Researchers at Wake Forest University report that, in some cases, quality of life improves for those who undergo cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with peritoneal mesothelioma.

The surgery and corresponding chemotherapy have become an accepted treatment for this type of cancer which affects the lining of the abdominal cavity (peritoneum). Peritoneal mesothelioma results from asbestos exposure and manifests by small tumor nodules growing and spreading in the stomach lining of an afflicted patient.

Doctors diagnose 3,000 new cases of mesothelioma each year in the United States, and 30% of those are peritoneal.

Peritoneal Mesothelioma Patients Report Improved Well-Being

In the study which spanned 13 years, 46 patients completed “Quality of Life” surveys after they received the surgery and accompanying chemotherapy.

Results of the surveys showed:

  • Physical functioning returned to baseline at 12 months
  • General health improved by 6 months
  • Pain level improved overall
  • Physical well-being improved at 6 months

Researchers concluded that despite the risks of the invasive surgery, patients tolerated it well, and their quality of life benefited as a result.

Prior to utilizing this treatment as the standard of care, peritoneal mesothelioma patients received only palliative care and faced a grim prognosis. Medical strides in the last decade, including this protocol, now give these same patients hope of more time. Those who participated in this study showed a median survival rate of 3.4 years.

Who May Be Candidates for Mesothelioma Surgery?

Those who served in the military or worked in the trades are most at risk of asbestos exposure — and, in turn, developing mesothelioma.

However, spouses and children may also face exposure because of asbestos fibers traveling to the home via clothing. Coming in contact with the affected garments through laundering or even hugging a person covered in the invisible fibers puts family members in danger.

Microscopic asbestos fibers enter the body through inhalation and lodge in internal tissue. Sometimes their presence — after decades — causes cell mutation, leading to deadly cancers like pleural, peritoneal, or pericardial mesothelioma.

How Cytoreduction With HIPEC Targets Peritoneal Mesothelioma Tumors

Cytoreductive surgery, which often takes 10-12 hours, involves removing tumors throughout the abdominal cavity. Some patients see the growth of tumors so numerous that they combine into large masses within the peritoneum.

During surgery, some organs — such as the gallbladder, spleen, part of the small or large intestine, and the lining of the abdominal wall — may be removed if tumors are so pervasive that the organ is compromised.

Surgeons follow up tumor removal with hyperthermic intraperitoneal chemotherapy (HIPEC) directly in the operating room while the abdominal cavity is open.

During HIPEC, a heated chemotherapy solution enters the body through catheters to kill any microscopic cancer cells still remaining. The heat increases the effectiveness of the cancer-killing drugs, which target only the area where administered.

The chemotherapy solution is heated to a narrow margin of 107.6 to 109.4 degrees Fahrenheit — just high enough to kill cancer cells and preserve healthy ones. Normal cells die at approximately 111.2 degrees Fahrenheit.

Recognizing Signs of Peritoneal Mesothelioma

Mesothelioma is a rare cancer with symptoms that present as vague. Further, because of its long latency period (20-50 years after exposure to asbestos), diagnosis is sometimes difficult.

Most peritoneal mesothelioma patients report abdominal pain and fluid build-up as their primary symptoms.

Other peritoneal mesothelioma symptoms may include:

  • Abdominal swelling, and bloating
  • Fever, night sweats, and fatigue
  • Nausea and vomiting
  • Unexplained weight loss

Because these symptoms often result from other conditions as well, a correct diagnosis of peritoneal mesothelioma can be missed. Doctors must be informed of any previous asbestos exposure, even if it was indirect.

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Sources
  1. Yasmin, A.M., J. Sweeney, P. Shen, K. I. Votanopoulos, R. McQuellon, K.Duckworth, K. C. Perry, G. Russell, and E. Levine. (2020. January). Effect of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy on Quality of Life in Patients with Peritoneal Mesothelioma. Retrieved from: https://link.springer.com/article/10.1245%2Fs10434-019-07425-5
  2. Sugarbaker, P.H., K. Turaga, H.R. Alexander, Jr., M. Deraco, M. Hesdorffer. (n.d.). Management of Malignant Peritoneal Mesothelioma Using Cytoreductive Surgery and Perioperative Chemotherapy. Retrieved from: https://ascopubs.org/doi/10.1200/JOP.2016.011908
  3. Yan. T.D., M Deraco, D. Baratti, S. Kusamura, D. Elias, O. Glehen, F.N. Gilly, E. Levine, P. Shen, F. Mohamed, B.J. Moran, D.L. Morris, T.C. Chua, P. Piso, P.H. Sugarbaker. (2009, Dec. 20). Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma: Multi-Institutional Experience. Retrieved from: https://ascopubs.org/doi/pdfdirect/10.1200/jco.2009.23.9640
  4. Tufts Medical Center.org. (n.d.) Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Retrieved from: https://www.tuftsmedicalcenter.org/-/media/Brochures/TuftsMC/Patient-Care-Services/Departments-and-Services/Cancer-Center/HIPEC_Final.ashx?la=en&hash=49ECD33312242DC03D3DA5722A6C25C80E5B46A6

Last modified: January 24, 2020