Peritoneal mesothelioma is a cancer that develops in the lining of the abdomen, called the peritoneum. Surgery with heated chemotherapy is the most effective treatment for this type of mesothelioma, often extending life expectancy to 5 years or longer.
What Is Peritoneal Mesothelioma?
Malignant peritoneal mesothelioma is a form of cancer caused by asbestos exposure that affects the lining of the abdominal organs.
A very rare form of cancer, peritoneal mesothelioma accounts for only 10-15% of all malignant mesothelioma cases in the United States — around 450 cases a year.
What Causes Peritoneal Mesothelioma?
The only known cause of peritoneal mesothelioma is inhaling or ingesting asbestos fibers. After these fibers enter the body, they can travel to the abdomen where they become embedded in the peritoneum and may eventually cause cancer.
There are 2 ways asbestos fibers may end up in the abdominal cavity:
- When asbestos fibers are inhaled, they can travel to the abdomen through the lymphatic system.
- Swallowed asbestos fibers may work themselves into the abdominal cavity as they move through the digestive system.
Asbestos fibers can remain in the lining of the abdomen for 20-50 years before the irritation eventually triggers mutations in mesothelial cells. This cell mutation is what leads to peritoneal mesothelioma.
Asbestos Exposure and Veterans
Veterans may develop peritoneal mesothelioma after being exposed to asbestos during their military service. Following their service, many veterans worked industrial and construction jobs, both high-risk occupations for asbestos exposure.
Peritoneal Mesothelioma Symptoms
The symptoms of peritoneal mesothelioma often take the form of digestive issues. Many common symptoms are subtle and can be mistaken for other illnesses like the flu, irritable bowel syndrome (IBS), and celiac disease.
Early Symptoms of Peritoneal Mesothelioma
- Abdominal pain
- Swelling of the peritoneal cavity
- Nausea and vomiting
Symptoms of Advanced Peritoneal Mesothelioma
- Anemia (low red blood cell count)
- Breathing difficulties
- Constantly feeling full
- Night sweats
- Weight loss
“I had a big weight loss in just a matter of a few months. After I ate, I was so uncomfortable, very bloated. I was tired all the time. I had the sweats.”
– Mary Jane W., Peritoneal Mesothelioma Patient
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Diagnosing Peritoneal Mesothelioma
Peritoneal mesothelioma can be challenging to diagnose because of its nonspecific symptoms and long latency period of 20-50 years. However, doctors can follow certain steps to make an accurate peritoneal mesothelioma diagnosis.
- Physical exam: Upon experiencing abdominal symptoms, veterans should report them to their doctor. This often prompts doctors to order imaging tests for a closer look.
- Imaging scans: An X-ray or CT scan of the abdomen may expose tumors. Excess fluid build-up (ascites) can also show up on a CT scan of the abdomen, indicating irritation in the peritoneal lining.
- Biopsy: During a biopsy, doctors take a sample of tissue from the peritoneum. A biopsy is the only way to conclusively diagnose mesothelioma.
Since they are a high-risk group for this disease, veterans should inform their doctors about any possible asbestos exposure during their military service and get screened for asbestos-related illnesses. An early diagnosis can significantly increase a veteran’s chance of survival.
Obtaining a Biopsy
The only way to get an accurate mesothelioma diagnosis is by performing a biopsy.
After obtaining a sample of tissue from the affected area, a pathologist examines this sample in a lab to determine whether the cells are cancerous and which mesothelioma cell type the patient has.
The 3 main mesothelioma cell types are:
Doctors can obtain tissue samples from the patient through a needle biopsy, endoscopy, or surgical biopsy. Needle biopsies can accurately diagnose peritoneal mesothelioma up to 84% of the time.
Peritoneal Mesothelioma Prognosis
Mesothelioma is incurable and has a poor overall prognosis, but patients with peritoneal mesothelioma have a better prognosis than those with other mesothelioma types, especially pleural mesothelioma and pericardial mesothelioma.
The 5-year survival rate for peritoneal mesothelioma patients who undergo curative treatment is about 50%.
The average life expectancy for peritoneal mesothelioma patients is 28-35 months.
Peritoneal Mesothelioma Treatment
Currently, the most effective treatment for peritoneal mesothelioma is cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). This treatment option can increase a patient’s survival time by 4-5 years or longer.
Cytoreduction with HIPEC consists of two primary procedures:
- Cytoreduction: Mesothelioma surgeons remove tumors from the patient’s abdominal cavity.
- HIPEC: Doctors fill the patient’s abdominal cavity with heated chemotherapy drugs to kill any remaining cancer cells they may have missed during surgery.
“For patients referred very early, I would say we are successful nearly 100% of the time. We can get a complete cytoreduction with the primary cancer resection, removing the peritoneal metastases and using HIPEC. We can almost promise those patients that they will not have further peritoneal metastases.”
– Dr. Paul Sugarbaker, Retired Peritoneal Mesothelioma Specialist
Additional surgery options for peritoneal mesothelioma include:
- Peritonectomy: Also called debulking, this operation removes the whole lining of the abdomen.
- Bowel Resection: This procedure involves removing parts of the intestines that are affected by advanced cancer.
- Organ Removal: This involves surgery that removes any abdominal organs affected by cancer, such as the spleen, kidneys, stomach, or liver.
Since surgery for peritoneal mesothelioma is exceptionally invasive, patients must be in good enough health for this form of treatment.
Doctors may prescribe chemotherapy before, during, or after surgery.
Heated chemotherapy is said to be the best option for peritoneal mesothelioma. Heating the chemotherapy drugs and applying them directly to the abdomen during surgery can be far more effective than traditional chemotherapy delivered through the bloodstream.
Common chemotherapy drugs for peritoneal mesothelioma include cisplatin, carboplatin, pemetrexed, and gemcitabine.
Applying radiation to the abdomen is risky because it can harm the sensitive organs in the abdominal cavity.
Your specialist will determine if radiation therapy makes sense for you, but it’s typically only used to relieve pain and control symptoms during advanced stages of peritoneal mesothelioma.
In clinical trials for mesothelioma, doctors test new techniques to see if they are more effective at controlling the cancer than the best existing treatments. Current trials are studying emerging treatments like immunotherapy, targeted therapy, and gene therapy.
A 2021 study from the University of Texas MD Anderson Cancer Center combined the immunotherapy drug atezolizumab with bevacizumab, a targeted chemotherapy, to treat peritoneal mesothelioma. This treatment was highly effective, with tumors shrinking in 40% of cases. Further, 85% of patients were still alive a year after starting this treatment.
Patients diagnosed with advanced peritoneal mesothelioma, or those who are not healthy enough to withstand intensive surgery, may benefit from palliative care instead. Palliative care is focused on relieving uncomfortable symptoms instead of curing the disease.
Top Mesothelioma Specialists
Treatment is vital to your survival outcome, and it is crucial to see a mesothelioma specialist.
Trained specialists have invaluable insight into this rare disease, while general oncologists typically do not have the experience needed to treat patients.
Veterans have access to some of the top peritoneal mesothelioma experts in the country both in and outside of the VA Health Care System.
Some of the top peritoneal mesothelioma specialists include:
Director of the Peritoneal Surface Malignancy Program at the Washington Cancer Institute, Dr. Sugarbaker treated hundreds of mesothelioma patients before his retirement. He also developed the cytoreduction with HIPEC procedure that is still in use today.
Dr. James Pingpank
A specialist in peritoneal mesothelioma and other abdominal cancers, Dr. Pingpank has specific expertise in cytoreductive surgery and HIPEC.
Dr. Eugene Choi
Dr. Choi is a peritoneal mesothelioma doctor practicing at the Michael E. DeBakey VA Medical Center in Houston, Texas.
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Next Steps for Peritoneal Patients
Veterans with peritoneal mesothelioma have a cause for hope that some mesothelioma patients don’t have. Science is progressing to the point where peritoneal patients are able to live with the disease much longer than before.
Early treatment from a peritoneal mesothelioma doctor can significantly improve disease outlook, with many patients having survived more than 7 years.
The Mesothelioma Veterans Center can help you connect with a top mesothelioma doctor near you.
Call our team today or download a free Mesothelioma Veterans Packet.