Introduction
Peritoneal mesothelioma is an uncommon and severe malignancy arising from the peritoneum. This membrane surrounds the abdominal cavity and its essential organs and poses a serious medical challenge. Despite being rare in comparison to other malignancies, this disorder has unique clinical features and presents serious diagnostic and treatment challenges for both patients and healthcare professionals.
Peritoneal mesothelioma is a serious health hazard that is mostly linked to exposure to asbestos, a mineral that is frequently found in industrial settings and building materials. Despite advances in medical knowledge and treatment options, peritoneal mesothelioma often remains undetected until the late stages of the disease.
The disease's rapid advancement within the stomach lining impedes the effectiveness of treatment, frequently restricting available alternatives and deteriorating outcomes for patients. On the other hand, recent developments in interdisciplinary approaches, such as palliative care approaches, chemotherapy regimens, and surgical procedures, present encouraging possibilities for symptom management, enhancing the quality of life, and prolonging survival rates. Considering the complicated clinical presentation and treatment challenges associated with peritoneal mesothelioma, a thorough investigation is necessary to guide appropriate management approaches and improve patient outcomes in this dynamic disease scenario.
What Is the Difference Between Peritoneal Mesothelioma and Pleural Mesothelioma?
The protective linings surrounding important body cavities and internal organs are the site of onset for both pleural and peritoneal mesothelioma. Whereas pleural mesothelioma grows in the membrane enclosing the chest cavity and protecting the lungs (pleura), peritoneal mesothelioma develops in the membrane surrounding the abdominal cavity and lining abdominal organs (peritoneum). Since mesothelial cells are the source of both forms, the word "mesothelioma" is used. These abnormal mesothelial cells, usually cancerous, cause uncontrolled growth that harms nearby healthy tissues. In comparison, pleural mesothelioma is more common than peritoneal mesothelioma.
How Common Is Peritoneal Mesothelioma?
All age groups can be affected by peritoneal mesothelioma, although it is uncommon in young children. The average diagnostic age is in the 50s. Although it is the second most common type of mesothelioma after pleural mesothelioma, only 10 to 20 percent of individuals are affected by this rare form of all the cases. Only 400 to 1,000 new cases are reported annually in the United States.
What Are the Symptoms of Peritoneal Mesothelioma?
Peritoneal mesothelioma frequently shows no symptoms until it spreads to the abdominal organs. Abdominal expansion due to fluid collection in the abdomen is the main symptom. Pain in the abdomen is the second most common symptom. Additional indicators include fluid retention in the abdomen, abdominal distension or enlargement, widespread or localized abdominal discomfort, pelvic mass, intestinal blockage, gastrointestinal manifestations such as nausea and vomiting, fever, nocturnal sweats, unexplained weight loss, and reduced appetite.
What Are the Causes of Peritoneal Mesothelioma?
Mesothelioma is mostly caused by asbestos exposure, which is prevalent in industries such as manufacturing, plumbing, and construction. Although there is an apparent link between asbestos exposure and pleural mesothelioma cases, the relationship with peritoneal mesothelioma cases is not as strong. Even though many individuals with peritoneal mesothelioma did not have occupational asbestos exposure, additional research is necessary to explain this connection.
One of the risk factors for peritoneal mesothelioma is exposure to asbestos particles in the air, which can damage peritoneal mesothelial cells and possibly cause tumor growth. Mesothelioma has also been connected to exposure to minerals prevalent in the environment, namely silica and erionite. When combined with asbestos exposure, some gene alterations, most notably in the BAP1 gene, may increase the risk of peritoneal mesothelioma. Furthermore, previous radiation therapy for abdominal cancer may increase the risk of developing peritoneal mesothelioma; however, further research is necessary to understand this link completely.
How Is Peritoneal Mesothelioma Diagnosed?
Peritoneal mesothelioma tends to be asymptomatic in its early stages, making diagnosis difficult. When symptoms occur, they resemble more prevalent gastrointestinal disorders and malignancies; thus, these ailments must be ruled out throughout the diagnosis. Computed tomography (CT) scans are a diagnostic technique used to identify abdominal tumors and rule out related diseases such as ovarian cancer. Detailed imaging can be obtained using magnetic resonance imaging (MRI), especially when CT contrast is insufficient. Blood tests evaluate tumor markers, and peritoneal fluid examination identifies mesothelioma signs. Nevertheless, tissue information is not provided by this approach. A biopsy, which involves surgically removing tissue for analysis and is guided by CT or laparoscopy, is essential for confirming the diagnosis.
What Is the Staging of Peritoneal Mesothelioma?
Cancer staging evaluates the extent of peritoneal mesothelioma using the Peritoneal Cancer Index (PCI) system. This method divides the abdomen into 13 sections, assigning a score from zero to three to each based on cancer involvement. A score of zero signifies no cancer, while three indicates extensive cancer presence. The sum of scores across sections determines the cancer stage, ranging from Stage one (least advanced) to Stage four (most advanced), with specific PCI score ranges delineating each stage: Stage one (1 to 10), Stage two (11 to 20), Stage three (21 to 30), and Stage four (31 to 39).
How Is Peritoneal Mesothelioma Treated?
Treatment options vary based on cancer stage, overall health, and individual factors.
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Cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) is the main treatment for peritoneal mesothelioma.
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The process of cytoreduction involves surgically excising tumors, peritoneal segments and impacted abdominal organs that harbor cancerous cells.
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After surgery, HIPEC involves injecting warm chemotherapy straight into the abdomen. The higher temperature helps chemotherapy target any cancer cells that may still be present. The localized administration of HIPEC reduces adverse effects in comparison to conventional chemotherapy.
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For individuals not qualified for HIPEC-assisted cytoreduction, systemic chemotherapy is an option. It includes circulating medications, sometimes a combination of agents, into the bloodstream to eliminate cancer cells throughout the body.
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Immunotherapy, which uses immune checkpoint inhibitors to boost the immune system's capacity to combat cancer, is increasingly being utilized to treat peritoneal mesothelioma in addition to pleural mesothelioma.
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Targeted treatment focuses on genetic abnormalities in tumor cells to undo the cellular aberrations that promote the growth of cancer.
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For patients in advanced stages of illness or who are not a good candidate for surgery, palliative care—which focuses on managing symptoms and reducing side effects from treatment—becomes crucial.
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Paracentesis, a surgery to remove fluid from the abdomen and relieve discomfort caused by fluid buildup, is one possible treatment.
Conclusion
Since peritoneal mesothelioma is asymptomatic in the early stages, it offers a complicated clinical issue and is frequently discovered at an advanced stage. Despite its rarity, its devastating effect requires an integrated approach to diagnosis and treatment. Improvements in targeted treatments, immunotherapy, cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy (HIPEC) provide promise for improved outcomes. Further research is necessary to improve the understanding of the condition and provide more potent treatment plans.
