Peritoneal Mesothelioma

Asbestos exposure is the primary cause of peritoneal mesothelioma. When workers get near asbestos fibers, they either inhale or swallow them. The ingested fibers travel through the digestive system and become lodged in the abdomen. Inhaled fibers can also migrate to the abdominal area via the lymph nodes.

Once embedded in abdominal tissue, the asbestos fibers cause irritation and scarring, which leads to abnormal changes to the surrounding cells. The resulting cancerous cells create tumors that spread through the abdominal cavity.

Causes of Peritoneal Mesothelioma

Peritoneal mesothelioma, like other types of mesothelioma, is linked to workplace asbestos exposure. Studies show that about 15% to 20% of all mesothelioma diagnoses are peritoneal. About 15,000 cases of peritoneal mesothelioma will be diagnosed between 2005 and 2050. About 60 percent of those diagnosed are male, with an average age of 53.
Most of the people diagnosed with peritoneal mesothelioma have worked in factories, industrial careers or in the military where contact with asbestos was frequent. At the same time, women are more likely to develop peritoneal mesothelioma than any other form of the disease. This is likely due to second-hand asbestos exposure.

Occupational Exposure

Workers in refineries, construction sites, power plants and other industrial settings were routinely exposed to large amounts of asbestos through the 1980s. High levels of exposure to asbestos increase the likelihood of developing peritoneal mesothelioma. At-risk occupations include (but are not limited to):

Miners
Shipyard workers
Quarrymen
Plumbers
Dockworkers

In addition, military veterans (in particular, Navy veterans) are at a high risk of developing peritoneal mesothelioma. Asbestos was used extensively in ships, shipyards and living quarters.

What are the Symptoms?

Peritoneal mesothelioma takes 20 to 50 years to develop. The slow progression means patients do not know they are sick until the late stages of the disease. The most apparent symptoms are related to the gastrointestinal system and abdomen, including:

Abdominal swelling
Cramps and pain
Fluid retention
Intestinal blockages
Changes in bowel habits
Unexplained weight loss
Unexplained fever
Blood clotting
Coughing up blood
Extreme Fatigue
Nausea and vomiting

Diagnostic Testing

Since peritoneal mesothelioma is a rare disease, the average physician misses the symptoms or mistakes them as another disease. An accurate diagnosis can take some time. Peritoneal mesothelioma diagnostic testing includes:

X-ray
MRI
Blood work
CT scans
PET scans

With a suspected diagnosis, doctors perform biopsies to determine specific information about the disease such as location, stage and types of cells involved. A biopsy is the only way to confirm a diagnosis accurately.

Staging and Cell Types

To determine the extent of the disease, doctors use the Peritoneal Cancer Index (PCI) scoring system. For the PCI system, the abdomen is visually divided into 13 well-defined areas. Each area receives a score of 0 to 3 based on tumor size (with 3 being larger tumors).

A patient’s overall score (with a range of 0 to 39) describes the extent of the disease. A higher score indicates more widespread and/or more significant tumors in the peritoneal cavity. More specifically:

Stage 1 – As the earliest stage of the disease, Stage 1, the cancerous nodules are localized (or non-metastatic). A PCI numerical index between 1 and 10 indicates Stage 1 cancer.
Stage 2 – Specialists identify Stage 2 by the spread and growth of the disease. In Stage 2, tumor growth is localized in the abdominal area (including some tissues and organs) with some lymph node involvement. A PCI numerical index between 11 and 20 indicates Stage 2 cancer.
Stage 3 – Stage 3 is identified as cancerous growth in areas distal to the point of origin, including organs, tissue and lymph nodes. Using the PCI scale, Stage 3 is associated with a numerical index between 21 and 30.
Stage 4 – As the most advanced stage of the disease, Stage 4 is marked by extreme tumor growth and metastasis. The cancerous tissue is found in distal organs, bones and tissue. A PCI score up to 39 is indicative of late-stage peritoneal mesothelioma.

Cell Types

The cell type of the cancer can help doctors determine how to treat the disease and the overall prognosis. Three primary cell types are commonly seen in mesothelioma:

Epithelial (Epithelioid) – Of the three cell types, epithelial cells are the most common and least aggressive, making them easier to treat. Epithelial cells allow for a better overall disease prognosis.
Sarcomatoid – As the least common type of cell, sarcomatoid cells are challenging to treat. Sarcomatoid cells are also more aggressive than other cell types.
Biphasic – Biphasic cells present as a combination of epithelial and sarcomatoid cells, which makes them challenging to treat.

Prognosis and Treatments

Patients diagnosed with peritoneal mesothelioma live about a year (12 months) following a diagnosis. The prognosis is more promising than other forms of the disease (pleural or pericardial).

Advanced medical techniques, including Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and cytoreduction surgery (debulking surgery), have greatly improved the prognosis for peritoneal mesothelioma patients over those diagnosed with other types of mesothelioma.

Patients who are diagnosed in the early disease stages have the best chances of living longer. One patient, Paul Kraus, was diagnosed with peritoneal mesothelioma in 1997. Through dietary and lifestyle changes and medical intervention, Kraus has survived well past any expectations.

Available Treatments

While surgery, chemotherapy and radiation (also known as multimodal treatment) remain the standard for mesothelioma management, the leading specialists have developed advanced therapies that allow patients to live longer than ever before. Other therapies also provide patients with a better quality of life.

Surgery – Peritoneal cancer surgery removes cancerous tissue and tumors to reduce associated pain and growth. Surgery is an aggressive treatment and is not an option for patients in the later stages of the disease.
Chemotherapy – Chemotherapy is a commonly used treatment option for many types of cancer because it stunts or halts tumor growth. Chemotherapy is either used alone or in combination with surgery to reduce or remove cancerous tissue.
Radiation therapy – Radiation treatment is used in combination with surgery and chemotherapy or alone to reduce tumors. It works by damaging cancer cell DNA to stop growth. Radiation is also used in palliative care to ease the pain.

Alternative Treatments

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) – HIPEC — a combination of a targeted dose of heated chemotherapy and the surgical reduction of tumors (called cytoreduction or debulking) – has shown great promise in peritoneal mesothelioma patients. HIPEC improves peritoneal mesothelioma patient life expectancy, in many cases.
Immunotherapy – Early research on immunotherapy in peritoneal mesothelioma suggests it may positively impact survival rates. Research is continuing to determine the link between immunotherapy and reduced peritoneal mesothelioma cancer.
Palliative Care – Palliative care can be administered at any point during treatment, not just at the end stages. The intent is to reduce pain through the course of treatment to allow patients to live more comfortably.

Why are Specialists important?

Peritoneal treatment specialists use the latest and best available treatment options. Factors that play a role in treatment options include:

Patient’s age
Overall health
Type of mesothelioma
Level of functioning

Peritoneal mesothelioma patients who see a specialist have an advantage over patients who see a common oncologist. Seeking treatment from specialists can deliver an effective treatment plan based on years of experience with treating this disease.

Financial Assistance for Treatment

Studies show that HIPEC and debulking surgery provide the best results for peritoneal mesothelioma patients. On average, the cost of both procedures is estimated at about $84,000. The cost does not include chemotherapy (about $30,000 over eight weeks), radiation therapy (about $20,000), palliative care and other complementary and alternative medical treatments. Patients must also shoulder the cost of travel, prescription medications, lost wages and associated expenditures.

Since treatment costs are so high, many patients qualify for financial assistance and other support resources that can ease the burden of peritoneal mesothelioma.

Since most peritoneal mesothelioma patients developed the disease as a result of occupational exposure, responsible companies have set up trust funds to pay expenses. The financial awards from the trust funds can be used to finance any costs the patients deem necessary, including treatments, household bills and travel.

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