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

mesothelioma attorney What stage of mesothelioma is your cancer ?    
mesothelioma attorney Any other medical conditions you may have ?     
mesothelioma attorney
Your general fitness ?

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.  

mesothelioma Lawyer
This fluid can be drained off.  This is called abdominal paracentesis.  It is sometimes called an ascitic




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

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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

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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

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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

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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

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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

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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

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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

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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




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