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Monday, March 19, 2018

Peritoneal Mesothelioma | Treatment, Prognosis & Diagnosis

Peritoneal mesothelioma

A peritoneal mesothelioma is a form of cancer that develops in the lining of the abdomen (the peritoneum). It is caused by the ingestion of asbestos fibers, with approximately 500 cases diagnosed annually in the United States.

Peritoneal mesothelioma, sometimes called abdominal mesothelioma, is a form of mesothelioma that develops in the lining of the abdominal cavity (known as the peritoneum). It accounts for about 15 to 20 percent of all cases of mesothelioma diagnosed worldwide, with approximately 500 cases in the US. UU Diagnosed every year.

The peritoneal form is the second most common form of the disease (after pleural mesothelioma) and, although it is almost always fatal, it has a more favorable prognosis than other types of mesothelioma. The new treatments have prolonged survival times, with many patients living with the disease for seven years or more.

What causes peritoneal mesothelioma?

As with all types of mesothelioma, the peritoneal form is caused by exposure to asbestos. A very small number of people with a specific genetic predisposition can also develop peritoneal mesothelioma after a prolonged exposure to erionite, a natural mineral similar to asbestos.

It is not clear exactly how asbestos enters the abdomen, but the two most common theories are lymphatic transport and ingestion.

Lymphatic transport: the lymphatic system is a network of tissues and connected organs that are essential to help fight viruses, infections and diseases. Some experts believe that asbestos fibers enter initially through the lungs and are transported through the lymphatic system to the abdominal cavity, where they can be trapped in the mesothelial cells of the peritoneum.

Ingestion: Asbestos fibers can be swallowed, either directly or after being trapped in mucus during inhalation. The body can not digest asbestos, and as the fibers move through the digestive system, they can work in the peritoneal cavity and eventually in the lining of the abdomen.

Asbestos fibers in the peritoneum can cause inflammation that ultimately leads to cancer. As tumors grow, they will spread throughout the abdomen and eventually to other parts of the body.


Diagnosis of the symptoms of peritoneal mesothelioma

Regardless of the type, mesothelioma can take between 10 and 50 years to begin showing symptoms. Even when the cancer begins to manifest, the symptoms can easily be confused with other diseases or diseases because they are nonspecific.

Patients who experience any of these symptoms should be sure to inform their doctor about any possible prior exposure to asbestos, even if it occurred many years ago. Mesothelioma and other asbestos-related diseases develop slowly over decades, and no amount of exposure is considered safe.

All forms of mesothelioma are also notoriously difficult to diagnose, leaving some patients with erroneous diagnoses for months, which ultimately delays treatment. Peritoneal mesothelioma is often confused with other abdominal cancers, irritable bowel syndrome (IBS) or ovarian cancer. When facing any cancer diagnosis, it is always a good idea to consider getting a second opinion before starting treatment. Your GP or even general medical oncologists may not have much or no experience with mesothelioma and may have difficulty diagnosing the disease correctly. Scheduling an appointment with a mesothelioma specialist can help ensure that you are properly diagnosed and receive the best treatment available.

Typically, the diagnosis begins with a variety of tests to rule out other diseases and cancers, including imaging studies, blood tests, and biopsies. Currently, a biopsy is the only definitive method to diagnose mesothelioma. The doctor will perform a peritoneoscopy or laparotomy, which is a procedure to take a sample of the tissue around the abdomen. The biopsy can be uncomfortable, but usually ends in a few minutes.

Once the biopsy is taken, a pathologist will scrutinize the sample tissue under a microscope to determine if the cells are cancerous. The doctor will be able to further categorize the type of cell and the severity of the progression of abdominal mesothelioma.

Staging of peritoneal mesothelioma

Unlike pleural mesothelioma, there is no established staging system for peritoneal mesothelioma due to its rarity. However, doctors can still identify how advanced the disease is and its progression for an individual case. In general, mesothelioma can be staged according to the following characteristics.

Peritoneal cancers also have another system that helps identify the severity of tumor progression and helps determine for which treatments a patient is eligible. The peritoneal cancer index or PCI is a remarkable tool that has been used by oncologists for several decades. The PCI works by segmenting the abdominal region in 13 different sections. The oncologists will then "score" the region according to the size of the tumors present, known as injury score, through imaging scans or laparoscopy.

The overall ICP is calculated by summing the scores for each region as a whole, with the highest PCI 39. Regional scores and general PCI will help oncologists determine if abdominal cancer is localized or has spread. In general, a higher score means larger and more numerous tumors, indicating a more advanced stage and a worse prognosis. Some researchers have proposed that PCI scores can also be translated into the staging system used for pleural mesothelioma.

Staging of peritoneal mesothelioma

A difference of pleural mesothelioma, there is no established staging system for peritoneal mesothelioma due to its rarity. However, doctors can still identify how advanced the disease is and its progression for an individual case. In general, mesothelioma can be staged according to the following characteristics.

Peritoneal cancers also have another system that helps identify the severity of tumor progression and help determine what treatments a patient is eligible for. The peritoneal cancer index or PCI is a remarkable tool that has been used by oncologists for several decades. The PCI works by segmenting the abdominal region in 13 different sections. The oncologists will then "score" the region according to the size of the tumors present, known as injury score, through imaging scans or laparoscopy.

The overall ICP is calculated by adding the scores for each region as a whole, with the highest PCI 39. Regional scores and PCI usually help oncologists determine if the abdominal cancer is localized or has spread. In general, a higher score means larger and more numerous tumors, indicating a more advanced stage and a worse prognosis. Some researchers have proposed that PCI scores can also be translated into the staging system used for pleural mesothelioma.

Prediction of peritoneal mesothelioma

Mesothelioma in all its forms generally has a rather poor prognosis, which can vary depending on a variety of factors, including location and stage. The average life expectancy of patients with peritoneal mesothelioma is one year. Thanks to advances in treatment, peritoneal mesothelioma patients have begun to see improved life expectancy compared to the other forms of mesothelioma, with even half of patients surviving five years or more.

Peritoneal mesothelioma survival rate

The type of cell can also have a big impact on the prognosis, as it can help show how aggressive the cancer cells are and can affect the available treatment options. Epithelioid cells represent 50-70% of cases of mesothelioma. This type of cell is most commonly associated with pleural mesothelioma, but it has also been found in peritoneal patients. It is the most studied type of cell and has the best prognosis, although it can be difficult to distinguish from other diseases such as adenocarcinoma.

Sarcomatoid is the rarest cell type, accounting for only 10% of cases, and is most commonly found in peritoneal mesothelioma. Sarcomatoid mesothelioma is also difficult to diagnose and has a higher probability of spread than the other types. The last type of cell, biphasic, is a combination of epithelial and sarcomatoid cells. The prognosis for this type will depend to a great extent on the distribution of the cells, since the presence of more sarcomatoid cells than epithelial cells can mean a worse survival rate.

Treatments for peritoneal mesothelioma

Mesothelioma specialists often rely on three standard treatments for any type of mesothelioma: surgery, chemotherapy and radiation. Very often, these treatments are used in tandem, known as multimodal treatment, to have the best effect on a patient's prognosis. Emerging treatments, such as immunotherapy, have also been well studied in recent years to determine their effectiveness for mesothelioma. Currently, these types of therapies are only available in clinical trials, which can sometimes be limited due to the rarity of mesothelioma, but they have shown promise to effectively treat the disease and extend overall survival.

For patients with peritoneal mesothelioma, there are two types of curative treatment, which are used most often in combination, which have shown the most positive effects in improving life expectancy. For some peritoneal patients, a minimally invasive surgery called paracentesis may also be an option for more palliative benefits. The operation eliminates the accumulation of fluid in the peritoneum, called ascites, to relieve symptoms such as respiratory problems and improve the quality of life in general.

Cytoreductive surgery and HIPEC

Many studies have shown the positive effects of abdominal mesothelioma treatment with cytoreductive surgery in combination with a heat chemotherapy washout called Intraperitoneal Hyperthermic Chemotherapy (HIPEC). The surgery aims to eliminate all visible tumors in the abdominal cavity, with the application of HIPEC throughout the abdomen after killing the remaining cancer cells.

Some studies have found that this combination therapy gives patients a median survival of approximately 53 months or more, and one study even reported a median overall survival of 92 months with this treatment. Through these studies, approximately 40 to 50% of patients have achieved at least five years of survival, while in general only 9% of patients with mesothelioma often survive so long.

Specialists in peritoneal mesothelioma

When faced with this rare diagnosis, a mesothelioma specialist will be the best person to evaluate your case and determine the most effective treatment options available to you. Many specialists also participate in clinical trials and conduct new research to advance treatment and work to find a cure.

Peritoneal mesothelioma treatment costs

The costs associated with peritoneal mesothelioma can grow rapidly. According to the most recent estimates, the cost of standard surgery treatment with HIPEC can average almost $ 40,000. Before starting treatment, medical bills can already accumulate, since diagnostic tests can range from $ 800 to $ 2,800. Many patients will also face travel and accommodation expenses as many have difficulty finding a mesothelioma specialist close to home.

What patients will have to pay out of pocket for the treatment will depend to a large extent on their insurance coverage and where they are treated. Even with good coverage, it can be difficult to keep up with all the bills with secondary expenses, ongoing care after treatment and the loss of income that many patients face since they can not continue working.

Since asbestos is the only known cause of mesothelioma, people diagnosed with peritoneal mesothelioma or their surviving family members may be eligible to file a claim and possibly receive compensation for use in medical expenses and loss of income. It is important to speak with a mesothelioma lawyer to know your legal rights as soon as possible, as there is a limited statute of limitations in most states.

Rare forms of peritoneal mesothelioma

While peritoneal mesothelioma is rare in itself, there are two rare subtypes that have also been diagnosed in some cases. Mesothelioma and papillary mesothelioma are not well studied or understood due to their extreme rarity, but they are still observed as important differential diagnoses.

Omental Mesothelioma

Oral mesothelioma develops in the omentum, a layer of the abdominal membrane that covers organs such as the intestines and the stomach. It has been observed as a possible result of peritoneal mesothelioma that has spread from the peritoneum, while in other cases it has become peritoneal mesothelioma as the tumors spread from the omentum. The diagnosis is extremely difficult and there is no standard treatment because there have been very few cases. As such, researchers have observed that omental mesothelioma has a very poor prognosis.

In one of the only cases cited, the researchers diagnosed a 54-year-old man with epileptic mesothelioma after experiencing severe abdominal pain and found an indistinct mass in his greater omentum. With more studies, they discovered that smaller tumors had spread to the peritoneum, diaphragm, and pelvic wall with epithelioid cell types to a large extent. The patient underwent 8 rounds of chemotherapy and was still doing well 14 months after the initial treatment.

Papillary mesothelioma

Papillary mesothelioma, also called well-differentiated papillary mesothelioma, is a rare variation of peritoneal mesothelioma that is most often diagnosed in women. Tumors, which are usually benign, usually originate in the peritoneum, although they have also occasionally been found in the lining of the lungs and parts of the male reproductive system. Like epileptic mesothelioma, it can be difficult to diagnose because there are few symptoms and this type of mesothelioma has not been definitively associated with exposure to asbestos.

Although there is no standard of care, surgery is usually an option in documented cases because tumors usually do not spread elsewhere in the body. In some cases, chemotherapy or radiation have also been applied to reduce tumors before resection. Studies on papillary mesothelioma have shown great survival, with patients surviving on average at least 6 years.

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