Peritoneal Mesothelioma-Basic Information For You Should Know

Peritoneal mesothelioma, a cancer of the lining of the abdominal cavity, is the secondly most common type of mesothelioma after the pleural form, comprising approximately one-fifth to one-third of the total number of all mesothelioma cases diagnosed. These diagnoses are approximately 54.7 per cent male versus 45.3 per cent female, with the median age being 65-69. The latency period appears to be shorter for asbestos-exposed individuals with symptoms appearing 20-30 years after exposure rather than the 30-40 year latency more commonly associated with pleural mesothelioma.

Symptoms

Clinical symptoms at the time of presentation may include;

-         abdominal pain,

-          abdominal mass,

-          increased abdominal size

-          distention of the abdomen,

-         ascites (fluid in the abdomen),

-          fever,

-          weight loss,

-          fatigue,

-          anemia and digestive disturbances

-          Some patients complain of more non-specific symptoms for a number of months prior to a confirmed diagnosis. In a percentage of cases, peritoneal mesothelioma is found incidentally when the patient has sought help for another surgical health disease such as gallbladder, hernia or pelvic mass.

Diagnosis

As with all other forms of mesothelioma, the diagnosis of peritoneal mesothelioma can be difficult.  Abdominal CT Scan findings may help differentiate between the two clinical types of peritoneal mesothelioma, termed “dry” or “wet”, since their appearances are very different upon imaging.

 In the “dry” type, CT scan may reveal multiple small masses or a single dominant localized mass. There is normally little or no ascites.

 In the “wet” type, CT scan may reveal widespread small nodules, but no dominant mass. Ascites is usually present.

If there is fluid in the peritoneum, it may be removed in a procedure referred to as abdominal paracentesis. Unfortunately, as is the case with pleural mesothelioma, the analysis of the fluid sample offer limited diagnostic value.  A definitive diagnosis is usually only made after a tissue biopsy obtained in a Laproscopic exploration is examined in the laboratory.

Staging of Peritoneal Mesothelioma

There is currently no distinct staging system for peritoneal mesothelioma, and if the disease is staged, it is normally done in accordance with the TNM system, the most common general cancer staging system. This system refers to the status of the tumor (T), lymph nodes (N) and metastases (M).

 There are general categories which may also be somewhat helpful in determining stage.

The first category shows a localized lesion able to be completely resected (entirely removed).

 In the second category, the disease is contained within the abdominal cavity on peritoneal and organ surfaces where debulking (the removal of as much, but not the entire tumor) is possible.

 Category three shows disease contained within the abdominal cavity with invasion of organs such as the colon or liver.

 Category four shows disease spreading outside the abdominal cavity.

Treatment

Most of the time, combination therapy treatment of peritoneal mesothelioma has become more common for a select patient population, since surgery alone and/or intraperitoneal chemotherapy alone have proven to be similarly ineffective. Cytoreductive (debulking) surgery involves the removal of all or nearly all visible tumor, and, depending on the physician’s choice, may be combined with Intra-Peritoneal Hyperthermic Chemotherapy (IPHC), intraperitoneal chemotherapy and/or radiation.

For patients found to have widespread disease, where surgery is not looked at as “potentially curative”, palliation of symptoms may be accomplished by debulking. Since peritoneal mesothelioma is a rare malignancy, specialized treatments should be conducted by doctors  that have practical experience in dealing with the disease.

Patients should also educate themselves about the different types of mesothelioma and treatment options and reach out to available resources to make coping with a mesothelioma diagnosis easier.