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Peritoneal Mesothelioma

Malignant peritoneal mesothelioma is a rare type of cancer found in the peritoneum, a thin membrane surrounding the abdominal cavity. Caused by exposure to asbestos, peritoneal mesothelioma is extremely rare, and the prognosis is generally poor.

Parts of the Lung Affected by Peritoneal Mesothelioma
Parts of the Lung Affected by Peritoneal Mesothelioma

How Is Peritoneal Mesothelioma Unique?

Peritoneal mesothelioma (formally known as diffuse malignant peritoneal mesothelioma) is the second-most common type of mesothelioma, accounting for approximately 15 – 20 percent of all new mesothelioma diagnoses each year. There are four key differences between peritoneal mesothelioma and other types of the disease:

Location: Peritoneal mesothelioma occurs in the abdominal lining (peritoneum), rather than the linings of the lungs or heart.

Symptoms: Due to the location of the disease, peritoneal mesothelioma symptoms most often develop in the abdomen and/or gastrointestinal system, rather than the chest and lungs.

Treatment: The most effective treatment for peritoneal mesothelioma is cytoreductive surgery followed by Hyperthermic Intraperitoneal Chemotherapy (HIPEC) – a heated chemotherapy “wash” that kills cancer cells within the abdominal cavity.

Survival: Peritoneal mesothelioma patients have a somewhat better prognosis and survival rate than those with other forms of the disease.

What You Need to Know About Peritoneal Mesothelioma
  • Peritoneal mesothelioma is the second most common form of asbestos-related cancer.
  • Fewer than 500 people are diagnosed with peritoneal mesothelioma each year.
  • Standard treatments include debulking surgery, chemotherapy, and radiation
  • Cytoreductive surgery with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) has shown promise as an effective therapy for significantly improving survival.
Cause
Asbestos inhalation or ingestion
Location
Abdominal lining (peritoneum)
Common Symptoms
  • Abdominal pain
  • Ascites/swelling
  • Anorexia/weight loss
Treatment
  • Surgery
  • Chemotherapy
  • HIPEC
  • Radiation
Prognosis
6 – 12 months

What is the Prognosis for Peritoneal Mesothelioma?

While the prognosis for all forms of mesothelioma is generally poor, the prognosis for peritoneal mesothelioma is somewhat better than for other types of the disease. The median survival period for peritoneal mesothelioma is 1 year, and the longest known survival was 19 years.

Patients who undergo cytoreductive surgery with HIPEC typically have significantly longer survival periods. According to one study, approximately half of peritoneal mesothelioma patients who undergo this form of treatment lived more than five years.

The biggest factors affecting the prognosis of peritoneal mesothelioma patients are:

  • Cell type (histopathology)
  • Tumor size and staging
  • Gender of the patient
  • Whether the cancer has spread (metastasis)

Two subtypes of peritoneal mesothelioma – multicystic mesothelioma and well-differentiated peritoneal (or papillary) mesothelioma – usually occur in women and are generally considered benign. Survival rates for these uncommon forms of the disease are much higher.

What are the Symptoms of Peritoneal Mesothelioma?

The symptoms of peritoneal mesothelioma can take decades to appear after being exposed to asbestos. When symptoms do start to appear, they typically develop first in the abdominal area and/or gastrointestinal system, though some symptoms (like weight loss or fever) can be systemic.

Common Symptoms

  • Abdominal pain
  • Abdominal swelling
  • Anorexia / weight loss
  • Ascites (fluid in the peritoneal cavity)

Less Common Symptoms

  • Night sweats
  • Hypercoagulability (blood clotting)
  • Fever with no known origin
  • Intestinal obstruction
  • Inflammatory lesions

Peritoneal mesothelioma can cause certain other conditions, known as paraneoplastic syndromes, that may exhibit additional symptoms. These include:

  • Thrombocytosis – high platelet numbers in the body’s blood supply
  • Hypoglycemia – low blood sugar
  • Venous thrombosis – blood clots that form in a vein

How is Peritoneal Mesothelioma Diagnosed?

Because the symptoms of peritoneal mesothelioma are often similar to those of other diseases, diagnosis can be difficult. Usually, diagnostic tests focus on first ruling out more common diseases, including other forms of cancer.

Initially, imaging scans are used to look for tumor masses. From there, blood tests may be able to detect certain biomarkers (abnormal substances in the blood). However, the only definitive way to confirm a peritoneal mesothelioma diagnosis is through an abdominal biopsy – usually through a peritoneoscopy or laparotomy.

The most common misdiagnoses for peritoneal mesothelioma include:

  • Irritable bowel syndrome (IBS)
  • Hernia
  • Other abdominal cancers, especially ovarian cancer

What Treatments are Available for Peritoneal Mesothelioma?

All types of mesothelioma are treated using a combination of three types of therapy:

  • Surgery – Known as debulking or cytoreduction, the primary goal is to remove as much of the tumor(s) as possible.
  • Chemotherapy – A systemic drug treatment (usually administered intravenously) that kills fast-growing cells, including mesothelioma cancer cells.
  • Radiation – A blast of targeted radiation to reduce the size of cancer tumors.
Top Peritoneal Mesothelioma Doctors in the Country
H. Richard Alexander, Jr., M.D.

H. Richard Alexander, Jr., M.D.

Surgical Oncologist Map Marker University of Maryland Marlene and Stewart Greenebaum Cancer Center
Claire Verschraegen, M.D.

Claire Verschraegen, M.D.

Professor of Medicine, Director, Hematology/Oncology Division Map Marker Vermont Regional Cancer Center

Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

In recent years, a new way of delivering chemotherapy to fight abdominal cancers – including peritoneal mesothelioma, colon cancer, and ovarian cancer, among others – is to use a heated chemotherapy “wash” that rinses out the abdominal cavity and, hopefully, kills any cancer cells left behind after cytoreductive surgery. This technique is called Hyperthermic Intraperitoneal Chemotherapy (HIPEC).

Although HIPEC is performed at only a few cancer centers around the world, it has shown to be more effective than the more common multimodal treatment of surgery followed by systemic chemotherapy. This may be because the chemotherapy drugs used in HIPEC treatments are stronger than that used for systemic treatment.

According to a study abstract presented at the 2015 meeting of the American Society of Clinical Oncology (ASCO), approximately two-thirds of peritoneal mesothelioma patients who received HIPEC treatment survived 3.4 years – significantly longer than the standard survival rate for peritoneal mesothelioma.

Resources for Peritoneal Mesothelioma Patients

Costs Related to Peritoneal Mesothelioma

As with any cancer, peritoneal mesothelioma treatment costs can be very high. Costs usually fall into the following categories:

  • Diagnostic costs
  • Treatment costs
  • Recovery and follow-up costs

The amount an individual may spend depends on many factors, including the specific diagnosis, the stage at which the disease is discovered, their insurance coverage, and even where they live.

Because malignant peritoneal mesothelioma is caused by asbestos, individuals diagnosed with this form of cancer may be eligible to receive legal compensation for medical expenses, lost wages, and pain and suffering related to the disease.

Learn more about the financial assistance that is available if you or a loved one has been diagnosed with peritoneal mesothelioma. Financial aid options available to you can include mesothelioma trust funds as well as grants to cover travel, treatment and housing. You can also explore your legal rights to compensation from asbestos companies liable for your exposure to asbestos.

View Sources

Baker, Patricia; Clement, Philip B.; Young, Robert H. “Malignant Peritoneal Mesothelioma in Women: A Study of 75 Cases With Emphasis on Their Morphologic Spectrum and Differential Diagnosis.” American Journal of Clinical Pathology. 1 May 2005: 724-737. DOI: 10.1309/2H0NVRERPP2LJDUA

Bridda, Alesio; Padoan, Ilaria; Mencarelli, Roberto; Frego, Mauro. “Peritoneal Mesothelioma: A Review.” Medscape General Medicine. 2007; 9(2): 32. PMCID: MC1994863.

Cao, S., et al. “Advances in malignant peritoneal mesothelioma.” International Journal of Colorectal Disease. 2015 Jan;30(1):1-10. DOI: 10.1007/s00384-014-2029-1

Gleneara, Elizabeth Bates, et al. “Long-term outcomes of cytoreduction and HIPEC for malignant peritoneal mesothelioma.” Journal of Clinical Oncology. 2015 ASCO Annual Meeting. (May 20 Supplement), 2015: 4111.

Shin, Hyun Deok; Kim, Suk Bae. “Benign Cystic Mesothelioma Misdiagnosed as Peritoneal Carcinomatosis.” Case Rep Gastronerology. 2016 Jan-Apr; 10(1): 115–120. DOI: 10.1159/000444445

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