This is a rare aggressive form of cancer which attacks the ‘peritoneum’, a thin protective membrane surrounding the stomach and upper abdomen which helps to keep the abdominal organs in place. The peritoneum is made up of two layers, an inner and outer layer and when mesothelioma develops the layers thicken and fluid collects within the space. Peritoneal mesothelioma is the second most common form of mesothelioma, accounting for 20% of all mesothelioma cases which is most common in men between the ages of 50 – 69 years.
In almost all cases the cause is attributed to exposure to asbestos fibres which are inhaled albeit there is growing belief swallowing asbestos could also be a link. Other factors which can increase the risk of developing peritoneal mesothelioma include genetics and body types.
Once asbestos fibres enter the body, its defence mechanism attempts to filter and remove them but due to some of the fibres being sharp and irregular in shape they become lodged in the peritoneum. Over a long period of time this causes inflammation and irritation which leads to genetic change in the cells and formation of a malignant tumour.
Statistically, men are five times more likely than women to develop mesothelioma due to the work related nature of this disease.
There are various ways to measure risk in developing a disease like mesothelioma but this does not always mean a disease or cancer will develop. Certain types of cancer have different risk factors and with mesothelioma the risk is higher in people exposed to asbestos before the age of 30.
It is estimated that almost 6% of British men born in the 1940’s who worked in carpentry for more than 10 years before the age of 30 develop mesothelioma. A high risk group would typically include those who have worked in manufacturing asbestos and those who have used asbestos materials and products in one or more of the following industries;
Asbestos was widely used after the Second World War (post 1945) across many industries and given mesothelioma develops slowly, between 15 – 60 years after exposure, symptoms are generally experienced late in the day often when the condition is advanced which inevitably has an impact upon the outcome of any treatments.
As in most cancer cases early diagnosis and intervention can produce the most favourable outcomes.
Common symptoms include;
If you have any health concerns and have been exposed to asbestos in your working life you should discuss these with your GP at the earliest opportunity. It might be nothing at all but you are likely to feel better raising the issue now rather than later on.
Your GP will examine you and discuss aspects of your general health, family history and in particular any symptoms or other concerns you might have. It is important you outline details of your earlier exposure to asbestos.
Peritoneal Mesothelioma can be difficult to diagnose and a number of diagnostic investigations can be carried out which include;
A blood test in itself will not detect mesothelioma but it is recognised that people with mesothelioma have higher concentrations of certain proteins in their blood and tests can help determine how advanced a cancer is.
Researchers in Japan are developing advanced blood tests using an enzyme-linked system to detect a protein biomarker (N-ERC/mesothelin) which could enable earlier diagnosis of mesothelioma. Early diagnosis and early intervention offers a more favourable outcome in terms of treatment options and survival periods.
An x-ray in many cases will highlight abnormalities in the abdomen such as fluid and thickening in the peritoneum and if found you will have further tests to identify the cause which could be totally unrelated.
A chest x-ray might be required to examine the lungs for abnormalities.
CT Scan (computerised tomography)
Essential to any diagnosis of peritoneal mesothelioma will be a CT Scan of the abdomen which is a painless process involving a series of x-rays which produce a 3D image. A CT Scan can help differentiate malignant from benign disease and will provide reliable information regarding the location and thickness of any tumours in the abdomen and show if mesothelioma has affected other organs.
The result of the CT Scan is not always conclusive and further investigation is often necessary.
MRI Scan (magnetic resonance imaging)
An MRI scan produces high-resolution cross-sectional images of bones and body tissues to help in the diagnosis of peritoneal mesothelioma but can also indicate if the mesothelioma has metastasized (spread) to other areas.
PET Scan (positron emission tomography)
A PET Scan is a specialised imaging test which can help to identify cancer cells not detected by other tests and determine if the mesothelioma has spread into the lymph nodes or other parts of the body.
This involves obtaining a sample of fluid or tissue from the abdomen to enable microscopic examination (normally by a Pathologist) of the cell type present to determine if any tumour is mesothelioma and, if so, what type of cells are present, ie. epithelioid, sarcomatoid or biphasic.
Where there is an accumulation of fluid in the abdomen (ascites) in the first instance this will normally be drawn off into a syringe and examined by a Pathologist. This procedure can also provide pain relief to the patient.
A biopsy is the only definitive method of diagnosing mesothelioma and several methods can be used. The type of biopsy to be used in each particular case will be determined by the imaging reports, blood tests and location of the tumour.
Methods of biopsy
Initial diagnosis of mesothelioma can be overwhelming, both physically and emotionally, not only for the sufferer but their loved ones and friends and the enormity and implication of such a diagnosis cannot be overstated. Given the prognosis, sufferers might feel burdened by the responsibility of getting their affairs in order and coping with the knowledge of a reduced life-expectancy.
Sufferers will deal with their diagnosis in different ways but in most instances there will be fundamental steps one could take to make dealing with their situation that much easier.
Peritoneal mesothelioma can be a difficult cancer to diagnose with treatment options determined by several factors;
Major surgery known as ‘peritonectomy’ involves removing part of the lining of the abdomen in order to remove as much of the cancer as possible and reduce symptoms. Another surgical procedure known as cytoreductive surgery is used to perform ‘total peritonectomy’ which involves the removal of as much of the tumour and affected tissue as possible followed by a heated chemotherapy treatment (hyperthermic intraoperative intraperitoneal chemotherapy – HIIC) which is directed into the peritoneal cavity.
In cases of advanced mesothelioma radical surgery is required to remove the tumour which is referred to as debulking.
Chemotherapy treatment as an out-patient might also be offered with the aim of shrinking the cancer and involves drugs administered by injection into a vein or when complimentary to surgery by means of a catheter which is fed into the abdomen through an incision on the stomach. Chemotherapy can be offered on its own or complimentary to surgery.
Supportive care (Palliative care) will be offered by a palliative care team in those instances where coping with intensive chemotherapy treatment is not possible due to illness. Treatments are still available for the management of pain relief and for symptoms of weight loss and build-up of abdominal fluid. Abdominal fluid can be drained from the abdomen using an ascetic tap.