Peritoneal Mesothelioma, also known as malignant mesothelioma of the peritoneum, is a very rare form of cancer found in the mesothelium.
The mesothelium is a thin layer of tissue that covers most internal organs. Mesothelioma is further categorized by the location of the affected mesothelium. The type of cancer affecting the mesothelium around the lining of the abdomen is peritoneal mesothelioma. It is most often associated with exposure to asbestos and has a very high mortality rate.
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Peritoneal mesothelioma is extremely rare. The symptoms of this disease are similar to other diseases involving the abdominal area and testing is required to render a diagnosis. The symptoms that do manifest may be caused by the cancer itself or a buildup of fluid caused by the cancer. Symptoms consist of, but are not limited to:
• Abdominal pain
• Night sweats
• Blood clotting anomalies
• Bowel obstruction
• Swelling in the abdomen
• Unexplained weight loss
The primary risk factor of peritoneal mesothelioma is exposure to asbestos. This typically occurs in a work or home setting. Mesothelioma is more common near the lungs because the asbestos is usually inhaled. Peritoneal mesothelioma is thought to occur when the asbestos is inhaled then coughed up and swallowed.
Secondary exposure is also possible in patients who live with people who work in an environment that contains asbestos. The fibers may be brought home on the clothing and/or body and then inhaled and ingested by other household members.
Because the disease is so uncommon, there are no widely available screening tests for this type of cancer, even for people who are in a high risk category for developing peritoneal mesothelioma. However some imaging tests, such as MRIs or CT scans may be recommended for some patients. If peritoneal mesothelioma is suspected, the following biopsy procedures may be used:
• Thoracoscopy – a thoracoscope is inserted between two ribs to allow the physician to examine the area
• Peritoneoscopy – a peritoneoscope is inserted into the abdominal wall to allow the physician to examine the area
• Laparotomy – an incision into the abdomen wall allows the physician to look for additional evidence of the disease
Treatment options are limited because of the severity of the disease. The first stage offers the best prognosis; however, the disease is typically diagnosed at a more advanced stage due the rarity of the disease and the lack of initial symptoms.
• Chemotherapy – May be utilized to reduce symptom severity.
• Clinical Trials – Any treatment that has not yet received FDA approval
• Radiation – May be utilized to reduce symptom severity.
• Radical resection – This is a surgical procedure during which the organ, blood supply to the organ, and lymph nodes surrounding the organ are removed. This offers the best prognosis.
Because of the severity of the disease palliative care is sometimes the only option available for patients suffering from peritoneal mesothelioma. This type of care focuses on making the patient as comfortable as possible and improving their quality of life.
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Peritoneal mesothelioma does not have a staging system like pleural mesothelioma or other forms of cancer. However, the TNM Classification of Malignant Tumors is a staging system generally used to classify the extent of cancer in a person’s body. This system may be used, though not widely accepted, in staging peritoneal mesothelioma. There are four stages in the TNM system that can be broken into two categories; localized and advanced.
Localized – This describes the first stage of cancer. The cancer is found only in one area.
Advanced – This describes stages II, III, and IV and means the cancer has spread to other areas of the body. The further the cancer has spread from the initial occurrence the higher the stage. The higher the stage, the more severe the prognosis becomes lowering the chances for survival.