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Peritoneal Mesothelioma

Peritoneal mesothelioma is a type of cancer that forms in the lining of the abdomen (the peritoneum). Representing as many as 30% of mesothelioma cases, it is the second most common type, and its only known cause is the inhalation or ingestion of asbestos fibers. It also has the best prognosis, with roughly 50% of patients surviving at least 5 years after diagnosis.

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What Is Peritoneal Mesothelioma?

Malignant peritoneal mesothelioma is a type of cancer that affects the peritoneum — a thin membrane that covers the abdominal cavity and the lining of the organs inside it, such as the stomach, liver, spleen, and intestines.

The second-most common form of mesothelioma, this disease makes up around 9% of all mesothelioma cases or almost 300 new cases a year, according to a 2017 report by the American Cancer Society.

Peritoneal mesothelioma has the best prognosis of all mesothelioma types.

Peritoneal Mesothelioma infographic
Peritoneal mesothelioma is usually caused by ingesting asbestos fibers that travel from the digestive or lymphatic systems to the peritoneum. The fibers can mutate into cancerous cells after many years.
Quick Facts About Peritoneal Mesothelioma
  1. Peritoneal mesothelioma is the second most common form of mesothelioma, accounting for up to 30% of all cases in the United States.
  2. The average life expectancy for patients with peritoneal mesothelioma is 12 months but can increase to several years with treatment
  3. Peritoneal mesothelioma has an unusually high proportion of female victims compared to pleural mesothelioma.
  4. The study, Malignant Peritoneal Mesothelioma, found that it took roughly 122 days to make a peritoneal mesothelioma diagnosis after a patient first reported symptoms.

Peritoneal Mesothelioma Causes

Asbestos exposure is the only known cause of mesothelioma, including peritoneal mesothelioma.

Considered a “miracle mineral,” asbestos was used heavily in the military and many blue-collar industries as cheap fireproofing and insulation material throughout much of the 20th century.

Unfortunately, those who worked with or around asbestos are often at a higher risk of developing asbestos-related illnesses when the fibers were disturbed, released into the air, and inhaled or ingested.

Although asbestos exposure remains the strongest proven risk factor for peritoneal mesothelioma, only 33-50% of patients with peritoneal mesothelioma report a known history of asbestos exposure compared to roughly 80% of pleural mesothelioma patients, according to Malignant Peritoneal Mesothelioma: A Review.

Did You Know?

The reasons for the lower incidence of peritoneal, as opposed to pleural, mesothelioma are unknown.

In addition, only 23% of women with the disease report having been exposed to asbestos compared to 58% of men.

This may be because women are potentially more likely to get mesothelioma through secondary exposure, inhaling asbestos fibers carried on the clothes and hair of family members who work with asbestos.

How Peritoneal Mesothelioma Develops

Peritoneal mesothelioma may form when patients ingest asbestos fibers, trapping the microscopic fibers in the stomach lining. With time, these fibers migrate to the peritoneum.

From there, peritoneal mesothelioma usually develops in the following way:

  • After years or even decades inside the peritoneum, asbestos fibers irritate and scar healthy tissues.
  • Scarred tissues mutate into cancerous cells.
  • Cancerous mesothelioma cells grow out of control, eventually forming tumors and spreading.

Once peritoneal mesothelioma begins to develop, it usually progresses rapidly, so individuals at risk for peritoneal mesothelioma must stay alert for any signs of the disease.

Who Is at Risk for Peritoneal Mesothelioma?

Asbestos exposure is the biggest known risk factor for peritoneal mesothelioma. Therefore, anyone with a higher-than-average exposure risk may be at higher risk for peritoneal mesothelioma.

The following groups have a higher risk of asbestos exposure:

  • Blue-collar workers
  • Loved ones of individuals exposed to asbestos
  • Men
  • People living near asbestos mines or natural deposits
  • Veterans, especially those in the Navy

However, men are not as overrepresented in cases of peritoneal mesothelioma as they are in pleural mesothelioma cases.

While several studies show that men are more likely to be diagnosed with peritoneal mesothelioma, some do not. According to a 2017 literature review, in the United States, men are diagnosed with new cases of peritoneal mesothelioma at the same rate as women.

Finally, although peritoneal mesothelioma may occur in any age group, it affects people between 50-69 years old most often.

Peritoneal Mesothelioma Symptoms

The symptoms of malignant peritoneal mesothelioma are often vague, especially in the early stages of the disease. Unfortunately, this allows peritoneal mesothelioma to go undetected in many patients until it is already advanced.

According to the Centers for Disease Control and Prevention (CDC), mesothelioma symptoms typically take 20-50 years to appear after asbestos exposure.

Peritoneal mesothelioma symptoms include:

  • Abdominal fluid buildup (ascites)
  • Abdominal pain
  • Bloating
  • Blood in stool (feces)
  • Decreased appetite
  • Fever and night sweats
  • Fatigue
  • Nausea and vomiting blood
  • Unexplained weight loss
  • Upper back and shoulder pain

Early on, patients most often complain of abdominal pain and swelling — symptoms shared with many other illnesses. Furthermore, most routine lab tests do not reveal signs of peritoneal mesothelioma.

Did You Know?

According to a 2014 study, the average time between a patient’s first symptoms and a peritoneal mesothelioma diagnosis was 4-6 months.

For the best chance of an early diagnosis, patients should inform their doctor of any asbestos exposure they may have had. Early treatment may extend a peritoneal mesothelioma patient’s life by years.

Peritoneal Mesothelioma Diagnosis

Peritoneal mesothelioma’s rarity and vague symptoms, unfortunately, make it difficult to diagnose until the disease has progressed.

However, specialists are constantly improving the use of imaging tests and biopsies to rule out similar diseases and make a mesothelioma diagnosis as soon as possible.

Imaging Tests

No imaging test can lead to a definitive peritoneal mesothelioma diagnosis. However, imaging is an essential first step.

Computed tomography (CT) scans of the abdomen are the widely-accepted first step doctors take toward making a peritoneal mesothelioma diagnosis. Patients will often receive a scan after complaints of abdominal pain and swelling, whether peritoneal mesothelioma is suspected or not.

Once a scan is completed, doctors use the results to help them perform a biopsy and make a diagnosis.

Biopsies

During a biopsy, a surgeon removes a fluid or tissue sample from a part of a patient’s body they suspect is cancerous. Once the sample is removed, it is examined under a microscope for cancer cells.

Peritoneal mesothelioma biopsy tests include:

  • Fine needle aspiration: This technique involves the insertion of a thin hollow needle into a mass or lump that doctors want to test. The cells from this mass are drawn out and examined under a microscope to determine if they are cancerous. While less invasive than most diagnostic tests, it is not the most accurate.
  • Core needle biopsy: A core needle biopsy can remove more tissue than a fine needle aspiration, providing more information about the removed cells.
  • Diagnostic laparoscopy: During a laparoscopy, an instrument with a tiny camera (laparoscope) is placed in the stomach through a cut a surgeon makes below the belly button. This camera allows surgeons to closely examine any suspicious lumps found in the imaging scans and collect samples.

Biopsies are more invasive than imaging tests, but they are the only tests that can make a confident peritoneal mesothelioma diagnosis.

Getting a Second Opinion

Rare with nonspecific symptoms, peritoneal mesothelioma is difficult to diagnose. As a result, misdiagnosis is common.

The following illnesses may present similarly to peritoneal mesothelioma:

  • Lymphomatosis
  • Ovarian carcinoma
  • Peritoneal carcinomatosis
  • Primary peritoneal serous carcinoma (PPSC)
  • Tuberculous peritonitis

That does not include other tumors that form in or near the abdomen.

Understandably, even an experienced oncologist could easily misdiagnose peritoneal mesothelioma, delaying — or even ending the possibility of — life-extending treatment.

This is why getting a second opinion from a mesothelioma specialist is critical.

Patients should seek a second opinion quickly. Peritoneal mesothelioma is often diagnosed at an advanced stage, so every day without treatment counts.

Peritoneal Mesothelioma Stages

Cancer is usually diagnosed by stage — the level of severity the disease has reached.

However, unlike most other cancers, peritoneal mesothelioma is not staged using the typical TNM cancer staging system because it advances in a different way, often remaining in the abdomen instead of spreading to other parts of the body.

In some cases, peritoneal mesothelioma is classified as early or advanced, but in 2011, Tristan D. Yan and his associates proposed a unique “TNM” staging system for peritoneal mesothelioma.

The peritoneal mesothelioma TNM staging system is based on 3 factors:

  • The burden of the disease on patient health (not tumor size)
  • The regional spread of cancer within the abdomen
  • The spread of cancer beyond the abdomen

Using these indicators, the disease is divided into stages 1-4. This grouping helps doctors better determine the prognosis for a peritoneal mesothelioma patient.

Peritoneal Mesothelioma Prognosis

A malignant peritoneal mesothelioma prognosis describes the way the cancer is likely to progress.

The prognosis for this cancer is poor, but individuals with peritoneal mesothelioma have the best survival rates of all mesothelioma patients.

Factors That Affect Prognosis

Several factors may affect the prognosis of a peritoneal mesothelioma patient.

Overall peritoneal mesothelioma patient survival is most strongly linked to:

  • Age: Patients who were older than 65 at the time of diagnosis in one 2014 study survived a median of 8.5 months compared to a 17-month median for those under 65.
  • Cell type: About 75% of peritoneal mesothelioma patients have an epithelioid cell type, which responds better to treatment than the other two cell types.
  • Sex: Several studies have identified female sex as an indicator of longer survival rates among mesothelioma patients. The reason for this difference is not clear.
  • Stage: Whether or not peritoneal mesothelioma has spread to the lymph nodes (stage 3) makes a significant difference. A 2009 study found that patients whose lymph nodes had not been affected by cancer lived a median of 56 months versus 20 months.
  • Treatment: The use of certain chemotherapy drugs and surgical procedures has been linked to better survival rates in peritoneal mesothelioma patients.

Improving Peritoneal Mesothelioma Prognosis

While cell type and time of diagnosis often make the biggest differences in the outcome of their cancer, patients can take steps to help improve their prognosis.

To help improve their peritoneal mesothelioma prognosis, patients may:

  • Seek early treatment: Patients should seek curative treatments as soon as possible after diagnosis. Surgeries often extend the lives of patients more than other mesothelioma treatment options but may only be available to early-stage patients.
  • Quit smoking: Smoking decreases overall patient health, making it more difficult to undergo and recover from invasive treatments.
  • Manage stress: High stress levels may affect overall health and patient recovery from treatments.
  • Eat well: Many peritoneal mesothelioma patients may struggle to meet their nutritional needs as their cancer progresses. However, getting the right nutrition boosts the immune system, giving patients undergoing treatment the best chance of survival and recovery.
  • Exercise: Exercise may decrease stress, improve blood flow, and help prevent bedsores and other secondary health problems.

Ultimately, the best peritoneal mesothelioma prognosis is strongly linked to a patient’s ability to undergo certain treatments.

Peritoneal Mesothelioma Treatment

Peritoneal mesothelioma patients may undergo mesothelioma treatments to extend their lives or to decrease symptoms.

Thankfully for peritoneal mesothelioma patients, mesothelioma specialists have pioneered and refined effective treatments, especially for the 75% of peritoneal mesothelioma patients with the epithelioid cell type.

These treatments mainly consist of surgery and chemotherapy.

Surgery

In most cases, mesothelioma surgery is the most effective form of treatment for increasing patient life expectancy.

If a patient’s tumors are able to be surgically removed at diagnosis, the standard treatment for peritoneal mesothelioma is cytoreductive surgery (cytoreduction) with hyperthermic intraperitoneal chemotherapy (HIPEC).

Cytoreduction with HIPEC involves two primary steps:

  1. Cytoreduction: During cytoreductive surgery, doctors open a patient’s abdomen through a large incision and surgically remove as much visible cancer from the patient as possible. Removing the mesothelioma allows chemotherapy drugs to target the remaining cancer more effectively.
  2. Hyperthermic Intraperitoneal Chemotherapy (HIPEC): Before closing the abdominal cavity, doctors instill heated chemotherapy into it. Once the drugs are given time to work, they are drained and the abdomen is rinsed and closed up.

The 2014 study Malignant Peritoneal Mesothelioma: Prognostic Factors and Oncologic Outcome Analysis found that candidates whose cytoreduction procedure thoroughly removed nearly all visible tumors before undergoing HIPEC lived a median of 56.7 months after surgery.

Candidates whose surgery only partially removed tumors before HIPEC lived for just 7.4 months after surgery.

Despite the surgery’s success, not all peritoneal mesothelioma patients are good candidates for cytoreduction with HIPEC.

Patients are usually good candidates if they:

  • Can undergo thorough and complete (not partial) cytoreductive surgery
  • Have cancer that has not spread beyond the abdomen
  • Have an epithelioid cancer cell type

Many patients with more advanced peritoneal mesothelioma also undergo cytoreduction with HIPEC to reduce the size of their tumors and increase their quality of life.

The 2014 study Malignant Peritoneal Mesothelioma: Prognostic Factors and Oncologic Outcome Analysis suggested that patients with sarcomatoid and biphasic cell types may not benefit from cytoreductive surgery with HIPEC. Their median survival was 10.5 months after surgery versus 51.5 months for those with the epithelioid cell type.

Chemotherapy

Chemotherapy is a treatment that uses powerful drugs to kill cancer cells. Peritoneal mesothelioma patients who cannot undergo cytoreductive surgery with HIPEC may turn to traditional chemotherapy both to extend their lives and reduce their symptoms.

Doctors may use chemotherapy to treat peritoneal mesothelioma in many ways:

  • Shrink tumors: Chemotherapy can decrease the size of a patient’s tumors, relieving symptoms or making the surgical removal of tumors easier.
  • Treat non-epithelioid mesothelioma: Patients with biphasic and sarcomatoid cancer cell types do not respond well to a cytoreduction with HIPEC. Since the surgery is invasive, traditional chemotherapy may be a better alternative.
  • Treat those not eligible for surgery: Patients who cannot tolerate a cytoreduction with HIPEC often still benefit from chemotherapy.
  • Part of cytoreductive surgery with HIPEC: Heated chemotherapy drugs are used during HIPEC, killing cancer cells that doctors cannot detect and physically remove.

As studies into chemotherapy techniques continue, treatment options are expected to expand.

Radiation

During radiation therapy, doctors use radiation to kill cancer cells. This procedure is not generally used to treat peritoneal mesothelioma because of the many organs that get in the way of the radiation beam.

Clinical Trials and Emerging Treatment

Clinical trials offer peritoneal mesothelioma patients access to emerging treatments that may help them if standard treatment methods are not available to them or are not effective.

Emerging treatment options for peritoneal mesothelioma include:

  • Anti-angiogenesis: Anti-angiogenesis involves the use of drugs that block blood vessel growth in cancerous tumors. Without extra blood to support their growth, mesothelioma tumors remain small.
  • Chemotherapy advancements: Doctors are hopeful that chemotherapy may be more effective in treating peritoneal mesothelioma by combining conventional chemotherapy with drugs that target specific molecules (targeted therapy) involved in the growth and spread of cancer cells.
  • Gene therapy: Gene therapy changes, removes, or adds genes to a patient to help them fight or prevent a disease. Gene therapy’s cancer-fighting potential is broad, and many applications are being tested.
  • Immunotherapy: Immunotherapy transforms a patient’s own immune system so that it can effectively find and destroy cancer cells.

Patients with limited traditional treatment options should talk to their doctors about participating in clinical trials.

Palliative Treatment

Palliative treatment seeks to decrease a patient’s pain and discomfort and increase their quality of life rather than helping them live longer.

Peritoneal mesothelioma patients have several palliative treatment options:

  • Chemotherapy: This procedure can be used to shrink tumors, reducing symptoms.
  • Cytoreduction with HIPEC: In addition to extending life, cytoreductive surgery with HIPEC is an effective palliative treatment for removing the growing tumors that cause an increasing amount of pain and discomfort as peritoneal mesothelioma advances.
  • Alternative therapies: Meditation, massage, and other non-medical techniques may also help reduce pain and stress.

Maintaining a high standard of living is an often overlooked but essential part of treatment for peritoneal mesothelioma cancer.

Top Peritoneal Mesothelioma Specialists

Patients stand the best chance of survival if they are treated by a peritoneal mesothelioma doctor.

Specialists have years of experience working with peritoneal mesothelioma patients, coming up with unique treatment plans, and performing the complex surgeries needed to extend a patient’s life.

Below, learn more about some of the top peritoneal mesothelioma specialists in the country.

Most doctors — including experienced oncologists — have little to no direct experience with a disease as rare as peritoneal mesothelioma and lack the expertise to diagnose and treat it.

Peritoneal Mesothelioma Cancer Centers

Specialists can be found working at peritoneal mesothelioma cancer centers across the United States.

These centers specialize in treating mesothelioma patients and often sub-specialize according to mesothelioma type or stage. Peritoneal mesothelioma cancer centers, for example, may be one of few medical centers where the complex cytoreduction with HIPEC procedure is available.

Top peritoneal mesothelioma cancer centers include:

  • Washington (D.C.) Cancer Institute at Washington Hospital Center
  • University of Chicago Comprehensive Cancer Center
  • UPMC Hillman Cancer Center

Thankfully, peritoneal mesothelioma patients have several excellent cancer centers to choose from. The right center may be determined by a patient’s treatment options, health insurance, distance to a particular center, and other factors.

Cost of Peritoneal Mesothelioma Treatment

The total estimated cost for mesothelioma treatment is around $500,000.

This figure does not calculate associated treatment costs such as lost work or any required travel and lodging expenses for patients seeking treatment at a top mesothelioma cancer center.

The cost of mesothelioma treatment may vary according to:

  • Caregiving needs
  • Healthcare providers
  • Individual treatment plan
  • Insurance coverage
  • Lodging needs
  • Lost income
  • Travel requirements
  • Veteran status

Patients may reduce these costs through health insurance, but the American Cancer Society (ACS) still cites the average yearly cost of lung cancer treatment (often comparable to mesothelioma costs) for insurance holders as $5,000-$10,000.

Support Options for Peritoneal Mesothelioma Victims

Today, mesothelioma victims may have several financial support options for their treatment expenses. Those who developed mesothelioma because asbestos companies hid the truth about the mineral’s dangers have even more options to obtain funds for treatment.

Financial support options for peritoneal mesothelioma victims include:

  • Asbestos trust funds
  • Charities and donations
  • Medicare or Medicaid
  • Private insurance
  • VA benefits

Patients and loved ones struggling with peritoneal mesothelioma treatment costs should research their financial options and reach out to organizations like the Mesothelioma Applied Research Foundation for guidance.

Receiving a peritoneal mesothelioma diagnosis can be devastating, but many patients have gone on to live several years after diagnosis.

The medical community has consistently improved the length and quality of patient lives through research, experience, and expertise. As advancements in cancer and mesothelioma treatment mature, this trend will undoubtedly continue.

Mesothelioma Support Team
Reviewed by:Dr. Mark Levin

Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Mark Levin, MD has nearly 30 years of experience in academic and community hematology and oncology. In addition to serving as Chief or Director at four different teaching institutions throughout his life, he is also still a practicing clinician, has taught and designed formal education programs, and has authored numerous publications in various fields related to hematology and oncology.

Dr. Mark Levin is an independently paid medical reviewer.

Stephanie KiddWritten by:

Editor-in-Chief

Stephanie Kidd grew up in a family of civil servants, blue-collar workers, and medical caregivers. Upon graduating Summa Cum Laude from Stetson University, she began her career specializing in worker safety regulations and communications. Now, a proud member of the American Medical Writers Association (AMWA) and Editor-in-Chief of the Mesothelioma Justice Network, Stephanie serves as a voice for mesothelioma victims and their families.

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