Peritoneal Mesothelioma

This article on Peritoneal Mesotheliomagoes into clearer detail on what is involved, how ti is caused and options for treatment.
Peritoneal mesothelioma is a rare form of cancer that is extremely difficult to diagnose and treat, and which in most cases, leads to death.

Peritoneal mesothelioma is a type of cancer that affects the lining of the abdomen. This lining is called the peritoneum and is responsible for covering and supporting the organs housed in the abdominal cavity, and also for secreting fluid that allows these organs to move against each other smoothly. Peritoneal mesothelioma attacks the cells in this lining causing them to over secrete fluid, which leads to abdominal swelling. The peritoneal mesothelioma tumor also kills the healthy cells in the abdominal cavity and encourages the growth of abnormal cells that can spread to other parts of the body.

The only known cause of peritoneal mesothelioma is a history of asbestos exposure. This type of cancer is caused by the settlement of microscopic asbestos particles in the abdominal lining. It is currently proven that materials containing asbestos can release fine particles, also called asbestos dust, when undergoing installation, repair, maintenance, or destruction. What is not completely understood is how this asbestos dust becomes lodges in the abdominal lining.

One theory is that the particles are inhaled and then transported through the blood stream or lymphatic system to the abdominal cavity. However, the most widely accepted theory is that the asbestos dust settles on the food items that are ingested by workers at lunch or carried home on the clothing of workers and allowed to settle in the kitchen where other meals are prepared. In this theory the asbestos fibers are ingested along with the food and allowed to settle in the stomach. Over a long period of time these fibers move from the stomach to the peritoneum where they cause chronic inflammation that eventually leads to the development of cancer.

After exposure to asbestos dust peritoneal mesothelioma can take up to 30 years to produce symptoms, but the period between diagnosis and death is shortest for this type of cancer. Peritoneal mesothelioma is just one type of cancer caused by asbestos, and it is extremely rare, comprising just one third of all mesothelioma cases (1, 2, 3).

In the early stages of the disease, where the fibers are moving into the peritoneum, there are no noticeable symptoms. However, once the inflammation begins the first noticeable symptom is usually abdominal pain. Since abdominal pain can be associated with a number of different viruses, infections, and stomach ailments many sufferers do not immediately seek medical attention for their symptoms.

As the disease progresses affected individuals will notice symptoms such as abdominal swelling (due to excess fluid retention), weight loss (even though the size or girth of the waist may be increasing), nausea, vomiting, breathing difficulties, loss of appetite, and weakness (3,5). In later stages symptoms such as bowel obstruction, fever, anemia, and new-onset hernia may present (5).

It is usually after the individual has dealt with a number of these symptoms for a peiod of months that they finally seek medical attention in the belief that they are suffering from a more usual type of digestive problem such as gallstones or hernia.

The diagnosis of peritoneal mesothelioma is difficult at best. After confirming a history of asbestos exposure the doctor will run numerous tests to confirm or deny the suspicion of peritoneal mesothelioma. The first of these test usually involve imaging of the suspected site. Traditional x-rays can be used to check the abdominal cavity for suspicious growths but MRIs and CT scans will offer a more detailed view.

After determining the location of the suspected mesothelioma most doctors will order a tissue biopsy to ultimately confirm the diagnosis of cancer. For the biopsy a small needle is inserted into the abdominal mass and a sample of the abnormal tissue is removed. This tissue is analyzed and a positive immunostain for calretinin confirms an accurate diagnosis of peritoneal mesothelioma (4).

With most other cases of mesothelioma a staging system is used after diagnosis to determine the progress of the disease and the most effective treatment options. However, there is currently not an established staging system available for use with peritoneal mesothelioma (6). Some doctors may choose to stage the disease under the guidelines of the TNM cancer staging system, but most physicians skip this process and move immediately to treatment.

With current medical options peritoneal mesothelioma treatment is often unsatisfactory. Surgical removal of the tumor has not been proven to prolong survival rates, radiation therapy used alone does not eradicate the tumor, and chemotherapy has proven ineffective in most patients (7,8).

The most promising options for treatment involve a multimodality approach. In this method radiation therapy is aimed at the tumor to reduce the size and kill the cancerous cells. This procedure results in pain relief and a decrease in abdominal swelling (9). Chemotherapy is then used via insertion directly into abdomen to further shrink the size of the tumor (5). Finally surgery is utilized to remove all, or almost all, of the visible tumor. In most cases surgery is then followed by postoperative chemotherapy (7).

If the cancer is diagnosed in the earliest stages the above treatment can be used to completely eradicate the tumor. However, the actual goal of any type of peritoneal mesothelioma treatment is not usually a total cure. Rather, since the tumor is most often diagnosed in its later stages, the main treatment goal is pain management, symptom relief, and an improvement in the quality of life of the patient.

In order to change the success rate of peritoneal mesothelioma treatment clinical trials and intensive research are currently focused on finding a cure for this deadly type of cancer and at increasing the time period between diagnosis and death.

With current medical science and technology the only way to increase the chance of cure lies in early detection. Individuals with a history of asbestos exposure are urged to schedule regular medical physicals and inform their doctors of the asbestos exposure and mesothelioma risk. With future discoveries lies a hope that the diagnosis technology will improve and early detection will be easier and more accurate.

‘Peritoneal Mesothelioma’ Resources:

  • Sridhar KS, et al.: New strategies are needed in diffuse malignant mesothelioma. Cancer 1992, 70:2969-2979.
  • Antman K, et al.: Malignant mesothelioma: prognostic variables in a registry of 180 patients, the Dana-Farber Cancer Institute and Brigham and Women’s Hospital experience over two decades, 1965-1985. J Clin Oncol 1988, 6:147-153.
  • Asensio JA: Primary malignant peritoneal mesothelioma: a report of seven cases and a review of the literature. Arch Surg 1990, 125:477-481.
  • Attanoos RL: Pathology of malignant mesothelioma. Histopathology 1997, 30:403-418.
  • Vidal-Jove J, et al.: A curative approach to abdominal mesothelioma: case report and review of the literature. Reg Cancer Treat 1991, 3:269-274.
  • Wagner JC: Diffuse pleural mesothelioma and asbestos exposure in the North Western Cape Province. Br J Ind Med 1960, 17:260-271.
  • Markman M: Intraperitoneal therapy in the management of peritoneal mesothelioma. J Infusional Chemother 1993, 3:50-52.
  • Zidar BL, et al.: Treatment of six cases of mesothelioma with doxorubicin and cisplatin. Cancer 1983, 52:1788-1791.
  • Biset D: The role of palliative radiotherapy in malignant mesothelioma. Clin Oncol 1991, 3:315-317.

More information can be found at http://www.asbestos.net/

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