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Peritoneal Mesothelioma
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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: October 3, 2024
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Written by Dr. W. Charles Conway | Medically Reviewed By Dr. Jacques Fontaine | Edited By Walter Pacheco | Last Update: October 3, 2024
What Is Peritoneal Mesothelioma?
Peritoneal mesothelioma is a cancer of the peritoneum. It’s the thin tissue around the abdominal organs. The main cause is asbestos exposure from inhaling its fibers. These thin fibers can eventually travel to and get stuck in the abdomen. Over time, they irritate the tissue and cause damage that leads to mesothelioma.
Key Facts About Peritoneal Mesothelioma
- Peritoneal mesothelioma accounts for 10% to 30% of all cases.
- Between 300 and 900 new cases each year are peritoneal mesothelioma.
- About 65% of patients live for 5 years or more.
- The average life expectancy without any treatment is 6 months.
- HIPEC, or heated chemotherapy, with surgery is the best treatment.
Many survivors of mesothelioma were exposed to asbestos in high-risk jobs. These include construction, firefighting and the military. Epifanio Figueroa, a mesothelioma survivor, was exposed to asbestos while working on cars. Decades later, doctors diagnosed him with peritoneal mesothelioma.
Symptoms of Peritoneal Mesothelioma
The most common symptoms of peritoneal mesothelioma are fluid buildup, abdominal pain and bloating. Fluid in the abdomen puts pressure on internal organs. This causes pain and discomfort. Other signs are changes in bowel movements, weight loss or fever. A 2023 report in Radiology Case Reports reported the risk of bowel obstruction with peritoneal mesothelioma.
Mesothelioma symptoms may not show for decades after initial asbestos exposure. For peritoneal mesothelioma, the latency period is 20 to 40 years. Many people don’t have symptoms until the later stages. Some have vague, intermittent symptoms. This makes it hard to get a correct diagnosis.
Peritoneal Mesothelioma Symptoms
- Abdominal pain and swelling
- Anemia
- Bowel obstruction
- Chest pain
- Difficulty breathing
- Fatigue and weakness
- Fluid buildup in the abdomen (ascites)
- Loss of appetite
- Nausea and vomiting
- Night sweats
Tammy Frank is a 25-year survivor of peritoneal mesothelioma. She told The Mesothelioma Center that she “had a lot of nausea and vomiting.” Tammy also lost some hair and experienced fatigue.
Severe and Rare Symptoms
Peritoneal metastasis can cause severe, rare symptoms. Tumors spread to the liver, intestines and other organs. Distant metastases are rarer. They occur in only 10% to 50% of stage 4 mesothelioma cases. It can affect distant organs, including the chest and brain.
Rare Peritoneal Mesothelioma Symptoms
- Blood clotting
- Fluid buildup around the lungs (pleural effusions)
- Fluid buildup in the sac around the heart (pericardial effusions)
- Hernia
- Jaundice
- Low blood sugar (hypoglycemia)
- Neurological symptoms such as seizures or paralysis
While not many patients show these rare symptoms, they should be reported to your doctor. They may be a sign of a worsening condition.
Causes of Peritoneal Mesothelioma
Asbestos exposure is the main risk factor for peritoneal mesothelioma. First, a person inhales asbestos fibers. Then, the fibers enter the abdomen via the bloodstream. Once there, the fibers can get trapped. Over time, they cause inflammation, irritation and DNA damage. This can lead to abnormal cell growth and tumors.
Many mesothelioma survivors were exposed to asbestos at work. We spoke to mesothelioma survivor James D. about his peritoneal mesothelioma. He told us the exposure happened while working as a mechanic in Chicago. Others were exposed while serving in the U.S. armed forces.
Asbestos workers may bring home fibers on their skin, hair and clothes. Anyone who touches that person or their clothes is at risk of secondary exposure.
Diagram shows how asbestos fibers cause peritoneal mesothelioma.
How Is Peritoneal Mesothelioma Diagnosed?
Peritoneal mesothelioma is diagnosed with a biopsy or tissue sample. It’s the only way to confirm malignant mesothelioma cells.
If you have a history of asbestos exposure, you should consider talking to your doctor. Your mesothelioma diagnostic process may require mesothelioma screenings. These tests involve X-rays or CT scans. Some have symptoms that prompt blood tests and imaging scans. Doctors may also order MRIs. They provide better images of abnormal growths in other scans.
Diagnostic Tests
- Biopsies: Doctors take tissue samples from the affected area for tests.
- Blood Tests: The mesothelin-related peptide test can find specific biomarkers.
- Imaging Tests: CT scans and MRIs find abnormalities in the abdomen.
A pathologist will examine the biopsy. They will look for epithelioid, sarcomatoid or biphasic mesothelioma cell types. Your doctor will use this to suggest the best therapies for your mesothelioma cell type.
Trina Reif is a 20-year survivor of peritoneal mesothelioma. Her first symptom was fluid in her abdomen. Her doctor, Dr. Anton Strocel, spoke to The Mesothelioma Center about her symptoms. “She presented to me with unexplained ascites (excess abdominal fluid),” he said. Trina had an exploratory laparotomy and peritoneal biopsies before her diagnosis.
Staging Peritoneal Mesothelioma
Peritoneal mesothelioma staging is vital. It shows how far the disease has spread and guides treatment options. The Peritoneal Cancer Index is the system most used to stage peritoneal mesothelioma. PCI measures the size and spread of tumors in the abdomen.
Peritoneal Mesothelioma Treatment Options
The most common treatment for peritoneal mesothelioma is chemotherapy. But treatment type depends on several factors. These include disease stage, patient’s overall health and treatment goals.
Most Common Treatment Options
- Chemotherapy: Systemic and intraperitoneal chemotherapy may slow the spread of peritoneal mesothelioma.
- HIPEC (Hyperthermic Intraperitoneal Chemotherapy): Heated chemotherapy applied directly to the abdomen during surgery.
- Immunotherapy: In clinical trials, immunotherapies show promise in some patients.
- Palliative Care: Treatments that relieve symptoms. Some also improve the patient’s quality of life.
- Radiation: Some doctors may recommend palliative radiation. But this is uncommon.
- Surgery: In eligible patients, cytoreductive surgery can remove tumors. It is often combined with HIPEC.
- Targeted Therapy: Treatments that focus on specific genetic changes in cancer cells.
A multimodal therapy using HIPEC may be best. But not all patients qualify for surgery. Enrolling in a clinical trial can provide access to new and experimental therapies.
Dr. W. Charles Conway is director of surgical oncology at Ridley-Tree Cancer Center. He specializes in peritoneal mesothelioma. We interviewed him about the benefits of peritoneal mesothelioma treatment.
“The first thing I like to tell [patients] is that they certainly do have [treatment] options,” Conway said. “Essentially, without treatment, the median survival is a year or maybe a little less. With the good treatment that we use now, median survival can be several years.”
Peritoneal Mesothelioma Prognosis
The prognosis for peritoneal mesothelioma varies. It depends on the diagnosis stage and how well the treatment worked. Early diagnosis and aggressive treatment with surgery and HIPEC can boost survival rates. Many patients can live for years after treatment. Some may have long-term remission.
Information About Peritoneal Survival
- The 5-year survival rate for peritoneal mesothelioma is 65%.
- Over 50% of peritoneal cancer patients who had HIPEC surgery live more than 5 years.
- About 75% of patients who have surgery and then chemo live longer than 5 years.
- The average life expectancy of peritoneal mesothelioma without treatment is 6 months.
- People who don’t qualify for surgery live about 13 months with chemotherapy alone.
Your overall health and any coexisting conditions also play a role. Karen Selby is a registered nurse and Patient Advocate at The Mesothelioma Center. We interviewed her about the life expectancy for peritoneal mesothelioma patients. “Everyone is different,” she said. “No one can look at a diagnosis of mesothelioma and tell you what your life expectancy is.”
Survivor Story
Survivor Story
Tammy Frank
Peritoneal Mesothelioma
Living With Peritoneal Mesothelioma
Living with peritoneal mesothelioma can be challenging. Patients and caregivers may face physical and emotional issues. Patients often need a strong support system. It should include family, friends and health care providers.
Support groups and counselors can help patients cope with these challenges. Patients must also work closely with their medical team. This is to manage symptoms and maintain the best quality of life.
How to Find a Peritoneal Mesothelioma Specialist?
Finding the right specialist is key for treating peritoneal mesothelioma. Experts in this field know advanced treatments like HIPEC. They know the unique challenges of this rare disease. The following doctors are top peritoneal mesothelioma specialists.
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
Top cancer treatment centers have experienced multidisciplinary teams. They offer mesothelioma clinical trials and support services for patients and their families. Experience matters when treating mesothelioma. Finding a top treatment center is crucial. It will help ensure the best outcomes.
Common Questions About Peritoneal Mesothelioma
- Is there a cure for peritoneal mesothelioma?
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There is no cure for peritoneal mesothelioma or any other type. HIPEC with cytoreductive surgery and long-term chemo gives the best results. It boosts lifespan by over 5 years. About 75% of patients treated with them live longer than 5 years.
- Why is early detection of peritoneal mesothelioma important?
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Early detection of mesothelioma improves treatment outcomes. It also boosts the chances of long-term survival. Those with a history of asbestos exposure should seek a peritoneal mesothelioma specialist.
- Can peritoneal mesothelioma go into remission?
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Yes, it can go into remission. About 12% of peritoneal mesothelioma patients who get aggressive treatment have complete remission. Partial remission is also possible. Remission isn’t the same as a cure. Doctors watch patients closely. Cancer can return after remission.
- Any 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. Knowing the details of your diagnosis can help you decide. Talking to a counselor, joining a support group, and eating well are all helpful. So are relaxing and exercising to manage your mental health.
Compensation for peritoneal mesothelioma can help pay for treatment. Legal options include lawsuits, settlements and trust funds.
- What questions should I ask my doctor about peritoneal mesothelioma?
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Health care communication is key. Here’s a short list of questions to ask.
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. It will help you communicate with care providers. You will also have more control over your diagnosis and treatment.
- Can peritoneal mesothelioma be misdiagnosed?
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Peritoneal mesothelioma is often misdiagnosed. It happens because of its non-specific symptoms. Many patients are first diagnosed with IBS or other gut issues. Later, they receive an accurate mesothelioma diagnosis.
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