Peritoneal mesothelioma is the second most common type of mesothelioma. It’s a cancer that affects your peritoneum, the membrane that lines your abdomen and abdominal organs. Asbestos exposure is the most common risk factor. There isn’t a cure, but surgery, chemotherapy and palliative care can improve your prognosis and quality of life.
Peritoneal mesothelioma is a rare type of cancer affecting your peritoneum. Your peritoneum is a membrane that lines your abdominal cavity and organs, like your liver and intestines. Like other types of mesothelioma, peritoneal mesothelioma can be related to prior asbestos exposure. Asbestos is a type of building material that’s harmful when inhaled or ingested (swallowed).
Peritoneal mesothelioma is an aggressive form of cancer because it has often spread throughout your abdominal lining at diagnosis and is difficult to detect early.
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Peritoneal mesothelioma and pleural mesothelioma form in the lining that protects important body cavities and internal organs. Peritoneal mesothelioma forms in the membrane that lines your abdominal cavity and covers your abdominal organs (peritoneum). Pleural mesothelioma forms in the membrane that lines your chest cavity and protects your lungs (pleura). Both membranes consist of mesothelial cells. This is where the name mesothelioma comes from.
Both types of mesothelioma are usually malignant (cancerous). Malignant mesothelial cells grow out of control and harm surrounding healthy tissue. Pleural mesothelioma is more common than peritoneal mesothelioma.
Anyone can be affected by peritoneal mesothelioma, although it’s rare in children. Most people get diagnosed in their 50s.
Peritoneal mesothelioma is the second most common type of mesothelioma (right behind pleural mesothelioma), but it’s still rare. Only 10% to 20% of all mesothelioma diagnoses are peritoneal mesothelioma. As few as 400 to 1,000 new cases get diagnosed in the United States each year.
Peritoneal mesothelioma often doesn’t cause symptoms until it’s spread to organs in your abdominal cavity. The most common symptom is fluid build-up in your abdomen. As the fluid collects, your abdomen may get bigger. Abdominal pain is the second most common symptom.
Signs and symptoms of peritoneal mesothelioma include:
The biggest risk factor for mesothelioma is asbestos exposure. Asbestos is a fiber used in professions like construction, plumbing, electrical work, roofing, manufacturing and the automotive industry. Many people with mesothelioma work in occupations that expose them to asbestos.
Although most people diagnosed with pleural mesothelioma have a history of asbestos exposure, the connection between asbestos and peritoneal mesothelioma isn’t as straightforward. Many people diagnosed with peritoneal mesothelioma don’t work in professions that expose them to asbestos.
More research is needed to understand the relationship between asbestos and peritoneal mesothelioma.
Risk factors for peritoneal mesothelioma include:
Peritoneal mesothelioma can be challenging to diagnose because it often doesn’t produce symptoms in the early stages. When symptoms do arise, they’re usually similar to other, more common, conditions affecting your gastrointestinal (GI) tract, as well as other cancers. Diagnosis often involves ruling out these more common conditions.
Diagnosis may include:
Cancer staging shows how advanced the disease is. The PCI system is the most commonly used cancer-staging system for peritoneal mesothelioma.
The peritoneal cancer index (PCI) classifies your cancer by dividing your abdomen into 13 sections and assigning a number from 0 to 3 to each section. Zero means no cancer, while 3 means cancer has overtaken an area. Your provider adds the numbers for each section to determine the cancer stage. Stage 1 is the least advanced. Stage 4 is the most advanced.
Treatment options depend on your cancer stage, your health and other factors.
The most common treatment for peritoneal mesothelioma is cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC).
Cytoreduction with HIPEC is a time-intensive procedure, lasting more than 10 hours. Still, research has shown that this treatment helps people with peritoneal mesothelioma live longer.
You may receive systemic chemotherapy if you’re not able to have cytoreduction with HIPEC. Systemic chemotherapy drugs travel through your bloodstream to kill cancer cells throughout your body. You may receive a combination of different types of systemic chemotherapy drugs.
Immunotherapy drugs called immune checkpoint inhibitors help your immune system locate and kill cancer cells. These types of drugs are commonly used to treat pleural mesothelioma. Your provider may also prescribe them to treat peritoneal mesothelioma treatment.
Some people with peritoneal mesothelioma may have genetic changes in their tumor cells that may be treated with targeted therapies. Targeted therapy targets the genetic changes that turn healthy cells into cancer cells. These treatments may be available to your treating oncologist or through studies that test the safety and effectiveness of new treatments called clinical trials. Your healthcare provider should perform gene testing on your tumor biopsy to find out if your tumor has any targetable gene changes.
Your provider may recommend palliative care to help you manage cancer symptoms and treatment side effects. Palliative care may be your best option if you’re not healthy enough for surgery or if your cancer’s in a later stage. Palliative care treatments may include a procedure called paracentesis. Paracentesis drains fluid from your abdomen, helping to relieve uncomfortable or painful pressure from fluid build-up.
The only known way to reduce your risk of developing peritoneal mesothelioma is to avoid asbestos exposure. In the 1970s, the Environmental Protection Agency (EPA) began regulating how industries use asbestos. Many buildings built before the EPA regulations still contain asbestos. Asbestos fibers can be harmful if they’re disturbed and become airborne.
Reduce your risk by avoiding repairs or remodels that may expose you to asbestos. Instead, hire an expert, like an asbestos abatement professional, to handle jobs that involve working around this material.
Peritoneal mesothelioma can’t be cured, but treatment can prolong your life, and the disease can go through periods of remission. Working with a team of cancer specialists with expertise in treating mesothelioma can improve your treatment outcomes. Working with palliative care professionals can improve your quality of life as you navigate your cancer diagnosis.
Your prognosis depends on a variety of factors, including:
People diagnosed with peritoneal mesothelioma live from six months to a year without treatment. Survival rates are much better with treatment. People with peritoneal mesothelioma who receive cytoreductive surgery and HIPEC live from two to six years after their diagnosis.
Still, your prognosis depends on multiple factors. Your provider is your best resource for understanding which factors will shape your prognosis based on your treatment options.
A note from Cleveland Clinic
Work with your healthcare provider to discuss your treatment options if you’re diagnosed with peritoneal mesothelioma. There isn’t a cure for this type of cancer. Still, depending on factors like how advanced the cancer is and your general health, there are treatment options that can help you live longer. Treatments, including palliative care, can improve your quality of life as you navigate your cancer diagnosis.
Last reviewed by a Cleveland Clinic medical professional on 08/03/2022.
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