Do you sometimes feel a vague pain or bloating in your stomach? Do you feel a loss of appetite and weight loss? Although we sometimes ignore these symptoms, they can be signs of a serious underlying disease. Today we are going to talk about a type of cancer that is a little rare, but deserves a lot of attention. That is a cancer called `Peritoneal Mesothelioma`.
What is this Peritoneal Mesothelioma?
Simply put, `Peritoneal Mesothelioma` is a cancer that develops inside our stomach, that is, in the thin membrane that covers the abdominal cavity, medically speaking, `peritoneum`. Think of it, this `peritoneum` is like a delicate protective covering around important organs inside our stomach, such as the liver, intestines, and stomach.
This cancer, like other types of mesothelioma, is often linked to previous exposure to a substance called asbestos. You may have heard that asbestos is a material used to make some building materials. It is very dangerous because the fibers in it can cause serious problems if you breathe them in or eat them.
Peritoneal mesothelioma is a relatively aggressive and rapidly spreading cancer. Most of the time, even when it is detected, the cancer has already spread throughout the lining of the stomach. Therefore, it is difficult to detect it early.
What is the difference between Peritoneal Mesothelioma and Pleural Mesothelioma?
Both `Peritoneal Mesothelioma` and `Pleural Mesothelioma` develop in the membranes that line the important cavities and internal organs of our body.
- Peritoneal mesothelioma develops in the membrane that lines the abdominal cavity and surrounds the abdominal organs, that is, the peritoneum we mentioned earlier.
- Pleural mesothelioma develops in the membrane that lines the chest cavity, especially the lungs. It is called the pleura.
Both of these membranes are made up of a special type of cell called `mesothelial cells`. That is why this cancer is called `mesothelioma`.
Both types of mesothelioma are usually malignant, meaning they are cancerous . These malignant mesothelial cells grow rapidly and uncontrollably, damaging surrounding healthy tissue. Pleural mesothelioma is a more common type of cancer than peritoneal mesothelioma.
Who is most likely to get this disease? How common is it?
Anyone can develop `Peritoneal Mesothelioma`. However, it is very rare among young children. Most often, this disease is diagnosed in people in their 50s.
Although `Peritoneal Mesothelioma` is the second most common type of `Mesothelioma` (the first is `Pleural Mesothelioma`), it is also a very rare cancer. `Peritoneal Mesothelioma` develops in between 10% and 20% of all `Mesothelioma` patients. Imagine, in a country like America, only between 400 and 1000 new cases of these patients are reported every year. So, although these patients may exist in Sri Lanka too, the number is very low.
What are the symptoms of Peritoneal Mesothelioma? How to recognize them?
This is a very important point because most of the time, Peritoneal Mesothelioma does not show any symptoms in the early stages. Symptoms only start to appear after the cancer has spread to the abdominal organs.
The most common symptom is fluid buildup in the abdomen. This is also called `ascites`. When the fluid builds up, the abdomen begins to enlarge and swell. The second most common symptom is abdominal pain.
Other symptoms may include:
- Ascites : Feels like the stomach is full and heavy.
- Abdominal swelling or bloating : Clothes can become tight.
- Stomach pain : This can be a pain that spreads throughout the stomach, or it can be a pain that is felt in just one place.
- You may feel a painful lump in the lower abdomen .
- Constipation or bowel obstruction : It feels like your stomach is bloated and you have difficulty passing stool.
- Nausea and vomiting .
- Unexplained fever and night sweats .
- Unimaginable weight loss .
- Food is tasteless .
Important: If you continue to have one or more of these symptoms, it is very important to see a doctor for advice. Don't worry, not all of these signs are caused by cancer. They could also be caused by other common conditions. However, it is always best to get checked out.
What are the causes and risk factors for developing Peritoneal Mesothelioma?
The main risk factor for developing mesothelioma is exposure to asbestos. Asbestos is a fibrous material used in construction, plumbing, electrical work, roofing, some manufacturing industries, and the automotive industry. Many people who develop mesothelioma have jobs that expose them to asbestos.
However, although most people who develop pleural mesothelioma (the type that affects the lungs) have a history of asbestos exposure, the link between peritoneal mesothelioma (the type that affects the lining of the abdomen) and asbestos is not as clear. Some people who develop peritoneal mesothelioma may not have had a history of occupational exposure to asbestos. This is still being researched.
Here are some other risk factors for developing `Peritoneal Mesothelioma`:
- Asbestos exposure : When asbestos fibers enter our environment, they become airborne. When they do, they can enter our body through our mouths and noses, travel to the lining of the abdomen (peritoneum), and lodge there. Once lodged, they damage the mesothelial cells, causing them to divide abnormally. This is what causes cancerous tumors to form. Imagine, mesothelioma occurs years after exposure to asbestos, sometimes as long as 40 years.
- Silica and Erionite Exposure : These are common minerals found in the earth. Exposure to these has also been found to be linked to both Pleural and Peritoneal Mesothelioma.
- Gene mutations : Some studies have shown that if you are exposed to asbestos and have certain gene mutations, your risk of developing peritoneal mesothelioma may increase. One of the most common mutations is a change in a gene called BAP1. This gene, called BAP1, is responsible for preventing the growth of cancer.
- Radiation exposure : Having received radiation therapy for a previous abdominal cancer is also thought to increase the risk of developing peritoneal mesothelioma. However, more research is needed to fully understand the relationship between radiation and mesothelioma risk.
How do you find out if you have Peritoneal Mesothelioma?
Diagnosing Peritoneal Mesothelioma can be challenging, as we mentioned earlier, because it often does not show symptoms in the early stages. When symptoms do appear, they can be similar to other common diseases of the gastrointestinal tract or other types of cancer. Therefore, these common conditions are often ruled out when making a diagnosis.
The following tests can be done to diagnose the disease:
- CT scan : Your doctor may order a CT scan to rule out other conditions that cause symptoms similar to peritoneal mesothelioma, such as ovarian cancer or adenocarcinoma. This may involve injecting a safe dye (contrast) into your bloodstream to make things like lumps in your abdomen more visible on the scan.
- MRI scan (Magnetic Resonance Imaging (MRI)) : An MRI can provide the same level of detail as a CT scan. An MRI may be done if you cannot have a CT scan with contrast.
- Blood tests : Your doctor may check certain markers in your blood, such as specific proteins, as they may be a sign of a cancerous tumor.
- Peritoneal fluid analysis : In this procedure, your doctor inserts a needle into your abdominal cavity and takes a sample of the fluid to check for signs of mesothelioma. However, this test has one limitation. It only provides information about the fluid in your abdomen, not the tissue in your abdomen. The stage of cancer depends on how much the cancer has spread to the tissue.
- CT-guided core needle biopsy or laparoscopic biopsy : The only way to confirm a diagnosis of peritoneal mesothelioma is to have a biopsy. In this, your doctor uses imaging (such as a scan) to find the exact location of your lump. Then, using surgical instruments, they take a tissue sample and send it to a lab for testing.
What are the stages of Peritoneal Mesothelioma?
Cancer stages indicate how far the disease has progressed and spread. The most commonly used staging system for peritoneal mesothelioma is the PCI (Peritoneal Cancer Index).
In the `PCI` method, your abdomen is divided into 13 sections, and each section is given a score from 0 to 3.
- 0 means there is no cancer in that area.
- 3 means that part is completely covered by cancer.
The doctor then adds up the scores for each of these sections and determines the stage of the cancer. Stage 1 is the least advanced stage. Stage 4 is the most advanced stage.
- Stage 1: PCI score from 1 to 10.
- Stage 2: PCI score from 11 to 20.
- Stage 3: PCI score from 21 to 30.
- Stage 4: PCI score 31 to 39.
What are the treatments for Peritoneal Mesothelioma?
Treatment options depend on the stage of your cancer, your overall health, and several other factors.
Cytoreduction surgery and HIPEC treatment (Cytoreduction with HIPEC)
The most commonly used treatment for peritoneal mesothelioma is a combination of cytoreduction surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) .
- Cytoreduction : This is a surgery that removes cancer cells from inside your abdomen. Doctors will remove any visible lumps. They may also remove parts of the peritoneum and abdominal organs where the cancer has spread.
- Hyperthermic intraperitoneal chemotherapy (HIPEC) : This is a special type of chemotherapy given after cytoreduction surgery. Chemotherapy drugs are heated to a safe temperature and given directly into the abdominal cavity. This heat makes the drugs much more potent than regular chemotherapy. HIPEC kills any small cancer cells that may have been left behind during surgery. HIPEC also has fewer side effects than regular chemotherapy.
Cytoreduction surgery and HIPEC are large, complex procedures that can take more than 10 hours. However, research has shown that this treatment method helps people with Peritoneal Mesothelioma live longer.
Chemotherapy
If you are unable to have cytoreduction surgery and HIPEC, you may be given systemic chemotherapy. Systemic chemotherapy drugs travel through your bloodstream and kill cancer cells throughout your body. Different types of chemotherapy drugs may be given together.
Immunotherapy
Immunotherapy drugs called ``immune checkpoint inhibitors`` help your own immune system find and destroy cancer cells. These drugs are commonly used to treat ``pleural mesothelioma.`` Your doctor may also prescribe them to treat ``peritoneal mesothelioma.``
Targeted therapy
Some people with peritoneal mesothelioma may have genetic changes in their cancer cells. This can be treated with targeted therapies. Targeted therapies work by directly targeting the genetic changes that cause healthy cells to become cancer cells. These treatments may be available through your treating oncologist, or through studies called clinical trials that test the safety and effectiveness of new treatments. It is important to have genetic testing (gene testing) done on the cancer tissue taken from your biopsy to see if your cancer has these targetable genetic changes.
Palliative care
To help you manage the symptoms of cancer and the side effects of treatment, your doctor may recommend palliative care. If you are not healthy enough for surgery, or if your cancer is at an advanced stage, palliative care may be the best option for you. Palliative care may also include procedures such as paracentesis, which removes fluid from the abdomen. This can help reduce the discomfort and pain caused by the fluid buildup.
How can you reduce the risk of developing this disease?
The only way to reduce the risk of developing peritoneal mesothelioma is to avoid exposure to asbestos. In the 1970s, agencies such as the Environmental Protection Agency (EPA) in the United States imposed regulations on the use of asbestos. However, buildings built before those regulations were in place may still contain asbestos. If asbestos fibers are disturbed, they can become airborne and become very harmful.
To reduce your risk, avoid making repairs or modifications that could expose you to asbestos. Instead, hire a specialist, such as an asbestos removal professional, to handle such work.
What kind of hope can you have when living with Peritoneal Mesothelioma?
Peritoneal mesothelioma is not a completely curable disease. However, treatment can extend your life and even induce periods of remission. Working with a team of oncologists who specialize in treating mesothelioma can improve your treatment outcomes. Working with palliative care professionals can also improve your quality of life as you live with this cancer diagnosis.
What factors affect your prognosis?
The prognosis of your disease depends on several factors:
- Cell type : There are three types of cells that can develop into tumors. The most common type, called epithelioid cells, has a better prognosis than the other two cell types, sarcomatoid cells and biphasic cells.
- The stage of your mesothelioma : If the disease is diagnosed and treated at an early stage, you are likely to have better outcomes.
- Your gender : When it comes to Peritoneal Mesothelioma, women have been shown to have a better prognosis than men.
- Complete removal of the lumps : If your doctor can completely remove all the lumps, your prognosis may be better.
- Thrombocytosis : If you have thrombocytosis, your prognosis may be poor. Thrombocytosis is a condition in which you have too many platelets in your blood. Platelets are cells that help your blood clot.
How long can you live with Peritoneal Mesothelioma?
People diagnosed with Peritoneal Mesothelioma can usually live for about 6 to 12 months without treatment. However, with treatment, the survival rate is much better. Peritoneal Mesothelioma patients who undergo cytoreductive surgery and HIPEC live for two to six years after diagnosis. Some people live even longer.
However, your prognosis depends on several factors. Your doctor is the best person to understand what factors will affect your prognosis, based on your treatment options.
What are the important questions to ask your doctor?
If you are diagnosed with Peritoneal Mesothelioma, talk to your doctor about:
- "Who are the specialist doctors who will treat me?"
- "Is it better for me to get help from a palliative care team?"
- "What type of mesothelioma do I have?"
- "How far has my cancer spread? (That is, what is the stage?)"
- "What treatment options do I have?"
- "Are there any `clinical trials` (studies testing new treatments) I can participate in?"
- "What results can I expect from the treatments available?"
- "What are the side effects of treatment? How can they be controlled?"
Finally, things to remember...
Peritoneal Mesothelioma is a rare but serious cancer. Exposure to asbestos can be a major cause. If you have any of the symptoms we've discussed, it's important to seek medical attention immediately.
It's normal to feel scared and anxious when you learn about a disease like this. But remember, you're not alone. You have doctors, family, and friends to help you. The most important thing is to get the right information, talk openly with your doctors, and get the best treatment for you. Treatment can definitely help extend your life and improve your quality of life.
` Peritoneal Mesothelioma, cancer, stomach cancer, asbestos, peritoneum, mesothelioma, HIPEC, symptoms, treatment
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