What Makes Peritoneal Mesothelioma Different?
Peritoneal mesothelioma is a cancer that starts in the peritoneum. This is the thin layer of tissue that lines the inside of your abdomen and covers organs like your stomach and intestines. Unlike the most common form of mesothelioma, pleural mesothelioma which starts in the lining of the lungs, with the peritoneal type, the tumor grows in your belly.
The location of the tumor means surgeons and doctors can use specific approaches that just aren’t possible for tumors in other parts of the body. Peritoneal often responds better to treatment than other mesothelioma types. In recent years, new treatment methods have led to real progress for people with this diagnosis. Some of these advances have meaningfully improved outcomes.
While this is the second most common type of mesothelioma, it’s still a very rare cancer. Only about 20% of all mesothelioma cases are the peritoneal type and only 3,000 mesothelioma cases are diagnosed each year in the U.S.
Why Peritoneal Mesothelioma Is Hard to Recognize
Because peritoneal mesothelioma develops in the abdomen, its early warning signs can be vague and attributable to other more common abdominal ailments. For example, these symptoms are also associated with irritable bowel syndrome, hernias or ovarian cancer. Doctors often test for those conditions first.
Common Peritoneal Mesothelioma Symptoms
- Abdominal pain or cramping: You might feel a general soreness or sharp pains in your stomach area.
- Ascites: This is a buildup of fluid in the abdomen, which can cause abdominal swelling and can make your clothes feel tight.
- Bloating: A feeling of fullness or pressure in your belly, even if you haven’t eaten much.
- Changes in bowel habits: This can include constipation, diarrhea, or other changes that don’t go away.
- Lumps in the abdomen: In some cases, a tumor can grow large enough to be felt from the outside.
- Nausea or vomiting: You might feel sick to your stomach or have trouble keeping food down.
- Unexplained weight loss: Losing weight without trying is a common sign of many cancers.
The abdomen is also a complex area that can be harder to get clear images of than the chest. This can contribute to delays in correct diagnoses. If you have a history of asbestos exposure and your symptoms continue, it’s important to tell your doctor and ask about seeing a mesothelioma specialist.
Treating Peritoneal Mesothelioma
Treating peritoneal mesothelioma requires a plan that fits this specific type of cancer. The approaches that work well for pleural mesothelioma in the chest aren’t always the best choice for the abdomen. Your medical team will build a treatment plan based on your unique situation, including your cancer stage, cell type and overall health.
Treatment Options for Peritoneal Mesothelioma
- Clinical trials: Because standard treatments are still being developed for peritoneal mesothelioma, clinical trials can offer access to promising new therapies like cancer vaccines.
- Cytoreductive surgery: CRS is a complex operation during which a surgeon removes all visible tumors from the abdomen.
- Hyperthermic intraperitoneal chemotherapy: HIPEC delivers heated chemo treatment directly inside the abdomen during surgery.
- Palliative care: This focuses on relieving symptoms from pain or fluid buildup. For example, a procedure can drain the fluid from ascites to make you more comfortable.
- Systemic chemo: This is standard chemo given through an intravenous line. The drugs travel throughout your entire body. It’s often used for patients who can’t have surgery or HIPEC.
Immunotherapy is now a standard treatment for pleural mesothelioma, but it’s still considered investigational for peritoneal patients. This is one reason why talking to a peritoneal specialist is so important. They can best explain your options, including whether a clinical trial might be right for you.
How HIPEC Changed Peritoneal Mesothelioma Treatment
Studies have shown that people who have CRS and HIPEC often live much longer than those who only get chemo. It represents a huge step forward from standard chemo through an IV.
During HIPEC your surgeon first carefully removes all the visible tumors they can find. Then they pump the heated chemo solution directly into your abdominal cavity. The heat helps the chemo drugs penetrate deeper into the tissues to kill any remaining cancer cells that are too small to see. The surgeon lets it circulate for about 60 to 90 minutes, then drains it out.
Not every peritoneal patient is a candidate. Your overall health, the stage of your cancer and your cancer cell type all play a role in whether this aggressive approach is right for you. For patients who are healthy enough to qualify, this combination of surgery and heated chemo has become the best treatment option.
Why Peritoneal Mesothelioma Has More Favorable Outcomes
There are a few key reasons why, in general, peritoneal mesothelioma has a better outlook than pleural mesothelioma. First, the tumor’s location in the abdomen makes it possible to use a very powerful, targeted treatment (surgery and HIPEC).
Second, the most common cancer cell type for peritoneal mesothelioma is epithelioid. This cell type tends to respond better to treatment than other mesothelioma cell types.
Patients with peritoneal mesothelioma who are able to have the full treatment of cytoreductive surgery with HIPEC have seen their survival times grow significantly. Many live for years after their diagnosis. This is a hopeful and empowering reality for patients who are candidates for this approach. It shows just how important advances in treatment have been.
Living With Peritoneal Mesothelioma
Living with peritoneal mesothelioma is about managing your day-to-day life and finding ways to feel as well as possible. Because the cancer is in your abdomen, it comes with its own set of challenges. Having a plan and a support system can make a real difference in your quality of life.
Tips for Managing Peritoneal Mesothelioma
- Connect with support groups: Talking with other people who have peritoneal mesothelioma can help you feel less alone. They understand what you are going through and can share advice.
- Follow recovery plans: If you have HIPEC, recovery takes time and patience. Follow your doctor’s instructions, accept help from others and give your body the rest it needs.
- Get help from patient advocates and navigators: These experts can help you find specialists, understand your options and connect you with resources. Their help is usually free.
- Manage ascites: If fluid buildup is a problem, talk to your doctor about ways to manage it. Draining the fluid in a clinic setting can provide fast relief from swelling and discomfort.
- Nutritional support: The tumor and its treatment can affect your appetite and digestion. A dietitian who understands your situation can help you find ways to get the nutrition you need.
- Use palliative care: This type of care is for any cancer stage. It works with your regular treatment to manage symptoms like pain, nausea and fatigue, helping you stay more comfortable.
You don’t have to manage this alone. Reaching out for support from specialists, advocates and peers can help you with the emotional and physical challenges, finding ways to live a full life while navigating your diagnosis.
Peritoneal Mesothelioma FAQs
How is peritoneal mesothelioma different from pleural mesothelioma?
Peritoneal mesothelioma begins in the lining of the abdomen. Pleural mesothelioma begins in the lining of the lungs. Because of this, they cause different symptoms, require different treatments and have different outcomes for quality of life and mortality.
What is HIPEC and is it right for me?
HIPEC is a treatment where heated chemotherapy is put directly into the abdomen during surgery. It’s used right after a surgeon removes visible tumors. Whether it’s the right treatment for you depends on your overall health, the stage of your cancer and your cancer cell type. A peritoneal specialist is the best clinician to determine if you are a candidate.
Why is peritoneal mesothelioma sometimes mistaken for ovarian cancer?
In women, the symptoms of peritoneal mesothelioma like abdominal pain, bloating and fluid buildup are nearly the same as the symptoms of ovarian cancer. Because ovarian cancer is more common, doctors may test for it first. A correct diagnosis usually requires a biopsy and a pathologist that can identify the cancer cell type.
Can peritoneal mesothelioma spread to other parts of the body?
In its later stages, peritoneal mesothelioma can spread (metastasize) from the abdomen to other organs such as the liver, lymph nodes or the lining of the chest. This is one reason why early detection and effective treatment is so important.
Is peritoneal mesothelioma more common in women?
While mesothelioma as a whole is more common in men, the gap is much smaller for the peritoneal type. A larger percentage of peritoneal mesothelioma cases are in women compared to pleural cases. Researchers are still studying the reason for this difference.
What should I look for in a peritoneal mesothelioma specialist?
Look for a surgical oncologist who has performed many cytoreductive surgeries and HIPEC procedures. Major cancer centers or teaching hospitals are often the best places to find these specialists. A patient advocate can help you find someone with the right background.
About The Author
Daniel Wasserberg
Founding Partner
Daniel Wasserberg, a founding partner of Meirowitz & Wasserberg, is a Best Lawyers-recognized and Super Lawyers-rated mesothelioma attorney with over 20 years of experience. Named a Top 100 Trial Lawyer and Top 10 Asbestos-Mesothelioma Lawyer, he leads the firm's national asbestos practice.
