The peritoneum is the lining of the abdomen. It has two layers: the inner (visceral) layer, which is next to the abdominal organs, and the outer (parietal) layer, which lines the abdominal wall.
The peritoneum helps to protect the contents of the abdomen and keep them in place. It also produces fluid that acts as a lubricant and helps the abdominal organs move smoothly against each other. Peritoneal mesothelioma is a primary tumor in the peritoneum, that is the tumor originates from the peritoneal lining. Like mesothelioma arising in the lining of the ribcage (pleural mesothelioma), in some people peritoneal mesothelioma can be caused by exposure to asbestos, although the links with asbestos are less clear and a number of patients have no history of asbestos exposure. Peritoneal mesothelioma is much less common than pleural mesothelioma and though the precise figures are unknown, peritoneal mesothelioma probably represents no more than 7-10% of all mesotheliomas.
Are there different types?
Peritoneal mesothelioma is categorised into two groups. Diffuse malignant peritoneal mesothelioma (DMPM) and low-grade peritoneal mesothelioma (LGPM). The two groups have different treatment regimes.
Diffuse malignance peritoneal mesothelioma: Malignant means that the tumour is made of cancer cells. They are abnormal and grow uncontrollably. DMPM is likely to spread throughout the abdomen. The majority of DMPM’s are treated with palliative chemotherapy regimens.
Low-grade peritoneal mesothelioma: LGPM includes multicystic mesothelioma and well-differentiated papillary mesothelioma. Low grade cells look more like normal cells and tend to grow and spread more slowly than high grade cancer cells. LGPM does not invade nearby tissues or spread to other areas of the body and these are the less aggressive forms of peritoneal mesothelioma.
What are the symptoms?
The main symptoms of peritoneal mesothelioma are:
- Pain in the abdomen (stomach)
- A swollen abdomen
- Constipation or diarrhoea
- Feeling or being sick
- Loss of appetite
- Weight loss
- Night Sweats
More detailed information on how to manage the effects of mesothelioma can be found here.
How is it diagnosed?
People who develop peritoneal mesothelioma may often have mild, vague symptoms including abdominal pain, sometimes with abdominal swelling, constipation or diarrhoea, tiredness, loss of appetite and weight loss. Because the symptoms are non-specific, and because the history of exposure to asbestos may have been many years previously, there is often a delay before the diagnosis of peritoneal mesothelioma is suspected. Occasionally patients will have had symptoms for several months or even years before the diagnosis is confirmed.
A CT scan of the abdomen will probably be advised to help with the diagnosis. This can show the thickening of the wall of the abdomen.
An ultra-sound scan may be used to find the best place to put a needle in the abdomen to draw off some fluid.
What treatment is available?
The choice of treatment for peritoneal mesothelioma depends on a number of factors including general fitness, other illnesses, which subtype of peritoneal mesothelioma and how advanced the disease is. There are various treatments options which include chemotherapy, surgery, immunotherapy, surveillance and medication.
A small number of selected cases may benefit from surgery for peritoneal mesothelioma and this is performed in a specialist centre. It is called complete Cytoreduction Surgery (CRS). Hyperthermic Intraperitoneal Chemotherapy (HIPEC, heated chemotherapy) is sometimes put in the abdominal space at the same time as the surgery. The aim of the surgery is to remove all of the visible disease. Palliative tumour “debulking” surgical procedures can be done to relieve symptoms where complete CRS is not indicated.
Some treatments are available through clinical trials. Ask your consultant or specialist nurse for information. A clinical trial is a research study designed to evaluate new or existing treatments. People who enter a clinical trial are among the first to receive new treatments before they become widely available. Because this research often leads to improved treatments, clinical trials play a key role in advancing the treatment for mesothelioma. You can also find more information in the clinical trials section.
What is the national peritoneal mesothelioma MDT?
To assist in the diagnosis and treatment of cancer, hospitals have teams of doctors and nurses, each with their own areas of expertise, who work together to try and provide the best care for patients.
These are known as Multi-Disciplinary Teams (MDTs). These teams are made up of Consultant doctors, radiologists, pathologists, oncologists (doctors who treat cancers using chemotherapy and radiotherapy), surgeons and specialist nurses. These teams meet regularly to discuss the cases of individual patients, with confirmed or suspected mesothelioma, to agree on the likelihood of the diagnosis being correct, on the stage of the disease and best treatment strategy. The wishes of the patient are taken into close consideration when treatment plans are discussed. Following MDT discussion, treatment options will be explained to the patient and referrals will be made as necessary.
There is a national peritoneal MDT at Basingstoke Hospital, Hampshire that meets monthly. Mesothelioma UK funds a peritoneal nurse specialist who attends this MDT. Please contact the Mesothelioma UK Freephone Information line for information about how cases can be referred to the peritoneal MDT.
What support is available?
Receiving a diagnosis of mesothelioma can be a frightening and overwhelming time for both the patient and their loved ones. There are a range of support services available.
For clinical advice about treatments or symptoms please call the Mesothelioma UK Freephone Information Line on 0800 169 2409 to speak to a mesothelioma clinical nurse specialist.
Many local areas have dedicated patient support groups, often run by local Asbestos Support Groups. Find the group nearest to you here. The groups offer benefits advice, support and often meet on a regular basis.
For benefits advice, either contact your local support group, or if you are in Leicester or Newcastle, Mesothelioma UK funds specialist advisors in both areas. You can contact the Mesothelioma UK specialist benefits advisor on our freephone information line on 0800 169 2409.
If you were a member of the armed forces and would like to speak to someone about the effects that might have on your benefits, please call the Mesothelioma UK Freephone Information Line on 0800 1692409.
If you are seeking legal advice around compensation, Mesothelioma UK has a panel of legal firms that are experts in dealing with mesothelioma cases. More information can be found here.
In addition to the local support groups that are open to patients with all types of mesothelioma, there is a virtual peritoneal mesothelioma support group that meets each month. This group is run by the peritoneal nurse specialist, Samantha Westbrook. Please email her at Samantha.email@example.com to join the meeting.