improve prognosis.
Overall prognosis for peritoneal mesothelioma patients is less than one year. However life expectancy
can increase with effective treatment and early detection. Some
patients may be candidates for surgery that can send the cancer into
remission, while others may elect to receive palliative measures that
improve symptoms and quality of life. Working with a mesothelioma
specialist can help patients receive the best possible care for their
cancer and potentially improve prognosis.
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Mesothelioma of the Peritoneum
The peritoneum is a membranous layer that is made up of two
sub-layers called the parietal and visceral layers. The parietal layer
covers the abdominal cavity, while the visceral layer surrounds
abdominal organs. Together these two layers provide support and
protection for abdominal organs and the abdominal cavity as a whole.
There are two main theories regarding how asbestos exposure leads to the development of peritoneal mesothelioma:
- Asbestos fibers are ingested and these fibers work their way from digestive organs into the peritoneal membrane.
- Asbestos fibers are inhaled and travel to the peritoneal membrane via the lymphatic system.
Regardless of how asbestos fibers actually enter the peritoneal
layers, the body experiences difficulty in expelling them. Trapped
asbestos fibers eventually cause changes in mesothelial cells, leading
to irritation and inflammation. The exact way in which asbestos fibers
cause these changes is uncertain, but researchers believe such changes
are responsible for cancer development.
Peritoneal Mesothelioma Symptoms
A patient with peritoneal mesothelioma may not demonstrate symptoms
for 20 to 50 years following asbestos exposure. Once asbestos fibers
have irritated and caused mesothelial cells to become inflamed, the
peritoneum starts to thicken. The buildup of fluid, known as ascites, is
the next phase of cancer progression for some patients. Overtime,
mesothelioma tumors form and this places pressure on internal organs.
Peritoneal mesothelioma symptoms usually include:
- Abdominal pain or swelling
- Changes in bowel habits (such as diarrhea or constipation)
- A feeling of fullness
- Night sweats or fever
- Unexplained weight loss
- Nausea or vomiting
- Fatigue
- Anemia
Peritoneal Mesothelioma Diagnosis
X-rays are the most common scans used to help diagnose peritoneal mesothelioma.
Peritoneal mesothelioma is not an easy cancer to diagnose. It often
takes several months from the initial presentation of symptoms to
confirm a diagnosis. This delay, combined with the speedy progression
of mesothelioma tumors, usually results in a late-stage diagnosis for
most patients.
A peritoneal mesothelioma diagnosis
cannot be made on the basis of symptoms alone. The process begins with
a thorough examination of a patient’s medical history and physical
condition, followed by CT scans and other X-rays. Any incidence of
asbestos exposure in a patient’s history should alert doctors to the
possibility of mesothelioma cancer.
Imaging scans are useful for detecting abnormalities and may even help with staging, but only a biopsy
can confirm a mesothelioma diagnosis. Doctors often use the imaging
scans as a guide for where the biopsy should be performed. Biopsies are
minor surgical procedures that involve the removal of fluid or tissue
samples from areas of the peritoneum.
Peritoneal Mesothelioma Treatments
There are several treatment options for peritoneal mesothelioma
patients. Surgery that attempts to remove the entire cancerous tumor
produces better results than any other traditional treatment option, but
this approach is only feasible during an early stage of peritoneal
mesothelioma. Because mesothelioma is often diagnosed at a late stage,
most surgical attempts only remove sections of the tumor. Common
surgical procedures for peritoneal mesothelioma include peritonectomy, cytoreductive surgery, bowel resection and removal of other organs.
Treatment uses chemotherapy drugs to shrink tumors and slow down
cancerous growth. It can be used before, during or after surgery and is
sometimes implemented as a standalone treatment option. Beneficial
chemotherapy drugs for peritoneal mesothelioma include pemetrexed,
cisplatin, carboplatin, and gemcitabine.
Doctors are now finding positive results with heated chemotherapy,
which utilizes warm chemotherapy drugs and administers them directly
into the abdominal cavity. This treatment is usually combined with
cytoreductive surgery and works best for early stage patients. There is a
solid rationale for this treatment as removal of large amounts of tumor
is likely associated with residual microscopic disease. The addition
of intraperitoneal chemotherapy to the cytoreductive surgery is to treat
the cells that may be left behind.
Radiation therapy is not typically recommended to slow cancer growth
in peritoneal mesothelioma patients because it’s considered too risky
with vital abdominal organs nearby, but studies show it can slightly
improve survival when combined with surgery and chemotherapy.
Alternative treatments and emerging therapies
for peritoneal mesothelioma are available but these have less
predictive outcomes. Immunotherapy is sometimes used to boost the body’s
immune system to help fight off cancer, but this approach is more
common for the pleural mesothelioma variety. Clinical trials provide
patients with the opportunity of trying experimental treatments. If a
poor prognosis is expected, patients can elect to receive palliative care to simply relieve symptoms and improve quality of life.
Peritoneal Mesothelioma Prognosis
Although doctors are diagnosing peritoneal mesothelioma at earlier
stages, life expectancy remains close to one year. There are cases of
patients surviving several years after diagnosis, but these are quite
rare.
Perhaps the best achievement in improving prognosis
was the recent introduction of cytoreductive surgery followed by
hyperthermic intraoperative intraperitoneal chemotherapy. This
treatment approach utilizes chemotherapy during or directly after
surgery. In addition to available treatments, a patient’s age, gender,
cell type of the tumor and tumor size play a role in prognosis.
Explore Your Options
If you think you may have peritoneal mesothelioma, or if you’ve
already been diagnosed, your first step is finding a mesothelioma
specialist. A specialist will explain all available treatments and
discuss your options. The Mesothelioma Center’s complimentary Doctor Match Program can pair you with a top doctor in your area.
Omental Mesothelioma
Omental mesothelioma develops in the omentum, a sheet of fatty tissue
in the abdomen that hangs in front of the intestines like an apron. In
addition to storing fat and protecting organs, the omentum holds
nutrients and prevents internal infections from spreading. The
peritoneum covers the omentum, and both contain mesothelial cells that
can turn cancerous.
Peritoneal mesothelioma is usually the cause of omental mesothelioma
because the cancer spreads into the omentum. It’s also possible for the
opposite to occur, for cancer in the omentum to cause peritoneal
mesothelioma. But to date, medical literature documents fewer than five
of those cases.
Symptoms of both cancers are similar, although one omental
mesothelioma patient experienced lower back pain and no other symptoms.
Because omental cancer is so rare, it is difficult to diagnose and
effectively treat. But in some cases, surgery and chemotherapy have
proven successful.
It’s unclear if the prognosis for omental mesothelioma patients is
better, worse or the same as it is for someone with peritoneal
mesothelioma. The disease is simply too rare to apply enough data. Some
evidence suggests a reason for optimism.
In a 2009 case, an omental mesothelioma patient was treated successfully with chemotherapy. When the study was published 14 months after initial diagnosis, the patient was alive and well. In a case reported in 2004, surgeons removed an omental mesothelioma tumor, and the patient recovered fully. Nearly three years later, the patient remained in good health.
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