Peritoneal Mesothelioma

 

Peritoneal Mesothelioma

Peritoneal mesothelioma is one of the four primary types of malignant mesothelioma. The name stems from the area where the cancer develops, along the peritoneum, also known as the lining of the abdomen. Roughly 250 to 500 new cases of peritoneal mesothelioma are diagnosed in the U.S. each year, making it the second-most common mesothelioma type.

All mesotheliomas, including peritoneal, stem from extended exposure to asbestos, usually at work. People diagnosed with the disease often can pinpoint a time in their lives when they were around asbestos dust, fibers or products for a sustained period. This exposure leads to ingestion or inhalation of microscopic asbestos particles, which can produce cancerous cells and then tumors.

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Mesothelioma in the Peritoneum

The peritoneum is a protective membrane that surrounds the abdomen, or belly. It has two layers, and mesothelioma can develop on both. The parietal layer covers the abdominal cavity, while the visceral layer surrounds the stomach, liver and other organs of the abdomen. Together, the layers support the abdominal cavity as a whole and the organs within it.

What Causes Peritoneal Mesothelioma?

Although no definitive answer is available, cancer experts most commonly associate the cause of peritoneal mesothelioma with the following theories:

• Swallowed asbestos fibers travel from the digestive system to the peritoneum.
• Inhaled asbestos fibers reach the peritoneum through the lymphatic system, which produces and stores cells that fight disease.

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Peritoneal Mesothelioma Symptoms

Early symptoms of peritoneal mesothelioma can include abdominal pain or swelling, and diarrhea or constipation. Unfortunately, some patients don't experience any symptoms until tumors have spread. This scenario makes treating the disease hard and surviving it even harder.

Common peritoneal mesothelioma symptoms include:

Abdominal pain or swelling
Diarrhea or constipation
Changes in bowel habits (including diarrhea or constipation)
A feeling of fullness
Night sweats or fever
Unexplained weight loss
Nausea or vomiting
Fatigue
Anemia

You may not experience cancer symptoms for 20 to 50 years after your first exposure to asbestos. Once asbestos fibers reach the peritoneum and irritate the cells, the peritoneal lining starts to thicken. As the cancer develops, the buildup of excess fluid in the abdomen, known as ascites, may occur next. Over time, tumors form and place pressure on the organs.

Diagnosis

The latest advances in medical technology allow doctors to diagnose this disease earlier than ever before, yet even experienced cancer doctors can struggle to diagnose it accurately. In fact, the process can take months.

Peritoneal mesothelioma accounts for 10-20 percent of all diagnosed cases.

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The Diagnostic Process for Peritoneal Mesothelioma

The process of diagnosing peritoneal mesothelioma is similar to that of other types. It starts with a thorough examination of your medical history, occupational history, and overall physical condition, followed by a series of tests including imaging scans and biopsies.
Be sure to mention any history of asbestos exposure, even if your doctors forget to ask. It's important to share every detail you can remember, including the dates the incidents occurred and the length and duration of the exposures. This information will alert your doctors about the possibility of an asbestos-related disease and help them determine the appropriate next steps.
Because this cancer is so rare, doctors who lack experience with the disease often misdiagnose mesothelioma patients with more common illnesses who have similar symptoms — a serious mistake that delays proper treatment. Peritoneal mesothelioma symptoms like abdominal swelling, weight loss and hernia also arise in other abdominal cancers and many less serious conditions, increasing the likelihood of a misdiagnosis.
If you have a history of asbestos exposure, the best way to ensure an accurate diagnosis is to schedule an appointment with a specialist. Doctors who specialize in mesothelioma and other asbestos-related conditions have the knowledge and tools needed to make a prompt diagnosis and explain all the treatment options available to you.

Imaging Scanning

When a patient is experiencing symptoms like pain or swelling in the abdomen, doctors likely will ask for a chest X-ray, CT scan or another type of imaging scan. These tests will help detect potential tumors and show any cancer spread. They also help doctors choose the best biopsy locations.

Learn more about image scanning

Biopsies

Biopsies come next. Radiologic biopsies are minor procedures that pull fluid and tissue samples that can be inspected under a microscope and can be used for other tests. This is an essential step in the diagnostic process because only a biopsy can confirm a peritoneal mesothelioma diagnosis.

Learn more about biopsies

Sometimes doctors need to perform a laparoscopic surgical biopsy, which is more invasive. In both cases, pathologists look to see if lab results show cancerous cells in your peritoneal fluid or tissue. This delay, combined with the speedy progression of tumors, usually results in a late-stage diagnosis for most patients.

Prognosis

Doctors who treat peritoneal mesothelioma generally deliver a projected life expectancy of less than one year. However, one promising and innovative treatment called HIPEC, which combines surgery and heated chemotherapy, can extend survival by several years.
Peritoneal cancer survival rates are better among those with an early diagnosis (stage I and stage II) than a late stage (stage III and stage IV) which makes early detection a key in improving a patient's prognosis. Stage I or stage II diagnoses typically give oncologists more options for treatment and gives patients more time for those treatments to work.
Although the stage of the cancer is the most important factor for determining the peritoneal cancer survival rate early, other things about the cancer can be meaningful. The location of tumors, their cell type, a patient's age and overall health all come into play. Someone who can withstand aggressive treatments like surgery often have an improved long-term prognosis.

25 percent of peritoneal mesothelioma patients survive three years after diagnosis.

There are many stories of patients surviving several years after diagnosis. The best way for you to improve your prognosis is by seeking the best available treatment options.

Treatment Options

Although an increasing number of cancer specialists have emerged as treatment leaders for peritoneal diseases in recent years, the total number of specialists remains small. If there are no peritoneal specialists nearby, you may want to look for one in a neighboring state.
Treatment options for peritoneal mesothelioma include surgery, chemotherapy, radiation therapy and combination therapy. Doctors believe combining traditional treatments often works better than any single treatment. A combination of one or more treatments is called multimodal therapy. Research shows that a multimodal treatment approach usually offers the best improvement in terms of survival.
The most promising therapy for peritoneal mesothelioma may be heated intraperitoneal chemotherapy (HIPEC), a multimodal treatment that combines surgery and heated chemotherapy. While doctors only give HIPEC on a case-by-case basis, it has shown excellent results for select patients in terms of extended survival and improved quality of life. In studies on small groups of patients treated with HIPEC, some people lived five years or longer.
To qualify for HIPEC, a patient's cancer must be limited enough for doctors to completely remove with surgery, and must not have spread beyond the abdomen. In addition, qualifying patients must spend more than half of their waking hours up and about and be capable of self-care, which includes basic health maintenance, personal hygiene and the ability to follow doctor recommendations. In studies on small groups of patients treated with HIPEC, some people lived five years or longer.

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• Surgery
• Chemotherapy
• Radiation
• Alternative Treatments

• Surgery

  Surgery is the most promising traditional treatment option for peritoneal mesothelioma, but it is only effective for early-stage cancer. Because doctors most commonly diagnose asbestos-related diseases after the cancer has spread, most surgeries only attempt to remove sections of the tumor.
  Surgery can be curative or palliative. Curative surgery aims to remove as much of the tumor as possible in hopes of curing the cancer. Otherwise, doctors may perform palliative surgery, which aims to remove parts of the tumor to relieve symptoms and improve quality of life. Palliative therapies do not stop the cancer.
  Tumor spread is usually too vast at stage IV for surgery to completely remove the cancer. Surgery with a curative intent is not recommended at stage IV. However, a surgery to remove the majority of tumors may be performed to alleviate pain and improve breathing.
  

  Learn more about mesothelioma surgeries

  

  Typical surgeries include peritonectomy, cytoreductive surgery, bowel resection and removal of some organs.

• Chemotherapy

  Doctors can provide chemotherapy drugs that shrink tumors and slow the growth and spread of cancer. It can be given before, during or after surgery. In some cases, doctors offer chemotherapy as the only treatment option. Chemotherapy drugs considered effective in peritoneal treatment include pemetrexed, cisplatin, carboplatin and gemcitabine.
  

  

  Doctors are now seeing extraordinary results with HIPEC. Once an experimental treatment, HIPEC starts with surgery to remove all visible tumors from the patient’s peritoneum. Next, doctors introduce a heated salt-water solution that contains chemotherapy drugs.
  A machine pumps the medicine throughout the patient’s abdomen, which helps destroy any cancer cells left behind after surgery. Some peritoneal mesothelioma patients who receive HIPEC can live several years after diagnosis.
  

  Learn more about chemotherapy for mesothelioma

• Radiation Therapy

  Although some studies show radiation therapy can improve survival slightly when combined with surgery and chemotherapy, doctors tend not to recommend radiation for peritoneal patients. Even though targeted radiation can shrink tumors and slow cancer growth, the procedure is risky because of the location of these tumors. The peritoneum wraps around the stomach, liver and intestines. Aiming radiation at nearby tumors could harm these organs and cause damage.
  

  Learn more about radiation therapy for mesothelioma

  

• Alternative Treatments

  Alternative treatments and emerging therapies are available, but these treatments have less predictable outcomes. One emerging therapy called immunotherapy works by boosting the body’s immune system to help fight off cancer. However, research on this approach mainly focuses on the treatment of pleural mesothelioma, which develops in the lining of the lungs.
  Many patients find hope in clinical trials, medical studies that test new and experimental treatments. Research from clinical trials helps improve treatment outcomes and may bring us the standard treatments of tomorrow.
  

  Learn more about alternative mesothelioma treatments

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Omental Mesothelioma

Omental mesothelioma is a rare form of cancer that grows in the omentum, a sheet of fatty tissue in the abdomen that hangs in front of the intestines like an apron. The omentum protects our organs, stores nutrients and prevents the spread of infection. The peritoneum covers the omentum, and both contain mesothelial cells that can turn cancerous and form tumors.
Peritoneal mesothelioma usually causes omental mesothelioma because the cancer spreads from the peritoneum to the omentum. It's also possible for cancer to develop in the omentum and spread to the peritoneum, but fewer than five cases like this have been reported in medical literature.
Symptoms of both cancers are similar, although someone with omental cancer may experience lower back pain and no other symptoms. Because this kind of cancer is so rare, it is difficult to diagnose and treat. In some cases, surgery and chemotherapy have proved successful.
It's unclear if the prognosis for patients with omental mesothelioma is better, worse or the same as for patients with peritoneal cancer. While there is not much data available on patient outcomes, some evidence suggests a reason for optimism.
In 2009, a patient diagnosed with omental mesothelioma was treated successfully with chemotherapy. When the study was published 14 months after diagnosis, the patient was still alive. In another case reported in 2004, surgeons removed a malignant tumor from the omentum and watched the patient recover and remain in good health for nearly three years.

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Author

Dr. W. Charles Conway

Dr. Conway is a surgical oncologist who joined the Ochsner Medical Center in New Orleans in 2009, taking a special interest in peritoneal mesothelioma, along with pancreatic, esophageal and