Mesothelioma Peritoneum

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The peritoneum has an inner and outer layer. The inner layer covers the abdominal organs and the outer layer lines the abdominal wall. The peritoneum helps protect the organs in the abdomen and keep them in place (shown as the thick line surrounding the abdominal organs in the illustration). When mesothelioma develops in the peritoneum, the layers of the peritoneum thicken. And, fluid may collect between the two layers. This is known as ascites.

The epidemiology of peritoneal mesothelioma is complicated by possible geographic and temporal variations in diagnostic practices. The incidence rates in industrialized countries range between 0.5 and three cases per million in men and between 0.2 and two cases per million in women. Exposure to asbestos is the main known cause of peritoneal mesothelioma. Results on peritoneal mesothelioma have been reported for 34 cohorts exposed to asbestos, among which a strong correlation was present between the percentages of deaths from pleural and peritoneal mesothelioma (correlation coefficient 0.8, P < 0.0001). Studies of workers exposed only or predominantly to chrysotile asbestos resulted in a lower proportion of total deaths from peritoneal mesothelioma than studies of workers exposed to amphibole or mixed type of asbestos. Cases of peritoneal mesothelioma have also been reported following exposure to erionite and Thorotrast, providing further evidence of common etiological factors with the pleural form of the disease. The role of other suspected risk factors, such as simian virus 40 infection and genetic predisposition, is unclear at present. Control of asbestos exposure remains the main approach to prevent peritoneal mesothelioma.

TreatmentTreatment options are dependent on the stage a peritoneal mesothelioma patient is diagnosed with. There are more curative treatment options, like cytoreduction surgery, for patients with earlier stages.Patients in the later stages may receive palliative treatments, like radiation or chemotherapy. Another palliative treatment option may be a paracentesis to drain the fluid buildup in the abdomen.The most successful treatment of peritoneal mesothelioma has been the combination of cytoreduction surgery and HIPEC (heated intraperitoneal chemotherapy). The cytoreduction removes most of the cancerous tumor, and HIPEC is used to kill the remaining cells.A study involving Dr. James Pingpank analyzed 211 patients with malignant peritoneal mesothelioma between the years of 1992 and 2010. All of the participants were treated with cytoreduction surgery and HIPEC. Patients that underwent both procedures had a 5-year survival rate of 41% and a 10-year survival rate of 26%. Researchers discovered that the median overall survival of the patients was 38.4 months.This treatment has been successful in patients with good general health. Some patients have lived as long as 7 years after having this surgery.Find a mesothelioma specialist offering this treatment option using our free Doctor Match program.

Patients with peritoneal mesothelioma often present late, and as a result treatment is often palliative. Interventions include cytoreductive (debulking) surgery and intraperitoneal chemotherapy or radiotherapy. Peritoneal mesothelioma is a very rare disease entity, yet a diagnosis to be considered in a patient with an abdominal mass, previous asbestos exposure, and pleural calcification.

SummaryBackgroundPeritoneal mesothelioma is a very rare diagnosis with an incidence of 1 case per 4–5 million of the population. It accounts for 20–30% of all mesothelioma type cancers. There is great interest in this disease entity amongst the medical community and indeed the general population due to the well-substantiated link between asbestos related exposure and mesothelioma.Case presentationIn this article we report a case of a 77 year old man who presented with a one week history of breathlessness and a right pleural effusion. An incidental right upper quadrant abdominal mass was noted leading to ultrasound and subsequent CT scans. A large subhepatic mass was identified, in addition to pleural calcification and thickening. Biopsy and histological examination of the abdominal mass suggested a spindle cell tumour, most likely a mesothelioma. Thoracocentesis and cytology of the pleural fluid confirmed the diagnosis of a malignant mesothelioma. Our patient is a retired dairy farmer. A detailed occupational history revealed likely asbestos exposure when he worked as a plumber, approximately 50 years ago.DiscussionPatients with peritoneal mesothelioma often present late, and as a result treatment is often palliative. Interventions include cytoreductive (debulking) surgery and intraperitoneal chemotherapy or radiotherapy. Peritoneal mesothelioma is a very rare disease entity, yet a diagnosis to be considered in a patient with an abdominal mass, previous asbestos exposure, and pleural calcification.