Peritoneal Mesothelioma – What is it?

Peritoneal Mesothelioma represents one of the four different types of mesothelioma. Peritoneal Mesothelioma is a rare type of cancer that affects the lining of the abdomen, the peritoneum caused by the ingestion of asbestos fibers. This type of cancer accounts for about 10-15% of all mesothelioma cases and tends to be more prevalent among females ages 51-59. It is also noted that it does not tend to spread into the lymph system and is most often isolated to the abdominal cavity.

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Signs and Symptoms

The signs and symptoms associated with peritoneal mesothelioma are many of the same presented in the scope of diagnosing other adverse health conditions. As with most types of cancers, early detection is pivotal for achieving optimal patient outcomes.

Some of the most common symptoms are:

  • Abdominal pain
  • Nausea
  • Blood Clots
  • Loss of Appetite
  • Fever/Night Sweats
  • Anemia
  • Tissue Lumps in Abdomen
  • Seizures
  • Fatigue
  • Bowel Problems
  • Fluid Build Up (Ascites)

Peritoneal Mesothelioma and Asbestos Exposure

Most cases of Peritoneal Mesothelioma are related to asbestos exposure. Experts state the asbestos fibers penetrate the body via nasal passages or the mouth. This occurs by swallowing asbestos fibers during the process of inhaling or coughing up air with lingering asbestos fibers. The body attempts to filter and discard them, but the fibers are sharp and become lodged in the stomach lining.

The sharp asbestos fibers are irritating to the lining and cell damage results. The damaged cells become unable to send or receive signals and ultimately replicate into a malignant tumor. Cell damage occurs over the span of a decade or more, making late diagnosis a common consequence.

How is Peritoneal Mesothelioma Diagnosed?

Many of the signs and symptoms of peritoneal mesothelioma are non-specific. This means symptoms like abdominal pain, gas or bloating are also among some of the common symptoms belonging to other health conditions. Because of the similarity of the way symptoms, it is difficult to diagnose peritoneal mesothelioma. One should expect a wide battery of testing modalities such as:

  • CT Scans
  • PET Scans
  • Blood Testing
  • Biopsy

Doctors don’t utilize a standard cancer staging system for peritoneal mesothelioma. Before the tumors spread, the cancer is isolated to the abdomen space. Even at stage 2, the cancer is isolated and has not spread past the peritoneum (lining of the abdomen). At stage 4, the cancer has metastasized past the peritoneum and spread to other organs.

Treating Options for Peritoneal Mesothelioma

Treatment choices may vary according to the stage of cancer and also cell type. Other factors are taken into consideration such as the patient’s age, health history, and overall wellness at the time of diagnosis. Some of the most common treatments include:

Cytoreductive Surgery or Debulking

Cytoreductive surgery is typically the first area of treatment in an attempt to remove all visible tumors from the peritoneum. At this time, tissues are often taken for biopsy and further analysis. When paired with HIPEC, it can help with killing off cancer cells and also slowing or halting the spread of cancer. In optimal cases, it prevents cancer reoccurrence.

HIPEC

Peritoneal mesothelioma is very difficult to treat. Though chemotherapy is a traditional treatment option for cancer, the efficacy is still relatively low and the side effects are very rough for most patients. When the cancer is contained with the peritoneum cavity (the stomach lining) Hyperthermic Intraperitoneal Chemotherapy may be an option for certain patients.

Intraperitoneal refers to the treatment being delivered right inside the abdominal lining or cavity (peritoneum). The term hyperthermic chemotherapy means the solution containing the chemotherapy is heated to a temperature greater than normal body temperature (98.6). Before the solution can be administered, the surgeon has to remove all visible malignant tumors. (cytoreductive surgery) and in the operative setting, the chemotherapy heated solution will then be administered by a sterile instrument that delivers the solution directly inside the lining for approximately two hours.

HIPEC works best for patients in general good health. The treatment is designed to lyse all remaining cancer cells within the cavity that remains following the tumor removal. The procedure also improves drug absorption and the normal side effects associated with traditional chemotherapy is avoided. The cytoreductive surgery and HIPEC procedure is often 6-8 hours.

Traditional Chemotherapy

Chemotherapeutic drugs are administered to lyse cancer cells and to limit or halt the spread of cancer. In some cases, chemotherapy is administered following surgery. There are many different chemotherapeutic drugs that are chosen depending on the cancer type and stage.

Targeted Therapy

New on the treatment landscape for aggressive cancer types, are targeted therapies. Oncologists are leaning towards a precise way of using immunotherapy type strategies to help prevent cancer from spreading and help improve survivorship. Targeted therapies work by halting the spreading of cancer by the administration of immunomodulation drugs. Some of the drugs are designed to specifically target mesothelin, a protein found in high levels in mesothelioma cells.

Many of these drugs work by enlisting the help of the immune system via certain lab-modified viruses. The mechanism of action works by infecting the cancer cells with a virus, subsequently once the chemotherapy is introduced, the lysing of cancer cells is facilitated. For an added benefit, the immune system is boosted further assisting with the destroying of cancer cells and prevents cancerous cells from replicating into malignant tumors.

Radiation Therapy

Radiation therapy is considered a non-invasive treatment that uses high energy beams focused upon the affected area in an effort to kill cancer cells. In patients with advanced peritoneal mesothelioma, some oncologists recommend radiation as part of an integrative treatment regimen.

Palliative Care

Peritoneal Mesothelioma is considered a rare and aggressive cancer type. Unfortunately, the prognosis is not always optimal especially considering the usual diagnosis stage is late. Also, in some cases surgery is not possible or safe due to ill-health. If the patient cannot endure advanced treatment options, then palliative treatment care planning is what most oncologists recommend at this stage. This is type of care delivered to keep the patient comfortable and as pain free as possible. The goal for palliative care (hospice) is to give as much medical and emotional support needed to maintain the best in quality of life standards.

Prognosis

The prognosis for peritoneal mesothelioma is in most cases poor. Additionally, since most mesotheliomas are diagnosed at late stages, it makes it even more difficult to treat with only so many viable options. Currently, treatment strategies such as combined debulking surgery and HIPEC provide the options for managing the spread of cancer and hopefully extending life.

Are There Any New Drug Discoveries for the Treatment of Peritoneal Mesothelioma?

Genomics or gene therapy will no doubt play a major role in treating chronic disease or rare cancers such as peritoneal mesothelioma. Combined with various targeted therapy regimens, Oncologists are exploring treating patients according to their own personal genetic makeup. A marginal amount of success based a treatment plan based upon genetic markers have fueled a new platform of potential new therapies – especially for hard to treat cancers such as peritoneal mesothelioma. Researchers are putting new drugs into clinical trials to test for efficacy – one in particular labeled Drug AZD5363 shows promise for treating Mesothelioma.

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