What is Peritoneal Mesothelioma?

What is Peritoneal Mesothelioma?

Our stomach has linen called the peritoneum. Peritoneal mesothelioma develops in this part of the body. The causes of this disease are similar to Pleural Mesothelioma, which is overexposure to Asbestos. If someone absorbs or swallows asbestos fibers, then the tiny particles get accumulated in the stomach lining. It might take up to 20-50 years for the fibers to cause mutations (breakdown) in healthy mesothelial cells. Now, it can eventually lead to constant genetic damage resulting in the growth of cancer cells and tumors on the peritoneum. It takes a while for cancer to grow. Hence, the latency period of its detection is also delayed and long.

This article covers following topics:

#1. What are the other types of Mesothelioma?

#2. Who are in the highest risk groups?

#3. Symptoms of Peritoneal Mesothelioma

#4. What is the Process of Peritoneal Mesothelioma Diagnosis?

#5. Peritoneal Mesothelioma Treatment

#6. Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

 

What are the Other types of Mesothelioma?

·       Pleural mesothelioma: Pleura is the mesothelium that covers each lung. The type of cancer that develops in the pleura is known as malignant pleural mesothelioma. Or, it is called pleural mesothelioma. Maximum cases of mesotheliomas, about 90% grow in the chest.

·       Pericardial mesothelioma: It grows in the heart and is rare. It is known as pericardial mesothelioma.

·       Testicular mesothelioma: This mesothelioma develops around the testicles’ membrane. This testicular mesothelioma is again very rare.

Who are in the highest risk groups?

The highest risk group constitutes of people who may have worked with Asbestos-related products for their work. These include builders, plumbers, electricians, boilermakers, and welders. Then there are Asbestos miners, asbestos cement manufacturing workers, insulators, automotive industry workers, mechanics, transport workers (especially waterside workers), and textile workers.

People who have not directly worked with Asbestos but may somehow get exposed to it can also develop mesothelioma. These constitute people washing clothes that have been worn by people exposed to Asbestos. The asbestos fibers on these clothes can affect the washers or cleaners.

Long Latency Period

As mentioned earlier, it usually takes many years for mesothelioma to develop after a person exposed to asbestos, also referred to as latency period or interval.  It is between 20 and 60 years (most commonly around 40 years) after exposure.

Staging and Life Expectancy

For many years, there was no official staging system. Hence peritoneal mesothelioma experts had developed their own. However, in 2011, some researchers proposed three stages based on surgical cases. Though, the official adoption of this staging system is still far as there is a need for more evidence to confirm it. But many specialists use this system already:

·       Stage 1: At this stage, the cancerous tissue is minimal. And there are tumors within the abdominal lining. The lymph nodes are free of cancer.

·       Stage 2: At this stage, the cancerous tissue is moderate, and tumors have not spread outside the lining or to lymph nodes.

·       Stage 3: In here, the cancerous tissues become more extensive. At this stage, tumors may have spread outside the peritoneal lining, to lymph nodes, or both.

·       Stage 4: Experts cannot define this stage clearly yet. When the tumor is spreading extensively, it is called ‘stage four.’

Symptoms of Peritoneal Mesothelioma

 The buildup of fluid in the abdominal cavity may cause Peritoneal mesothelioma. Signs of this mesothelioma are the accumulation of fluid in the abdomen and weight loss. In some cases, loss of appetite, abdominal pain, seizures (less common), and formation of gas may occur.

What is the Process of Peritoneal Mesothelioma Diagnosis?

The early symptoms of peritoneal mesothelioma are not unique. The signs could be the same as a common illness. Hence, its diagnosis is hard. The symptoms are usually similar to that of irregular bowel syndrome, stomach ache, Crohn’s disease, colitis, and other such common gastrointestinal disorders. Doctors can therefore misdiagnose these as signs of common diseases. It is especially possible if they are unaware of the patient’s history of exposure to Asbestos. Since the latency period is long, the patient might not also connect the cause with the effect and not reveal it to the doctor.

Ist Step

· The first step of an accurate diagnosis therefore is a thorough medical examination of the patient and collecting his/her life history. Do not forget to tell your healthcare provider if you have worked with Asbestos-related products.

IInd Step

· After reviewing your symptoms and performing a thorough checkup, your doctor will probably prescribe a simple X-ray or CT scan. These reports will help to identify peritoneal changes, if any, such as thickening of the stomach lining or a tumor mass that could indicate the presence of cancer. Doctors can also prescribe other specialized imaging such as an MRI or PET/CT scans. They generally prescribe this imaging after reviewing biopsy reports.

Blood tests can also reveal if there is a tumor growth in the body of unnatural substances that are usually because of cancer. If there are visible abnormalities on a scan, a biopsy can reveal whether the growth is cancerous. An interventional radiologist conducts the test in local hospitals.

· In some cases, doctors prescribe a more detailed surgical biopsy. It can happen when the tissue in question is difficult to reach for a test. And the routine biopsy has not been able to gather enough cells to give your doctor a firm diagnosis. At this point, a surgeon will usually recommend a laparoscopy. In the operation room under general anesthesia, surgeons perform this laparoscopy. This test entails the surgeon to use a camera to look inside the abdominal cavity looking for any signs of cancer and also choose the best location for conducting the biopsy.

· Laparoscopy is a method through which a surgeon can directly locate tumors within the abdomen area, pelvis, and also facilitate a biopsy of a cancerous nodule.

Peritoneal Mesothelioma Treatment

Oncologists generally use a multimodal approach to treat peritoneal mesothelioma. It is a combination of conventional treatments like surgery, chemotherapy, and radiation therapy.

Chemotherapy and radiation therapy have not shown much success in patients. Most clinical trials have depicted a survival time of approximately one year. However, some studies have presented success stories of using chemotherapy during surgery.

For patients in advanced-stage of this cancer, doctors use the standard method of treatments. Palliative care is the most conventional treatment.

There are regular clinical experiments to test new treatments for this disease. Treatment options include PIPAC (pressurized intraperitoneal aerosol chemotherapy) and chemotherapy applied in a pressurized form. Treating mesothelioma with PIPAC is still in the early phases and requires further testing. However, the treatment has shown success in a median life expectancy of approximately 27 months.

Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

For patients suffering from Peritoneal Mesothelioma cancer, a combination treatment of debulking surgery along with heated chemotherapy is the conventional model of care. During surgery, surgeons apply heated chemotherapy treatment on the abdomen. It is also known as HIPEC (hyperthermic intraperitoneal chemotherapy).

Sometimes doctors perform debulking surgery or cytoreductive surgery. Before HIPEC, surgeons conduct this surgery to remove visible tumors and tissues that have been damaged by mesothelioma cells. It may involve cleaning the abdominal lining growth or other organs to remove as much of the tumor as possible. The heated chemotherapy ranges between 104°F – 109°F and consists of a stronger dosage than traditional chemotherapy.

HIPEC is a kind of specialized treatment. It is available in a few clinics. Patients should know the treatment costs are very high. HIPEC can average to $40,000.

Clinical trials showed some success in this treatment. Life expectancy can go up from 53 to 92 months. Data suggest that approximately 65% of patients survive four years or longer.

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