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Peritoneal Mesothelioma

Peritoneal mesothelioma is a rare form of cancer that develops in the lining of the abdomen. 20% of mesothelioma patients are diagnosed with this type of the disease.The only known cause of mesothelioma is exposure to asbestos. Peritoneal mesothelioma is caused by ingesting asbestos fibers. These fibers get stuck in the digestive tract and over time develop into a tumor.

Symptoms

Some people may experience very few symptoms and find out something is wrong only when they have surgery or a radiology test for a different medical issue. When symptoms do appear, they typically include:

  • Abdominal pain
  • Abdominal swelling or fluid
  • Lumps of tissue in the abdomen
  • Unexplained weight loss
  • Nausea and vomiting
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Cell Types

The 3 major cell types of peritoneal mesothelioma are:

epithelial-cell-type
Epithelial – the most common and least aggressive cell subtype. It accounts for 60% to 70% of cases. Medical professionals have indicated that this cell type responds best to treatment.
sarcomatoid-cell-type
Sarcomatoid – a rare cellular subtype accounting for 10% to 20% of cases. It is known as the most aggressive and least responsive to treatment.
biphasic-cell-type
Biphasic (mixed type) – a combination of both epithelial and sarcomatoid cells within one tumor. It accounts for 20% to 30% of cases. Treatment options and responses vary depending on the ratio of the cell types within the tumor.
Because peritoneal mesothelioma is so rare, it’s important to have a mesothelioma specialist and a skilled pathologist determine which subtype you may have. This will help your doctor decide the best treatment option for your particular case.

Diagnosis

To make an accurate diagnosis, a doctor will collect and study a sample of fluid from your abdominal tumor. This fluid will determine if you have peritoneal mesothelioma. It is also used to identify the cell type within your tumor.Doctors use a special needle to collect this fluid. The needle is passed through your skin from the abdomen. You will be given medicine to numb the area to minimize any discomfort. Sometimes your doctor may also need to take a biopsy so the cells inside the tumor can be studied and identified. To do so, he or she will remove a piece of tissue. These straightforward procedures are typically performed on an outpatient basis, so you probably will not have to stay overnight in the hospital.

To get an even more definitive diagnosis, your doctor might recommend a minor surgical procedure called a laparoscopy, performed when a patient is under general anesthesia. The doctor will insert a tiny video camera through a small incision in the abdomen. The doctor will then remove a small amount of tissue for a pathologist to study. Most people recover from this procedure in 1 to 3 days. Many people don’t even need to stay in the hospital overnight.


Treatment

There are 2 main treatment options for peritoneal mesothelioma: surgery and chemotherapy. Many doctors have found that the best results come from combining these methods. This is called “multimodal therapy.”

Surgery Options for Pleural Mesothelioma Patients

  1. Cytoreduction with HIPEC (Heated Intraoperative Peritoneal Chemotherapy)
    • Invasive and complex procedure
    • Removal of all visible tumors
    • Heated chemotherapy drugs circulated throughout abdominal wall
    • Likely outcomes: significantly improved quality of life, increased life expectancy
  2. Peritonectomy
    • Invasive and complex procedure
    • Removal of the tissues that line the abdominal cavity
    • Often requires removal of a portion of the stomach, small intestine, or colorectum

Doctors can often look at a CT image and estimate ahead of time the organs that need to be removed and how long the surgery might take. In cases where mesothelioma has spread beyond the original tumor site, these surgeries can take 10 or more hours to complete.

Chemotherapy

For most people, surgery alone is not enough to completely treat peritoneal mesothelioma. In such cases, chemotherapy, also known as “chemo,” is prescribed as part of the treatment protocol. Chemotherapy is a combination of strong chemicals and drugs that can attack and kill the remaining cancer cells. If your doctor recommends chemo, you need to prepare for uncomfortable side effects such as hair loss, loss of appetite, mouth sores, and nausea. The reduction of red and white blood cells may also cause fatigue and increase your chance of infection. Fortunately, these difficult side effects typically fade away after you have completed treatment.

Managing Symptoms of Peritoneal Mesothelioma

Many patients who are living with peritoneal mesothelioma find relief from their symptoms through a procedure called “paracentesis.” During this procedure, your doctor will drain fluid from your abdomen, using a local anesthetic, to relieve abdominal distension (bloating) and any shortness of breath you may be experiencing.