Peritoneal mesothelioma is the name given to the cancer that attacks the lining of the abdomen. This type of cancer affects the lining that protects the contents of the abdomen and which also provides a lubricating fluid to enable the organs to move and work properly.
Malignant peritoneal mesothelioma is an extremely rare cancer. Only 100 to 500 cases are diagnosed in the US each year, making up less than 30% of all mesothelioma cases. According to the SEER (Surveillance, Epidemiology, and End Results) database, 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 exposured individuals with symptoms appearing 20-30 years after exposure rather than the 30-40 year latency more commonly associated with pleural mesothelioma.
Like in the case of all types of mesothelioma, asbestos is considered to be the main cause for peritoneal mesothelioma. Asbestos can be fatal for the body and can also cause cancer along with other severe diseases.
Asbestos dust causes significant harm when it enters into the body. The dust may enter the body in two ways.
Firstly, it can enter the body through the lungs during breathing. In this case the dust travels through the lymph nodes and reaches the peritoneal cavity. Secondly, it can enter due to involuntary ingestion while working with asbestos.
It can also occur due to the passive inhalation of asbestos dust. This is called Tail Piece Passive exposure. The clothes of a worker who works amidst asbestos traps the dust between the layers of fabric. When these clothes are washed, or used by another person, the asbestos dust enter into that person's body.
Peritoneal mesothelioma has two clinical types which can be differentiated with the help of CT findings, the "dry" type and the "wet". It is classified as "dry" when there are multiple tiny masses or one dominant localized mass and generally little or no ascites. The "wet" type has widespread small nodules, no dominant mass and a presence of ascites.
If fluid is found, the process of eliminating it is through paracentesis; however the analysis of this fluid has limited diagnostic significance. Normally, a definitive diagnosis may be obtained through tissue biopsy.
As there is currently no staging system for peritoneal mesothelioma, the most popular system for general cancer staging (TNM system) is used. TNM system has the following criteria: (T) status of the tumor, (N) lymph nodes and (M) metastases. Other general categories may also be helpful in order to determine the stage.
Category 1 - with a localized lesion that can entirely be removed (resected)
Category 2 - the disease is located inside the abdominal cavity on peritoneal or organ surfaces where there is a probability of removing as much tumor as possible (debulking)
Category 3 - the disease is located inside the abdominal cavity and invades organs such as liver or colon.
Category 4 - the disease extends outside of the abdominal cavity
Mesothelioma doctors may suspect peritoneal mesothelioma if the patient complains of stomach, chest, or abdominal pain. Suspicious hernias may actually be a pleural effusion caused by peritoneal tumor growth. Misdiagnosis is common and patients will likely undergo multiple imaging scans and a diagnostic biopsy before an official diagnosis is made.
Diagnostic procedures in which fluid is extracted from the peritoneum for lab testing are the only way to conclusively diagnose peritoneal mesothelioma. Samples will be examined for the presence of malignant cells. Once malignant cells are detected, further testing will be needed to classify these cells as malignant mesothelioma.
Diagnosing peritoneal mesothelioma is very difficult, and cases of peritoneal mesothelioma misdiagnosed or undiagnosed are unfortunately not uncommon. It is important to share your case history of work experience (especially in shipyards and at construction sites) and asbestos exposure potential with your physicians if you feel mesothelioma is a risk. Asbestos fibres can also be carried into the home on clothing, inadvertently exposing the deadly fibres, and the risk of mesothelioma, to family members.
In addition to determine a diagnosis, many diagnostic test also help determine the stage the cancer is in, providing a better idea of a patient's prognosis. The chance of recovery depends on the size of the cancer, where the cancer is, how far the cancer has spread, how the cancer cells look under the microscope, how the cancer responds to treatment, and the patient's age. Peritoneal mesothelioma is usually diagnosed when it has had time to advance; as with most types of cancer, early diagnosis is an excellent first step in fighting the disease.
The treatment options available for the patient of peritoneal mesothelioma include:
1- Radiotherapy (using radiations to destroy cancer tumor)
2- Chemotherapy (injecting medicine directly to damaged part for instant and deep affect)
3- Surgery (removing affected parts completely)
In some cases radiotherapy is used to shrink the cancer tumor before surgery and then chemotherapy is applied to inject medicine directly into peritoneum after surgery. In this way combination of treatment options can be applied to destroy the cancer tumor and to stop the process of cancer cell proliferation.
Many patients, however, are not good candidates for surgery since mesothelioma has often spread too extensively or because the patient’s general health is too poor to cope with the stress of surgery. These patients may elect to participate in palliative treatment options that do not attempt to cure a patient, but work to relieve symptoms and improve the quality of life for peritoneal mesothelioma patients.
There are many treatments for mesothelioma but no single treatment is capable of curing the patient single handedly. Doctors therefore take a multimodality approach. It means that a combination of many treatments are used instead of a single treatment. There are several factors that determine the type of combination of treatments to be used, and it varies from case to case.
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