peritoneal mesothelioma

Peritoneal mesothelioma is a rare and aggressive cancer that affects the lining of the abdomen, known as the peritoneum. It is the second most common type of mesothelioma, after pleural mesothelioma, which affects the lining of the lungs.

Characteristics:

• Peritoneal mesothelioma typically remains confined to the peritoneal cavity for most of its natural history [4].
• The growth pattern of peritoneal mesothelioma is locally expansive masses [4].
• It is a malignancy of serosal membranes, with the second most common location being the peritoneum [5].

Symptoms:

• Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen [13].
• Other symptoms may include bowel obstruction, blood clotting abnormalities, anemia, and fever [13].
• If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the lymph nodes [13].

Causes:

• Peritoneal mesothelioma is caused by ingesting asbestos fibers, which can lead to malignant cells in the peritoneum [10].
• It is also known as abdominal mesothelioma because it develops in the peritoneum, or the tissue lining the abdomen [10].

Types:

• Doctors divide mesothelioma into different types based on what part of the mesothelium is affected [15].
• Peritoneal mesothelioma affects the tissue that surrounds the organs in the abdomen, such as the stomach and intestines [12].

Peritoneal mesothelioma, a rare form of cancer, can cause a range of symptoms that may be similar to other conditions. The most common signs and symptoms include:

• Fluid buildup in the abdomen: This is often the first symptom, causing abdominal swelling and distension.
• Abdominal pain: Pain in the abdominal area is another common symptom, which can worsen over time.
• Bloating and ascites: Fluid accumulation in the abdomen (ascites) can cause bloating and discomfort.
• Nausea and vomiting: Some people may experience nausea and vomiting due to the fluid buildup or other complications.
• Unexplained weight loss: Weight loss without a clear reason can be a symptom of peritoneal mesothelioma.

It's essential to note that these symptoms can be nonspecific, meaning they could be attributed to various other conditions. For example, abdominal pain and bloating can also be caused by irritable bowel syndrome (IBS) or Crohn's disease.

Early-stage peritoneal mesothelioma may not exhibit severe symptoms, making it challenging to diagnose. However, as the disease progresses, symptoms can worsen, including:

• Abdominal hernia
• Cancerous mass in the abdomen
• Bowel obstruction and constipation
• Diarrhea
• Fatigue
• Fever

If you're experiencing any of these symptoms or have concerns about your health, it's crucial to consult a healthcare professional for proper evaluation and diagnosis.

References:

[1] (6) Fluid buildup, abdominal pain, and bloating are the most common symptoms of peritoneal mesothelioma. [2] Abdominal swelling and distension from ascites and abdominal pain are other symptoms. [3] Symptoms include belly pain, bloating, and fluid buildup (ascites).

Diagnostic Tests for Peritoneal Mesothelioma

Peritoneal mesothelioma, a rare and aggressive cancer affecting the lining of the abdomen, can be challenging to diagnose due to its similarity in appearance to other types of cancer under a microscope. Various diagnostic tests are employed to confirm the diagnosis, stage, cell type, and type of mesothelioma.

• Imaging Tests: X-rays, CT scans, MRI scans, and PET scans are commonly used to rule out other conditions and help make decisions about treatment. A CT scan is often the main test used to diagnose and stage pleural and peritoneal mesothelioma [9].
• Blood Test: Blood tests may be performed to check for tumor markers or other signs of cancer, although these tests are not definitive in diagnosing peritoneal mesothelioma [7][8].
• Biopsy: A biopsy is the only way to definitively diagnose peritoneal mesothelioma. This involves removing a fluid or tissue sample from the affected area for analysis [11][12]. Biopsies help doctors confirm the diagnosis, stage, cell type, and type of mesothelioma.
• Paracentesis (Fluid Drainage/Tap): In some cases, a build-up of fluid in the abdomen may be drained to check for cancer cells. This test is less commonly used but can provide valuable information [8].
• Other Tests: Initial tests may include a review of the patient's medical history and a complete physical examination, including x-rays of the abdomen [6]. Less commonly used tests may also be employed, such as blood tests, X-rays, CT scans, MRI scans, PET scans, and biopsies.

It is essential to note that peritoneal mesothelioma can be challenging to diagnose in its early stages due to a lack of symptoms or similar symptoms to other conditions affecting the gastrointestinal tract [10]. A diagnosis should only be made by a qualified medical professional after thorough testing and evaluation.

Treatment Options for Peritoneal Mesothelioma

Peritoneal mesothelioma, a rare and aggressive form of cancer, requires a comprehensive treatment approach. While there is no cure for this disease, various drug treatments can help manage symptoms, slow disease progression, and improve quality of life.

Common Chemotherapy Drugs

The most commonly used chemotherapy drugs for peritoneal mesothelioma include:

• Cisplatin: A platinum-based chemotherapeutic agent that has been shown to be effective in treating peritoneal mesothelioma [5].
• Pemetrexed: An antifolate drug that has demonstrated modest response rates and duration of response in clinical trials [3].
• Gemcitabine: A nucleoside analog that has been used in combination with pemetrexed to treat peritoneal mesothelioma [3].
• Vinorelbine: A vinca alkaloid that has shown promise in treating this disease, particularly when used in combination with other chemotherapeutic agents [5].

Immunotherapy and Targeted Therapy

In addition to chemotherapy, immunotherapy drugs like atezolizumab and bevacizumab have been investigated as potential treatments for peritoneal mesothelioma. These medications help the immune system locate and kill cancer cells [6]. Targeted therapy agents, such as those used in clinical trials, are also being explored to treat this disease [10].

Intraperitoneal Chemotherapy

A treatment approach known as heated intraperitoneal chemotherapy (HIPEC) involves administering heated chemotherapy drugs directly into the abdominal cavity. This method has been shown to be effective in treating peritoneal mesothelioma, particularly when used in combination with surgery [14].

Multimodal Treatment Plans

The most effective treatment plans for peritoneal mesothelioma often involve a combination of these approaches, tailored to individual patient needs and disease characteristics. Multimodal treatment plans that incorporate chemotherapy, immunotherapy, targeted therapy, and HIPEC have been shown to achieve the best survival results [4].

References:

[3] CY Li · 2022 · Cited by 10 — Systemic chemotherapy using a couplet of cisplatin or gemcitabine with pemetrexed has modest response rates and duration of response.

[4] Peritoneal Mesothelioma Survival Rate and Prognosis. Prognosis for peritoneal mesothelioma may be better than for pleural mesothelioma.

[5] Types of Mesothelioma Drug Treatment. A mesothelioma drug is any non-food substance used to treat or relieve symptoms of mesothelioma cancer.

[6] Malignant peritoneal mesothelioma arises from the mesothelial cells of the peritoneum and spreads within the confines of the abdominal cavity.

[10] NCCN Guidelines Version 1.2023 Malignant Peritoneal Mesothelioma. Updated December 2022.

Differential Diagnosis of Peritoneal Mesothelioma

Peritoneal mesothelioma, a rare and aggressive cancer of the peritoneum, can be challenging to diagnose due to its similarity in appearance with other conditions. The differential diagnosis for peritoneal mesothelioma includes:

• Peritoneal carcinomatosis: This is the most common cause of omental nodules/caking and is more likely to contain dystrophic calcification [12].
• Serous surface papillary carcinoma: A type of cancer that affects the lining of the abdominal organs, which can be difficult to distinguish from peritoneal mesothelioma based on CT findings alone [3].
• Lymphomatosis: A rare condition characterized by the infiltration of lymphocytes into the peritoneum, which can mimic the appearance of peritoneal mesothelioma [5].
• Tuberculosis: A bacterial infection that can cause inflammation and scarring in the peritoneum, which can be mistaken for peritoneal mesothelioma [2].
• Pleural metastases: Cancer cells from other parts of the body that have spread to the pleura, which can be difficult to distinguish from peritoneal mesothelioma based on imaging features [2].
• Extrapleural hematoma: A rare condition characterized by bleeding into the space between the pleura and the lung, which can mimic the appearance of peritoneal mesothelioma [2].

Key Features for Differential Diagnosis

To differentiate peritoneal mesothelioma from these conditions, clinicians should look for:

• Complex papillary or solid architecture: A characteristic feature of peritoneal mesothelioma that is often seen on imaging studies [4].
• At least moderate cytologic atypia: The presence of abnormal cells in the peritoneum, which can be a sign of cancer [4].
• Increased mitotic activity: The rate at which cells are dividing, which can be a sign of cancer [4].

References

[1] These more commonly seen entities are still in the differential diagnosis for peritoneal mesothelioma [1]. [2] Pleural metastases and extrapleural hematoma can mimic the appearance of peritoneal mesothelioma on imaging studies [2]. [3] Serous surface papillary carcinoma can be difficult to distinguish from peritoneal mesothelioma based on CT findings alone [3]. [4] Complex papillary or solid architecture, at least moderate cytologic atypia, and increased mitotic activity are key features for differential diagnosis of peritoneal mesothelioma [4]. [5] Lymphomatosis and tuberculosis can be mistaken for peritoneal mesothelioma based on clinical presentation and imaging studies [5].