Peritoneal Mesothelioma

Peritoneal Mesothelioma

What Is Peritoneal Mesothelioma?

Peritoneal mesothelioma is one of the four primary types of malignant mesothelioma. The name stems from the area where the cancer develops. It is a rare cancer that forms in the peritoneum, the thin layer of tissue that lines the inside of your abdomen and covers your organs. The peritoneum is a protective membrane that surrounds the abdomen. It has two layers, and mesothelioma can develop on both. The parietal layer surrounds the abdominal cavity, while the visceral layer encompasses the stomach, liver and other organs of the abdomen. Together, the layers support the abdominal cavity as a whole and the organs within it.

Asbestos exposure is the main risk factor for developing this type of cancer. All mesotheliomas, including peritoneal, stem from extended exposure to asbestos, usually at work. People diagnosed with the disease can usually pinpoint a time in their lives when they were around asbestos dust, fibers or products for a sustained period.

When asbestos fibers are inhaled or ingested, they can travel to the abdomen and become lodged in the peritoneum. Over time, these fibers can irritate the mesothelial cells, which are the cells that line the peritoneum. This irritation can lead to cancerous cells and then tumors.

Peritoneal mesothelioma is an aggressive form of cancer, and there is no cure. However, there are treatments available that can help to improve symptoms and extend life expectancy.


Exposure to asbestos fibers is the only known cause of mesothelioma. Asbestos is a group of naturally occurring minerals that were once widely used in a variety of industrial and commercial products, including insulation, building materials, and fire retardants. When asbestos-containing materials are disturbed, tiny fibers can be released into the air.

Cancer experts most commonly associate the cause of peritoneal mesothelioma with either swallowed asbestos fibers that travel from the digestive system to the peritoneum or inhaled asbestos fibers that reach the peritoneum through the lymphatic system, which produces and stores cells that fight disease.

Other risk factors for peritoneal mesothelioma are much less common than asbestos exposure and include:

  • Erzolan exposure - Erzionite is a naturally occurring mineral similar to asbestos that can also cause mesothelioma.
  • Radiation therapy - Radiation therapy to the abdomen can increase the risk of developing peritoneal mesothelioma.
  • Simian Virus 40 (SV40) - SV40 is a virus that can contaminate some vaccines. There is some evidence that SV40 exposure may be a risk factor for mesothelioma, but more research is needed.

How Common Is Peritoneal Mesothelioma?

Peritoneal mesothelioma is the second-most common type of mesothelioma, but it's still significantly less frequent than pleural mesothelioma. Estimates suggest only 10% to 20% of all mesothelioma diagnoses are peritoneal. Roughly 300 to 500 new cases are diagnosed in the U.S. each year.

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Symptoms of Peritoneal Mesothelioma

Peritoneal mesothelioma often doesn't cause symptoms until the disease is advanced. In many cases, early symptoms can be vague and easily confused with other conditions.

  • Fluid buildup in abdomen (ascites)
  • Abdominal pain or swelling
  • Diarrhea or constipation
  • Changes in bowel habits (including diarrhea or constipation)
  • A feeling of fullness / loss of appetite
  • Night sweats or fever
  • Unexplained weight loss
  • Nausea or vomiting
  • Fatigue and weakness
  • Anemia

It can take decades for mesothelioma to develop after initial asbestos exposure. You may not experience cancer symptoms for 20 to 50 years after your first exposure to asbestos. However, once asbestos fibers reach the peritoneum and irritate the cells, the peritoneal lining starts to thicken. As the cancer develops, the buildup of excess fluid in the abdomen may occur next. Over time, tumors form and place pressure on the organs.

Diagnosing Peritoneal Mesothelioma

Because this cancer is so rare, doctors often misdiagnose mesothelioma with more common illnesses that have similar symptoms — a mistake that delays proper treatment. Peritoneal mesothelioma symptoms, like abdominal swelling, weight loss, and hernias, also arise in other abdominal cancers and many less serious conditions, increasing the likelihood of a misdiagnosis.

If you have a history of asbestos exposure, the best way to ensure an accurate diagnosis is to schedule an appointment with a specialist and begin the process of diagnostic testing. Doctors who specialize in mesothelioma and other asbestos-related conditions have the knowledge and tools needed to make a prompt diagnosis and explain all the treatment options available to you.

Imaging Scanning

When a patient is experiencing symptoms like pain or swelling in the abdomen, doctors will typically order a chest X-ray, CT scan or another type of imaging scan. These tests will help detect potential tumors and show where any cancer spread. They also help doctors choose the best biopsy locations.


Only a biopsy can confirm a peritoneal mesothelioma diagnosis. Radiologic biopsies are minor procedures that extract tissue samples from tumors or tissues that can be inspected under a microscope. Sometimes doctors need to perform a laparoscopic surgical biopsy, where a surgeon makes small incisions in your abdomen and inserts a laparoscope (a thin viewing instrument) and surgical tools to collect a tissue sample. In both cases, pathologists look at the lab results for cancerous cells in the peritoneal fluid or tissue.

Fluid Analysis

If imaging reveals fluid buildup in your abdomen (ascites), a doctor may extract a sample using a needle for analysis. This can help identify the presence of abnormal cells.

Difference Between Peritoneal and Pleural Mesothelioma

Peritoneal mesothelioma and pleural mesothelioma are both rare and aggressive cancers that arise from mesothelial cells, but they differ in their location and some associated factors:


  • Peritoneal mesothelioma: This cancer forms in the peritoneum, the thin lining that covers your abdominal cavity and organs.
  • Pleural mesothelioma: This is the more common type, forming in the pleura, the lining of your lungs and chest cavity.

Risk Factors:

  • Asbestos exposure: The leading risk factor for both types is asbestos exposure. However, it's interestingly not as dominant in peritoneal mesothelioma. Up to 80-90% of pleural mesotheliomas are linked to asbestos, whereas only 30-40% of peritoneal cases have a clear asbestos connection.

Other Risk Factors:

  • Peritoneal mesothelioma: While less common risk factors exist, they are not well understood. Erzionite exposure (a mineral similar to asbestos), radiation therapy to the abdomen, and Simian Virus 40 (SV40) contamination in some vaccines are possibilities, but require further research for conclusive links.
  • Pleural mesothelioma: Unlike peritoneal mesothelioma, there are no major risk factors besides asbestos exposure.


  • Due to their different locations, these cancers may present with slightly varying symptoms. However, some overlap exists.
  • Shared symptoms: Abdominal pain, fatigue, weight loss, and night sweats can occur in both types.
  • Peritoneal mesothelioma specific: Fluid buildup in the abdomen (ascites) and bowel problems are more common with this type.
  • Pleural mesothelioma specific: Shortness of breath, chest pain, and coughing are more specific to this type due to its location near the lungs.
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Treatment Options for Peritoneal Mesothelioma

Patients with peritoneal mesothelioma often go undiagnosed until the disease is in its final stages. While treatment is mostly palliative, doctors and mesothelioma specialists can offer a number of treatment options, including peritoneal mesothelioma surgery, to relieve symptoms and possibly extend life expectancy. 

Several treatment centers now offer peritoneal mesothelioma sarcoma treatments that involve several courses of surgery, with chemotherapy, radiation and other treatments being used either during or after a surgery:

Cytoreductive Surgery with HIPEC

This is considered the standard of care in the treatment of peritoneal mesothelioma. It involves a two-part process:

  • Cytoreductive surgery: The surgeon aims to remove as much of the visible cancer tissue as possible, including tumors and affected parts of the peritoneum and abdominal organs.
  • HIPEC (Hyperthermic intraperitoneal chemotherapy): During the same surgery, heated chemotherapy drugs are circulated and perfused throughout the abdominal cavity to target remaining cancer cells. The heat helps the medication penetrate deeper and be more effective.


This is the mainstay treatment for peritoneal mesothelioma, even for patients who are not eligible for surgery. Chemotherapy is not considered curative as a treatment option, however it can provide benefits to a patient affected by mesothelioma. Studies have demonstrated that the most active regimen can reduce tumors in 40% of patients and extend life expectancy in those that respond to the treatment.  Chemotherapy has also been shown to suppress symptoms associated with mesothelioma, including shortness of breath, swelling and pain. It has also been shown to improve the patient’s quality of life.

Palliative Care

This type of care focuses on managing symptoms and improving a patient's quality of life, regardless of the stage of cancer. It can involve pain management, medication to manage nausea and fatigue, and emotional support. Other procedures like draining excess fluid from the abdomen (paracentesis) can also be used for palliative purposes.

  • Radiation Treatments: Radiation has proved to have limited effect as a primary treatment for abdominal (peritoneal) mesothelioma. However, as a palliative treatment in conjunction with surgery, it has proven useful in preventing malignant seeding of the incision sites. The use of radiation is highly recommended in both pleural and peritoneal mesothelioma to prevent the spread of mesotheliomas in the area of surgical incisions.

Clinical Trials

These trials test the effectiveness of new medications and treatment approaches for mesothelioma. While not suitable for everyone, they can offer access to promising new therapies.

What Are the Stages of Peritoneal Mesothelioma?

Unlike some other cancers, peritoneal mesothelioma doesn't have a universally accepted staging system. There are two main approaches doctors use to determine the extent of the cancer:

The Tumor, Node, Metastasis (TNM) System: This is a widely used cancer staging system that considers the size and location of the tumor (T), involvement of lymph nodes (N), and presence of distant metastasis (M). However, for peritoneal mesothelioma, applying the TNM system can be challenging due to the diffuse nature of the cancer's growth within the abdomen.

The Peritoneal Cancer Index (PCI): This is the more commonly used method for staging peritoneal mesothelioma. The PCI assigns a score based on the extent of tumor involvement in different regions of the abdomen and pelvis. Here's a breakdown of the PCI staging system:

  • Stage 1 (PCI score 1-10): Early-stage cancer with limited involvement in one or a few abdominal regions.
  • Stage 2 (PCI score 11-20): Cancer has spread to more extensive areas within the abdomen.
  • Stage 3 (PCI score 21-30): Advanced stage with significant tumor burden throughout the abdomen.
  • Stage 4 (PCI score 31-39): The most advanced stage with widespread involvement and possible distant metastasis (cancer spread beyond the abdomen).

The PCI is not a perfect staging system. It may not accurately reflect the overall prognosis for every patient. Other factors like a patient's overall health and response to treatment can also influence their outcome.

How long can you live with peritoneal mesothelioma?

The life expectancy for someone with peritoneal mesothelioma depends on several factors. However, it is an aggressive cancer with a poor prognosis.

Without treatment: People diagnosed with peritoneal mesothelioma typically live only 6 to 12 months without treatment.

With treatment: Fortunately, treatment can significantly improve life expectancy. Here's a range based on common treatment approaches:

  • Chemotherapy alone: Chemotherapy can improve life expectancy to an average of around 12 months.
  • Cytoreductive surgery with HIPEC: This is often the most effective treatment, with patients living an average of 2 to 6 years after diagnosis.

Individual factors affecting prognosis: Several factors can influence how long someone with peritoneal mesothelioma lives. These include:

  • Stage of cancer: Early-stage diagnosis offers a better chance of successful treatment and longer survival.
  • Overall health: A strong immune system and good overall health can improve treatment tolerance and outcomes.
  • Specific treatment response: How well an individual responds to treatment significantly impacts their prognosis.

Why Peritoneal Mesothelioma Is Often Misdiagnosed?

Some common factors that can contribute to a misdiagnosis include:

  • Deceptive symptoms: Because the early symptoms of peritoneal mesothelioma mimic various other conditions, it can be challenging to pinpoint the exact cause.  For example, abdominal pain could be due to irritable bowel syndrome (IBS) or a digestive issue, while fatigue can be a symptom of many different illnesses.
  • Lack of asbestos exposure association: While asbestos exposure is the main risk factor for peritoneal mesothelioma, it's not as dominant a factor as with pleural mesothelioma (cancer of the lung lining). This can lead doctors away from suspecting mesothelioma, especially if a patient doesn't readily volunteer a history of asbestos exposure.
  • Difficulty in early detection: There's currently no reliable screening test for peritoneal mesothelioma. Early diagnosis is often based on suspicion and investigation after a patient presents with symptoms.
  • Imaging limitations: While imaging scans can provide clues, they may not be definitive for diagnosing peritoneal mesothelioma. Biopsy is typically required for confirmation.

If you're concerned about potential asbestos exposure and are experiencing possible peritoneal mesothelioma symptoms, it's crucial to be proactive in advocating for your health. Call us anytime day or night at (855) 744-1922 or contact us online!

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