Peritoneal Mesothelioma
Mesothelioma is
cancer of the
mesothelium, which is the tissue that lines the lungs, stomach, heart and other organs. The most common form of mesothelioma begins in the lining of the lungs (
pleura), though a smaller fraction (10-20% of all cases) begins in the lining of the abdomen, known as the
peritoneum (1). It is thought that
peritoneal mesothelioma is caused by
exposure to asbestos fibers. It is likely that fibers are either ingested and travel from the intestinal tract to the peritoneum, or they are inhaled into the lungs and transported through the lymph node system, eventually becoming lodged in the peritoneum (2).
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The peritoneum is made of two membranes: the visceral peritoneum covers the internal organs and makes up most of the outer layer of the intestinal tract, while the parietal peritoneum covers the abdominal wall. Cells in both membranes secrete a fluid that allows the organs to move against one another, facilitating the smooth movement of the digestive track without unwanted friction (2).
As peritoneal mesothelioma develops, fluid often accumulates in the area enclosed by the peritoneum (the peritoneal space). The pressure from the fluid and the growing tumor can place increasing pressure on the organs in the abdomen, leading to bowel obstruction and distention. Depending on the manner in which the tumor grows, it can also impair breathing. As the condition advances, it may be referred to as diffuse peritoneal mesothelioma, indicating that the cancer cells have branched out (3).
Symptoms of peritoneal mesothelioma include abdominal pain, abdominal swelling, sudden diarrhea or constipation, lumps of tissue felt in the abdominal area, or unexplained weight loss (1). Diagnosis of the condition can be performed by imaging techniques, along with an examination that utilizes a peritoneoscope, which allows for the viewing and biopsy of the abdominal wall and peritoneal cavity. Doctors must rule out that the primary cancer is not the more common pleural mesothelioma, as cancer of the pleura can travel to the peritoneum (2, 3).
Treatment options for peritoneal mesothelioma include radiation therapy, chemotherapy, and surgery. Surgical options depend on the size of the tumor and the degree of spreading; sometimes it is necessary to remove a lung or part of the diaphragm in order for surgery to succeed in removal of the tumor. The fluid that accumulates between the membranes of the peritoneum is drained through a procedure known as paracentesis (3).