Peritoneal
Mesothelioma- Symptoms, Treatment Options, Medical Testing, Surgery(peritonectomy),
Chemotherapy and Pain Relief
What
is Peritoneal Mesothelioma ?
This type
of cancer is found in the abdomen in a thin membrane called the peritoneum.
Peritoneal mesothelioma is usually a rapidly fatal primary peritoneal
surface malignancy with a median survival time of less than 1 year, mainly
because of lack of effective treatment. Peritoneal mesothelioma is a tumor
of this membrane. Symptoms include abdominal swelling, loss of appetite,
and weakness. The only known cause to this disease is exposure to asbestos.
Due to the latency effect of this cancer, this exposure is likely to have
taken place 20 or more years ago. This type of mesothelioma is the less
common and is found in less than 25% of all mesothelioma cases. Like pleural
mesothelioma, peritoneal mesothelioma can be either benign or malignant.
Peritoneal Mesothelioma Symptoms
When the symptoms of peritoneal mesothelioma appear, they typically include
abdominal pains,abdominal weakness, weight loss, loss of appetite, nausea,
and abdominal swelling. Fluid often accumulates in the peritoneal space,
a condition known as ascites. Over time the wasting symptoms can become
more and more severe. The growing tumor can exert increasing pressure
on the organs in the abdomen, leading to bowel obstruction and distention.
If the tumor presses upward, it can impair breathing capacity. If the
tumor pushes against areas with many nerve fibers, and the bowel distends,
the amount of pain can increase.
Peritoneal Mesothelioma - Medical Testings
X-rays and CT scans are, typically, the first step towards detecting peritoneal
mesothelioma. The actual diagnosis is typically achieved by obtaining
a piece of tissue. The medical procedure of looking at the peritoneum
is known as a peritoneoscopy. It is a hospital procedure and requires
anesthesia. If an abnormality is seen, the doctor will attempt to obtain
a tissue sample - this is known as a biopsy. The tissue sample will be
examined by a pathologist who makes a diagnosis using microscopic analysis
of specialized stains.
Treatment of Peritoneal
Mesothelioma
Treatment may depend
on a number of factors
According to most
medical studies and experst, mesothelioma does not always respond to
typical cancer treatments.
Mesothelioma treatments may be designed to treat the immediate area
of the primary mesothelioma growth or the whole body. Whole
body treatments are called systemic treatments. Localised treatments
include surgery and radiotherapy. Systemic treatments act on cancer cells
no matter where they may be in the body and include chemotherapy.
Peritoneal Mesothelioma Surgery
It is often not possible to operate on peritoneal mesothelioma. But
if it is found very early, it may be possible to remove it with surgery.
The operation is called a peritonectomy. This means removing
the peritoneum - the lining of the abdomen where the mesothelioma has
started growing.
Chemotherapy Possible Option for Peritoneal
Mesothelioma Victims
Because
malignant peritoneal mesotheliomais usually confined to the peritoneal
cavity for most of its existence, regional chemotherapy is an attractive
option.Chemotherapy uses anti-cancer drugs, which are usually injected
into a vein. For mesothelioma, chemotherapy may be given directly
into the abdomen. Depending on the type of chemotherapy drugs
used, this treatment can be given weekly or every two to three weeks. Usually
the treatment is given as an outpatient.
Chemotherapy for mesothelioma is given with a variety of aims depending
on the stage. If you have early stage
disease, you may be given chemotherapy after surgery to remove your mesothelioma. This
is called adjuvant chemotherapy. It is given to try to lower
the chances of the cancer coming back.
Chemotherapy is often used to treat stage 2, 3 or 4 mesothelioma. The
treatment is given to help control symptoms and to try to slow the cancer
down.
Supportive care (Palliative care)
Unfortunately peritoneal mesothelioma is often diagnosed when it is quite
advanced. Some people are too ill to cope with intensive chemotherapy. But
your doctors will normally tell you that you can still have treatment
to try to relieve symptoms such as pain, weight loss and other symptoms
such as fluid in the abdomen.
With more advanced peritoneal mesothelioma, fluid
may collect inside your abdomen. If
too much fluid collects, it makes your abdomen swell. This
can be uncomfortable and heavy.
Source: CancerHelp.org.
PERITONEAL MESOTHELIOMA CASE STUDIES:
Peritoneal
mesothelioma in a 17-year-old boy with evidence of previous exposure
to chrysotile and tremolite asbestos.
Abstract:
We describe a case of malignant peritoneal mesothelioma arising in a 17-year-old
boy. The diagnosis was based on a comprehensive study including light
microscopy, histochemistry, immunohistochemistry, evaluation of the clinical
course, and autopsy examination. Analytical transmission electron microscopy
showed a concentration of 510,000 asbestos fibers/g dry lung tissue. The
fibers were represented by chrysotile (62%) and tremolite (38%) asbestos.
About 40% of the total fibers were longer than 5 microns. The presence
of tremolite fibers was probably due to environmental exposure to contaminated
cosmetic talc. This is the first reported case of pathologically proven
exposure to asbestos dust in malignant mesothelioma of childhood and adolescence.
Andrion A and Bosia S
Division of Pathological Anatomy, City Hospital, Asti, Italy.
Hum Pathol
1994 Jun, vol. 25, pages 617-622
UNITED STATES
* * * * * * * * * *
Intraperitoneal cisplatin
and etoposide in peritoneal mesothelioma: favorable outcome with a multimodality
approach.
Abstract:
Ten patients with histologically documented peritoneal mesothelioma were
treated with intraperitoneal cisplatin 200 mg/m2, sodium thiosulfate rescue
and etoposide 65-290 mg/m2 every 4 weeks for a maximum of six cycles.
All had epithelial or mixed epithelial-fibrous histology. Toxicity was
tolerable, with 50% sustaining grade 3 or 4 granulocytopenia. There was
one episode of neutropenic fever. Grade 2 peripheral neuropathy occurred
in one patient, grade 1 in five patients. Complete remission occurred
in one of five patients with measurable disease. Median survival for patients
whose tumors were surgically debulked to < 2 cm residua prior to treatment
was 22 months, while it was 5 months for those with measurable, surgically
inaccessible disease (P = 0.0731 by Cox regression proportional hazard
model). These data suggest that patients who present with resectable disease
may benefit from an aggressive adjuvant approach. This possibility warrants
prospective testing in a randomized clinical trial.
Langer CJ and Rosenblum
N
Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia,
PA 19111.
Cancer Chemother Pharmacol
1993, vol. 32, pages 204-208
GERMANY
* * * * * * * * * *
Intestinal obstruction
due to diffuse peritoneal fibrosis at 2 years after the successful treatment
of malignant peritoneal mesothelioma with intraperitoneal mitoxantrone
[published erratum appears in Cancer Chemother Pharmacol 1992;30(3):249]
Abstract:
A 44-year-old man who had achieved a complete remission of malignant peritoneal
mesothelioma after the intraperitoneal administration of 25 mg/m2 mitoxantrone
presented with clinical and radiological signs of intestinal obstruction
suggestive of recurrent disease at about 2 years following the initial
treatment. However, laparotomy revealed extensive adhesive fibrosis but
no sign of malignant mesothelioma. The peritoneal complications of intraperitoneal
cytostatic treatment are discussed.
Vlasveld LT and Taal BG
Department of Medical Oncology, The Netherlands Cancer Institute, Antoni
van Leeuwenhoek Huis, Amsterdam.
Cancer Chemother Pharmacol
1992, vol. 29, pages 405-408
GERMANY
* * * * * * * * * *
Malignant peritoneal
mesothelioma in childhood with long-term survival.
Abstract:
A diffuse, well-differentiated, malignant peritoneal mesothelioma (MPM)
developed in a nine-year-old girl. She received limited chemotherapy and
radiation therapy and is alive and well without clinical evidence of disease
109 months after diagnosis. The neoplastic cells stained immunohistochemically
for cytokeratin and epithelial membrane antigen but were unreactive with
B72.3, anti-carcinoembryonic antigen, and anti-Leu-M1. Ultrastructurally,
the tumor cells had abundant desmosomes, numerous tonofilament bundles,
and variable-length microvilli. These findings confirm the mesothelial
nature of the cells. Features consistent with malignancy included DNA
aneuploidy by flow cytometric analysis and diffuse peritoneal involvement.
The three previously described survivors with MPM were also premenarchal
girls. Some MPMs in premenarchal girls have an indolent biologic behavior
similar to that of low-grade peritoneal serous neoplasia or well-differentiated
papillary mesothelioma in adult women.
Geary WA, Mills SE and
Frierson HF, Jr
Department of Pathology, University of Virginia Health Sciences Center,
Charlottesville 22908.
Am J Clin Pathol
1991 Apr, vol. 95, pages 493-498
* * * * * * * * * *
Successful therapy
of peritoneal mesothelioma with intraperitoneal chemotherapy alone. A
case report.
Abstract:
Malignant peritoneal mesothelioma is a disease that remains relatively
refractory to conventional intravenous chemotherapy with currently available
agents. Single-agent and combination chemotherapy offer a response rate
of 20%. Direct intraperitoneal administration of some chemotherapeutic
agents results in a significant pharmacologic advantage with much greater
area under the concentration versus time curve (AUC). We report a case
of a patient with peritoneal mesothelioma treated with combination intraperitoneal
cisplatin and Ara-C who achieved a pathologic complete remission. This
patient is still alive and has been in complete remission for 53 months.
This combination of intraperitoneal chemotherapy deserves further evaluation
in malignant mesothelioma.
Garcia Moore ML
Section of Medical Oncology, University of Miami School of Medicine, Florida
33121.
Am J Clin Oncol
1992 Dec, vol 15, pages 528-530
UNITED STATES
* * * * * * * * * *
Intraperitoneal chemotherapy
for malignant peritoneal mesothelioma [published erratum appears in Eur
J Cancer 1991;27(12):1717]
Abstract:
4 patients with malignant peritoneal mesothelioma have been treated with
intraperitoneal chemotherapy in the Netherlands Cancer Institute in the
recent years. 1 patient achieved a complete remission for 36+ months and
another patient had a partial remission that lasted for 10 months. Intraperitoneal
chemotherapy alone or in combination with other treatment modalities may
yield a response rate of 58% with 24% complete remissions in 70 patients
reviewed in the literature. Although these data should be considered with
caution because of the heterogenicity of the patient group treated, cisplatin-based
intraperitoneal chemotherapy seems to be the best available treatment
for malignant peritoneal mesothelioma at present.
Vlasveld LT
Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam.
Eur J Cancer
1991, vol. 27, pages 732-734
ENGLAND
* * * * * * * * * *
Efficacy of cisplatin-based
intraperitoneal chemotherapy as treatment of malignant peritoneal mesothelioma.
Abstract:
In an effort to examine the potential clinical utility of intraperitoneal
(i.p.) therapy in the management of patients with malignant peritoneal
mesothelioma, 19 individuals with this disease were treated with a cisplatin-based
i.p. treatment regimen. All but 1 patient also received i.p. mitomycin.
The treatment was generally well tolerated, although a maximum of only
four or five courses of cisplatin (100 mg/m2 every 28 days) and mitomycin
(5-10 mg/treatment given 7 days after each i.p. cisplatin administration)
could be administered, the treatment principally being stopped because
of disease progression or catheter failure. Of 15 patients with malignant
ascites, 7 (47%) experienced control of fluid reaccumulation ranging from
2 months to 73+ months (median 8 months). While the median survival for
the 19 patients was only 9 months, 4 (21%) patients survived for more
than 3 years from the initiation of therapy, and 2 patients are currently
alive and clinically disease-free more than 5 years from the start of
the i.p. treatment program. We conclude that a subset of patients with
peritoneal mesothelioma, principally those with small-volume residual
disease following surgical tumor debulking, can benefit from a cisplatin-based
i.p. treatment strategy with control of ascites and prolonged disease-free
survival.
Markman M and Kelsen D
Breast/Gynecology Oncology Service, Memorial Sloan-Kettering Cancer Center,
New York, New York 10021.
J Cancer Res Clin Oncol
1992, vol. 118, pages 547-550
GERMANY
* * * * * * * * * *
Death certificate categorization
of malignant pleural and peritoneal mesothelioma in a cohort of asbestos
insulation workers.
Abstract:
Accuracy of diagnosis of malignant mesothelioma (pleural and peritoneal)
was studied in a cohort of asbestos insulation workers in the United States
and Canada. Initial clinical diagnosis, clinical diagnosis at death and
death certificate diagnosis were compared with the diagnosis of malignant
mesothelioma ascertained by full data review at the Division of Environmental
and Occupational Medicine, Mount Sinai Medical Center, New York ('best
evidence'). In both groups the death certificate diagnosis was somewhat
less frequently accurate than clinical diagnosis at death. Knowledge of
the patients' occupational history by the attending physician and its
relation to accuracy of diagnosis of malignant mesothelioma is considered.
Ribak J, Lilis R, Suzuki
Y, Penner L and Selikoff IJ
Division of Environmental and Occupational Medicine, Mount Sinai School
of Medicine, City University of New York.
J Soc Occup Med
1991 Autumn, vol. 41, pages 137-139
ENGLAND
* * * * * * * * * *
Asbestosis, laryngeal
carcinoma, and malignant peritoneal mesothelioma in an insulation worker.
Abstract:
Asbestos associated diseases consist of both benign and malignant conditions.
A rare constellation of asbestosis, laryngeal carcinoma, and malignant
peritoneal mesothelioma occurring in a patient with long term occupational
exposure to airborne asbestos fibers is presented. The observation illustrates
the powerful disease-causing potential of occupational exposure to asbestos.
A brief discussion of multiple primary neoplasms associated with exposure
to asbestos is also presented.
Fischbein A and Luo JC
Department of Community Medicine, Mount Sinai School of Medicine, University
of New York, New York 10029.
Br J Ind Med
1991 May, vol. 48, pages 338-341
ENGLAND
|
