Peritoneal Mesothelioma

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This page was medically reviewed by James Stevenson, M.D. on February 6, 2019. For information on our content creation and review process read our editorial guidelines. If you notice an error or have comments or questions on our content please contact us.

James Stevenson, M.D. Thoracic Medical Oncologist

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Peritoneal mesothelioma is a malignant cancer caused by ingesting asbestos fibers. It is also known as abdominal mesothelioma because it develops in the peritoneum, or the tissue lining the abdomen. Symptoms of peritoneal mesothelioma include stomach pain, nausea and swelling of the abdomen.

01. Overview

What Is Peritoneal Mesothelioma?

Peritoneal mesothelioma is a form of cancer caused by asbestos. When asbestos fibers are ingested or inhaled, they can become embedded in the lining of the abdomen. The fibers may migrate to the abdominal lining through the digestive or lymphatic systems. However, experts have not agreed upon any one mechanism explaining how asbestos reaches the abdominal lining.

  • Peritoneal mesothelioma is the second-most common form of mesothelioma cancer, accounting for about 15 – 20% of all diagnoses.
  • Each year, less than 1,000 people are diagnosed with the disease in the United States.
  • Common symptoms include abdominal pain and swelling, weight loss and fluid buildup in the abdominal cavity.
  • Diagnosis consists of a series of tests, including imaging tests, blood tests and biopsies.
  • Peritoneal mesothelioma is treated with surgery, heated chemotherapy and immunotherapy.
  • Peritoneal mesothelioma prognosis may vary depending on an individual’s case, with life expectancy ranging from two to six years.
Organs Affected by Peritoneal Mesothelioma

Peritoneal Mesothelioma Diagram

02. Peritoneal Mesothelioma Prognosis

What Is the Prognosis & Life Expectancy for Peritoneal Mesothelioma?

The life expectancy for peritoneal malignant mesothelioma cancer is more favorable than other types of malignant mesothelioma.

Peritoneal mesothelioma prognosis may vary depending on an individual’s case, with life expectancy ranging from two to six years. More patients are surviving five years or longer with advancements in treatment.

CRS stands for cytoreductive surgery, which is a surgical method of removing tumor tissue.
HIPEC stands for hyperthermic intraperitoneal chemotherapy. It is a form of heated chemotherapy administered within the abdomen.
Survival of Peritoneal Mesothelioma Patients Treated With CRS + HIPEC
1-year survival 86%
2-year survival 77%
3-year survival 59%
5-year survival 59%

Several factors can influence an individual patient’s prognosis, including:

Epithelioid cell type is most common in peritoneal mesothelioma. It responds more favorably to treatment, with a median life expectancy of 79 months with treatment.

A small percentage of peritoneal malignant mesothelioma patients are diagnosed with sarcomatoid cell type. Peritoneal mesothelioma patients diagnosed with this cell type have an average survival of 10 months with treatment.

03. Peritoneal Mesothelioma Causes

How Does Asbestos Cause Peritoneal Mesothelioma?

Ingestion of asbestos fibers causes malignant peritoneal mesothelioma. Experts have yet to determine how the mineral reaches the abdomen. However, tests have found asbestos fibers in parts of the abdomen and digestive tract.

Once in the abdomen, asbestos may cause mesothelioma through several mechanisms, including:

  • Causing irritation and inflammation
  • Destabilizing chromosomes
  • Disrupting normal cellular processes

Research has also tied certain genetic factors to mesothelioma, such as BAP1 mutations. Still, asbestos exposure is the only known cause of mesothelioma. The best way to minimize mesothelioma risk is to avoid asbestos exposure.

04. Peritoneal Mesothelioma Symptoms

What Are the Symptoms of Peritoneal Mesothelioma?

Peritoneal mesothelioma symptoms can take 10 – 50 years to appear after an individual inhales or ingests asbestos fibers. The fibers become lodged in the peritoneum, the lining of the abdomen, which leads to irritation and scar-tissue buildup. These damaged cells can develop into tumors and cause symptoms.

Peritoneal Mesothelioma Symptoms
  • Abdominal pain
  • Abdominal swelling
  • Anorexia/weight loss
  • Fever with no known origin
  • Fluid in the peritoneal cavity
    (peritoneal effusion)
  • Hypercoagulability
    (blood clotting)
  • Inflammatory lesions
  • Intestinal obstruction
  • Night sweats

For most patients, early peritoneal mesothelioma symptoms will typically present in the abdomen or gastrointestinal system. Patients may also experience systemic symptoms, such as weight loss, which can further complicate diagnosis.

05. Peritoneal Mesothelioma Diagnosis

How Is Peritoneal Mesothelioma Diagnosed?

A peritoneal mesothelioma diagnosis consists of a series of tests. Diagnosis often starts with imaging tests, like CT scans and X-rays. These tests can rule out more common diseases and other forms of cancer, like adenocarcinoma and ovarian cancer.

If a tumor is detected through imaging tests, a doctor may order blood tests to identify biomarkers that can further differentiate mesothelioma from other cancers.

Biopsies are the only way to confirm a peritoneal mesothelioma diagnosis. A doctor will take a fluid or tissue sample to confirm the cancer. The biopsy can also help identify cell type and mesothelioma progression.

Peritoneal Fluid Biopsy

Peritoneal Fluid Biopsy

06. Peritoneal Mesothelioma Stages

Peritoneal Mesothelioma Stages

When diagnosing peritoneal mesothelioma, a doctor will also determine the stage of the cancer. Although there is no well-defined staging system for peritoneal malignant mesothelioma, doctors may identify the advancement of the disease with relevant criteria. For example, doctors may identify if the cancer has metastasized to other organs or lymph nodes.

Peritoneal Mesothelioma Stages

The Peritoneal Cancer Index for Staging Peritoneal Mesothelioma

In some cases, doctors may rely on a tool called the Peritoneal Cancer Index (PCI), developed for abdominal cancers. With this method, the abdominal region is split into 13 distinct sections and scored on a scale of 0 – 3 based on the presence and size of tumors.

The 13 sections are then totaled for an overall PCI score, with 39 being the highest. Doctors suggest peritoneal mesothelioma stages equivalent to the scores. A higher PCI score indicates a more advanced stage of abdominal mesothelioma.

The Tumor Node Metastasis (TNM) System for Staging Peritoneal Mesothelioma

The TNM cancer staging system is commonly used for pleural mesothelioma but has been adapted for peritoneal mesothelioma. The adapted TNM system for peritoneal mesothelioma incorporates three components:

  • T factor: This factor is meant to account for the location and size of the primary tumor. Because peritoneal mesothelioma often has many tumors, doctors use the PCI score for this factor.
  • N factor: This factor accounts for the extent of tumor spread to lymph nodes. Because lymph node involvement is rare, doctors simply give patients a score of N0 or N1 for this factor. N0 means tumors have not spread to any lymph nodes, and N1 means they have.
  • M factor: This factor accounts for distant spread of mesothelioma. Patients receive a score of M0 or M1. M0 means the cancer has not spread to distant areas. M1 means the tumors have spread to distant areas.

Based on these factors, patients may fall into one of three stages. In this system, stage 3 indicates the most advanced stage.

Three Stages of Abdominal Mesothelioma According to Adapted TNM Staging
Stage 1
  • T factor: PCI up to 10
  • N factor: N0
  • M factor: M0
Stage 2
  • T factor: PCI of 11 to 30
  • N factor: N0
  • M factor: M0
Stage 3
  • T factor: PCI of 11 to 30
  • N factor: N0
  • M factor: M0

No matter which staging system doctors use, many factors affect prognosis. Patients can consult a mesothelioma doctor to determine the best treatment for their stage of peritoneal mesothelioma.

07. Peritoneal Mesothelioma Treatment

Treatment of Peritoneal Mesothelioma

Peritoneal mesothelioma is often treated with a multimodal approach, which combines conventional treatments like surgery, chemotherapy and radiation therapy.

Traditional chemotherapy and radiation therapy have shown limited success in peritoneal mesothelioma patients, with some clinical trials showing a median survival time of one year. However, some studies indicate success when using chemotherapy during surgery to treat peritoneal mesothelioma.

For patients with advanced stage peritoneal malignant mesothelioma, standard treatments may be used as palliative care. Palliative treatments are used to improve quality of life and extend life expectancy.

Minimally invasive procedures, like paracentesis, are often used palliatively. This procedure removes buildup of fluid and relieves symptoms associated with peritoneal malignant mesothelioma.

Clinical trials are continually testing new treatments for peritoneal mesothelioma. Emerging treatment options include pressurized intraperitoneal aerosol chemotherapy (PIPAC), a chemotherapy applied in a pressurized form. Treating mesothelioma with PIPAC is in early phases and requires further testing. However, the treatment has shown a median life expectancy of approximately 27 months.

Peritoneal Mesothelioma Patient Success Story

Peritoneal mesothelioma survivor Jim Dykstra.After a 26-year career in the HVAC industry, Jim Dykstra was diagnosed with peritoneal mesothelioma. Jim underwent cytoreductive surgery followed by HIPEC. After he recovered, he underwent multiple rounds of chemotherapy and radiation therapy to control the growth of his tumors. Though he is still battling malignant peritoneal mesothelioma, he is a survivor of more than five years.

Learn MoreLearn More About Jim’s Journey

Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

For eligible patients, a combination treatment of debulking surgery combined with heated chemotherapy is becoming a standard of care. The heated chemotherapy, known as hyperthermic intraperitoneal chemotherapy (HIPEC), is applied to the abdomen during surgery.

Doctors perform debulking surgery, also known as cytoreductive surgery, prior to HIPEC to remove visible tumors and tissue that have been damaged by mesothelioma cells. This may involve removing the abdominal lining or other organs in order to remove as much of the tumor as possible.

HIPEC is then applied throughout the abdominal cavity to kill any remaining cancer cells. The heated chemotherapy is applied at 104°F – 109°F and consists of a stronger dosage than traditional chemotherapy.

Clinical trials have shown the effectiveness of the treatment, with life expectancy ranging from 53 to 92 months. Data suggests approximately 30% to 90% of patients survive five years or longer.

Because HIPEC is a specialized treatment, it is available at select cancer centers. Patients should also be aware of treatment costs as they make treatment decisions. Recent estimates show that surgery with HIPEC can average $40,000.

08. Peritoneal Specialists

Peritoneal Mesothelioma Doctors

Finding a qualified mesothelioma doctor is one of the most important decisions someone diagnosed with peritoneal mesothelioma can make. Many of the best doctors work in dedicated cancer clinics across the country. Some of those doctors also conduct clinical trials to study new therapies and methods of treating and diagnosing mesothelioma.

Top Peritoneal Mesothelioma Doctors in the Country

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

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

Chief Surgical Officer
New Brunswick, NJ

Photo of Brian W. Loggie, M.D.

Brian W. Loggie, M.D.

Chief of Division of Surgical Oncology & Director of the Cancer Center at Creighton...
Omaha, NE

Photo of James Pingpank, M.D.

James Pingpank, M.D.

Surgical Oncologist
Pittsburgh, PA

Photo of Claire Verschraegen, M.D.

Claire Verschraegen, M.D.

Medical Oncologist and Associate Director of Translational Research
Columbus, OH

09. Common Questions

Common Questions About Peritoneal Mesothelioma

Is peritoneal mesothelioma curable?

There is no cure for peritoneal mesothelioma. There are treatment options available that may improve life expectancy.

How long do peritoneal mesothelioma patients live?

A peritoneal mesothelioma patient has a life expectancy of two to six years depending on stage at diagnosis.

What are the symptoms of peritoneal mesothelioma?

Some common symptoms of peritoneal mesothelioma are abdominal pain, abdominal swelling, weight loss, fever, fluid in peritoneal cavity, intestinal obstruction, night sweats and hypercoagulability.

Can peritoneal mesothelioma spread to the lungs?

Yes, peritoneal mesothelioma can spread to the lungs. This process is called metastasis.

How is peritoneal mesothelioma diagnosed?

A biopsy is the only way to definitively diagnose malignant peritoneal mesothelioma. Other diagnostic tests like imaging scans and blood tests may be used to confirm the tumors.

What causes peritoneal mesothelioma?

Peritoneal mesothelioma is caused by ingesting asbestos fibers.

How quickly does peritoneal mesothelioma spread?

Peritoneal mesothelioma may manifest multiple tumors at an early stage. However, it is rare for peritoneal mesothelioma to spread to lymph nodes or areas outside the abdomen.