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Smoking cigarettes is a well-known risk factor for developing mesothelioma, as is being exposed to asbestos in one’s work environment. Mesothelioma can be caused by both cigarette smoking and asbestos exposure. Peritoneal mesothelioma usually develops between 20 and 40 years after exposure to asbestos in an individual who has smoked cigarettes. Cigarette smoking seems to increase speed at which peritoneal cancer develops and may also promote growth of tumors.
Peritoneal mesothelioma is one of the kinds of malignant cancer that is developed by swallowing asbestos fibers. It grows in the peritoneum, the inner thin layer of tissue lining of the abdomen. Signs and Symptoms manifestation of peritoneal mesothelioma include abdominal pain, nausea and swelling in the abdomen.
Peritoneal mesothelioma is hardly seen and aggressive cancer that forms in the abdomen. The only proven cause of peritoneal mesothelioma is long time contact with asbestos and exposure.
Peritoneal mesothelioma can also be referred to as abdominal mesothelioma or mesothelioma of the stomach.
A very rare type of this cancer grows in a layer of the abdominal membrane, the omentum, that lines the stomach and other organs.
NOTICEABLE SYMPTOMS INCLUDE:
1. Abdominal pain
2. Swelling of the abdomen
3. Sweating at Night
6. Instant weight loss
10. Loss of appetite
These many signs and symptoms are seen to mimic many other abdominal diseases. An accurate diagnosis often requires a mesothelioma specialist and a biopsy laboratory experiments.
Anyone with a history of asbestos exposure should monitor their health and see their doctor for new or worsening symptoms.
CAUSATIVE AGENTS OF PERITONEAL MESOTHELIOMA:
The major causes of peritoneal mesothelioma has been observed overtime to be swallowing of asbestos fibers. Current findings suggests that asbestos fibers migrate from the digestive tract and engulfed in the abdomen, causing cancer after so many years of inflammation.
Process of Peritoneal Mesothelioma Development
Like other asbestos-related diseases, peritoneal mesothelioma develops over a long period of time. The trapped asbestos fibers cause inflammation and irritation, damaging and degrading DNA.
Damaged DNA can lead to abnormal and unregulated cell growth. These errors cause tumors to form, and the tumors can grow uncontrollably and spread to other areas of the body.
DEVELOPMENTAL STAGES OF PERITONEAL MESOTHELIOMA:
Swallowed asbestos fibers pass through the stomach and digestive system.
Ingested asbestos fibers reach the lymphatic system and travel to the peritoneum.
Fibers become stuck in the peritoneum, irritating cells and damaging DNA for years.
The irritated cells become inflamed, form scar tissue and thicken the peritoneal lining.
Years of inflammation and scar tissue formation cause excess abdominal fluid buildup.
After prolonged damage, malignant tumors begin to form on the diseased peritoneum.
As tumors grow, they put pressure on vital organs and can spread to form new tumors.
Research on peritoneal mesothelioma is still ongoing. Other sources of this disease may include abdominal radiation and fibrous minerals besides asbestos, such as erionite.
DIAGNOSIS OF PERITONEAL MESOTHELIOMA:
Imaging scans, blood tests and biopsies are used to make an abdominal mesothelioma diagnosis.
Imaging scans show the size and location of tumors.
Blood tests reveal certain biomarkers associated with cancer.
Biopsies show what kind of cancerous cells are present.
Patients will also receive a thorough examination of their medical history, occupational history and overall physical condition.
While every test serves a contributing purpose to the diagnostic process, the only way to confirm a peritoneal mesothelioma diagnosis is with a biopsy.
Biopsies are samples of tumor tissue that doctors examine under a microscope in a lab. Medical professionals, called pathologists, perform tests on the biopsy sample to reveal the kinds of cancerous cells within the tumors. They then summarize the results in a pathology report.
Diagnosing Cell Types of Peritoneal Mesothelioma include the following:
The pathology report contains information about which cellular subtype of peritoneal mesothelioma you have.
1. Common Cell Types:
i. Epithelioid cells: are the most common, making up 75% of cases.
ii. Biphasic Cells: Second-most common type, making up 25% of cases. A mix of epithelioid and sarcomatoid cells.
iii. Epithelioid peritoneal mesothelioma can grow in four different patterns: Papillary, tubular, diffuse and deciduous. Papillary is the most common and often appears alongside the others.
Pure sarcomatoid tumors are uncommon in peritoneal mesothelioma. Specialists have only diagnosed about 30 cases of this variant since 2006. Sarcomatoid cells usually occur alongside epithelioid cells to form the biphasic subtype.
2. Rare Cell Types:
i. Well-Differentiated Papillary Mesothelioma: This variant is uncommon with less potential for malignancy and typically presents in younger women.
ii. Multicystic Mesothelioma: This subtype often recurs after surgery and does not have a definitive link with asbestos exposure.
iii. Desmoplastic Mesothelioma: This tumor type can present as nodules or a mass-like peritoneal thickening, ascites or lymph node disease.
iv. Lymphohistiocytoid Mesothelioma: A dense lymphatic infiltrate characterizes this variant.
v. Pure Sarcomatoid Mesothelioma: The rarest and most lethal form of peritoneal mesothelioma, this subtype is associated with aggressive metastasis.
Additionally, omental mesothelioma is a rare variant in the omentum, a part of the peritoneum surrounding the stomach and other abdominal organs. The omentum is a layer of fatty tissue that plays a role in immune function and metabolism.
WRONG DIAGNOSIS OF PERITONEAL MESOTHELIOMA:
Because this cancer is rare, doctors lacking experience with the disease often misdiagnose abdominal mesothelioma patients with more common illnesses that share similar symptoms. Peritoneal mesothelioma misdiagnosis can delay proper treatment.
If you have a history of asbestos exposure, the best way to ensure an accurate diagnosis is to schedule an appointment with a mesothelioma specialist. Doctors who specialize in peritoneal mesothelioma have the knowledge and tools needed to make a precise diagnosis.
PERITONEAL MESOTHELIOMA AND ITS STAGES:
There is no official staging system for peritoneal mesothelioma. Instead, peritoneal mesothelioma experts spent decades adapting other staging systems for their use.
Historically, the TNM staging system used in other cancers has not been a good fit for peritoneal mesothelioma due to its diffuse growth pattern. However, a research report in 2020 suggested that oncologists adapt the TNM system for peritoneal mesothelioma into three stages.
1. Cancerous tissue is minimal, tumors are only within the abdominal lining and lymph nodes are free of cancer.
2. Cancerous tissue is moderate and tumors have not spread outside the lining or into lymph nodes.
3. Cancerous tissue is more extensive and tumors may have spread outside the peritoneal lining or into lymph nodes.
There is no precise fourth stage in the adapted TNM system for peritoneal mesothelioma. Many doctors consider stage 4 to involve extensive tumors that have spread to distant sites throughout the body.
INDEX OF PERITONEAL MESOTHELIOMA:
The Peritoneal Cancer Index is a diagnostic tool that doctors use to assess tumor location and spread in the abdomen. It helps them determine the approximate mesothelioma stage and appropriate treatments.
This index divides the abdomen into 13 parts. Doctors assign a number (one to three) to each area based upon the most sizable tumor in that area. The Peritoneal Cancer Index score is the sum of the individual scores from the 13 regions. A patient’s maximum score is 39 (13 times three).
Lower index scores mean the patient may qualify for surgery. Index scores above 20 indicate cancer has spread too far and the patient likely won’t respond well to surgery.
TREATMENT OF PERITONEAL MESOTHELIOMA:
The most effective peritoneal mesothelioma treatment option is surgery with heated chemotherapy, known as hyperthermic intraperitoneal chemotherapy, or HIPEC. However, chemotherapy alone is the treatment most used for peritoneal mesothelioma.
More than 60% of patients are ineligible for surgery with heated chemotherapy because of the procedure’s intensity. Cytoreductive surgery can take several hours and may involve removing large portions of the intestines or whole organs.
1. Chemotherapy Option:
Patients who don’t qualify for surgery with heated chemotherapy can receive systemic chemotherapy alone. Chemotherapy drugs can shrink peritoneal mesothelioma tumors and slow the growth and spread of cancer. Chemotherapy drugs that are effective against peritoneal mesothelioma include pemetrexed, cisplatin, carboplatin and gemcitabine.
U.S. Navy pilot and peritoneal mesothelioma survivor Jim Madaris decided to seek out the HIPEC procedure after his diagnosis in 2013. The surgery took 14 hours and removed his gallbladder, spleen and parts of his intestine. Madaris extended his life by four years, allowing him to find joy in the little things and see his youngest child graduate high school.
2. Cytoreductive Surgery with Heated Chemotherapy Option:
Cytoreductive surgery, also known as a peritonectomy, attempts to remove as much cancer as possible. Then, heated chemotherapy is applied locally to the abdomen before the surgery ends. Doctors only perform this procedure on a case-by-case basis. A 2019 study reported that more than 65% of the patients who underwent this procedure lived five years or longer.
3. Palliative Option:
In addition to anti-cancer treatments, many peritoneal patients receive palliative care to control symptoms and improve quality of life. For example, a paracentesis procedure may be recommended to certain peritoneal patients to drain excess fluid from the abdomen.
A palliative care specialist prescribes medications to control pain and side effects. They may refer patients to physical or occupational therapy or recommend complementary therapies.