Peritoneal Mesothelioma

The peritoneum is a protective membrane that surrounds the abdomen, or belly. It has two layers, and mesothelioma can develop on both. The parietal layer covers the abdominal cavity, while the visceral layer surrounds the stomach, liver and other organs of the abdomen. Together, the layers support the abdominal cavity as a whole and the organs within it.

Early symptoms of peritoneal mesothelioma can include abdominal pain or swelling, and diarrhea or constipation. Unfortunately, some patients don't experience any symptoms until tumors have spread. This scenario makes treating the disease hard and surviving it even harder.

You may not experience cancer symptoms for 20 to 50 years after your first exposure to asbestos. 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, known as ascites, may occur next. Over time, tumors form and place pressure on the organs.

Although no definitive answer is available, cancer experts most commonly associate the cause of peritoneal mesothelioma with the following theories:

Swallowed asbestos fibers travel from the digestive system to the peritoneum.

Inhaled asbestos fibers reach the peritoneum through the lymphatic system, which produces and stores cells that fight disease.

Pleural Mesothelioma

Pleural mesothelioma accounts for about 75 percent of all mesothelioma cases. Like other types of mesothelioma, this particular form of the disease gets its name because of where it is formed — in the pleura, a soft tissue that surrounds the lungs. In almost all cases, pleural mesothelioma is caused by asbestos exposure.

The first symptoms of pleural mesothelioma typically include chest pain and shortness of breath. You may experience no symptoms at all in the first few stages of the cancer’s progression.

Symptoms of pleural mesothelioma include persistent dry or raspy cough, coughing up blood (hemoptysis), shortness of breath (dyspnea), and difficulty swallowing (dysphagia). There are four stages of mesothelioma that doctors use to describe how far the cancer has progressed. For many people, unfortunately, symptoms are not noticeable until the cancer is in a later stage — stage III or IV.

Asbestos fibers can cause excess fluid to build up between the two layers of the pleura, a condition called pleural effusion. While a little fluid in your pleural space is important, too much can make breathing difficult. The extra fluid puts pressure on the lungs, causing chest pain that gets worse when you cough or take deep breaths.

Types of Mesothelioma

Mesothelioma is mainly divided into 4 types bases their affecting area.

1. Pleural (lungs)
2. Peritoneal (abdomen)
3. Pericardial (heart)
4. Testicular.

Medical experts acknowledge four main types of mesothelioma — each named for the area of the body where the cancer forms. The most common type, pleural mesothelioma, develops in the lining of the lungs.



Peritoneal mesothelioma forms in the peritoneum, the membrane that lines the abdominal cavity. This is the second-most prevalent type. The overwhelming majority of mesothelioma specialists treat patients with one of these two types.

The rarest forms of the disease are pericardial and testicular mesothelioma. Pericardial mesothelioma starts in the lining of the heart, while testicular mesothelioma develops in the lining of the testicles. Together, these types account for less than 2 percent of all mesothelioma diagnoses.

All the different types and subtypes of this disease share one common thread. They are caused primarily by a prolonged exposure to asbestos, usually in the workplace. If a doctor suspects that you have any form of mesothelioma, you should think back through your work background to find a connection to when you worked with or around asbestos materials and products.

Most pleural mesothelioma patients can remember a time when they breathed in asbestos fibers. In cases of peritoneal mesothelioma, patients often swallowed the fibers. Researchers are less certain about how asbestos triggers the pericardial and testicular forms of the disease.

Mesothelioma Treatment

Mesothelioma is generally resistant to radiation and chemotherapy treatment. Long-term survival and cures are exceedingly rare. Treatment of malignant mesothelioma at earlier stages has a better prognosis. Clinical behavior of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favors local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease.

The histological subtype and the patient's age and health status also help predict prognosis. The epithelioid histology responds better to treatment and has a survival advantage over sarcomatoid histology.

Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months. However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008), or with one of the latter. A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.[citation needed] In localized pericardial mesothelioma, pericardectomy can be curative; when the tumor has metastasized, pericardectomy is a palliative care option. The entire tumor is not often able to be removed

Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, or vinorelbine on its own, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.

Mesothelioma Causes

Working with asbestos is the most common risk factor for mesothelioma. In the United States, asbestos is considered the major cause of malignant mesothelioma and has been considered "indisputably" associated with the development of mesothelioma. Indeed, the relationship between asbestos and mesothelioma is so strong that many consider mesothelioma a “signal” or “sentinel” tumor. A history of asbestos exposure exists in most cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos.

In rare cases, mesothelioma has also been associated with irradiation of the chest or abdomen, intrapleural thorium dioxide (thorotrast) as a contrast medium, and inhalation of other fibrous silicates, such as erionite or talc. Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma. This has been confirmed in animal studies, but studies in humans are inconclusive. Pericardial mesothelioma may not be associated with asbestos exposure.

Incidence of mesothelioma has been found to be higher in populations living near naturally occurring asbestos. People can be exposed to naturally occurring asbestos in areas where mining or road construction is occurring, or when asbestos-containing rock is naturally weathered. Another common route of exposure is through asbestos-containing soil, which is used to whitewash, plaster, and roof houses in Greece. In central Cappadocia, Turkey, mesothelioma was causing 50% of all deaths in three small villages—Tuzköy, Karain and Sarıhıdır. Initially, this was attributed to erionite. Environmental exposure to asbestos has caused mesothelioma in places other than Turkey, including Corsica, Greece, Cyprus, China, and California.

Exposure to asbestos fibers has been recognized as an occupational health hazard since the early 20th century. Numerous epidemiological studies have associated occupational exposure to asbestos with the development of pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumors, and diffuse malignant mesothelioma of the pleura and peritoneum. Asbestos has been widely used in many industrial products, including cement, brake linings, gaskets, roof shingles, flooring products, textiles, and insulation.

Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos related diseases. This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers via washing a worker's clothes or coming into contact with asbestos-contaminated work clothing. To reduce the chance of exposing family members to asbestos fibres, asbestos workers are usually required to shower and change their clothing before leaving the workplace.

Mesothelioma Prognosis

The general prognosis for someone diagnosed with pleural mesothelioma is often unfavorable. However, making informed decisions about treatment, lifestyle changes and overall health can improve survival and quality of life. Prognosis and diagnosis often are confused. A prognosis is the likely outcome of a disease, like a forecast of how the disease will affect a person. A diagnosis is the medical classification of which disease a person has. A pleural mesothelioma prognosis usually is not favorable, but may vary depending on the stage of the cancer.

Diagnosing the cancer in the early stages offers a more hopeful outlook because doctors can still perform curative surgery to remove tumors. People diagnosed with this type of asbestos-related cancer can improve their chances of survival. Many have lived well past their life expectancy by electing treatment and improving their overall health. That could include lifestyle changes, and following the advice of knowledgeable specialists and experts.

Medical professionals use these terms on a regular basis to discuss prognosis. Although they are similar, they are not interchangeable. Learning more about these terms may help you understand your prognosis a little better.

Life Expectancy: Life expectancy is the estimated amount of time someone will live after diagnosis. It is measured in months and years. Statistics show close to 40 percent of people who have this rare cancer live one year or longer following diagnosis.

About one in 10 people live longer than three years after diagnosis. Less than 10 percent survive after five years. Remember, your specialist will determine your prognosis and discuss survival rate and life expectancy.

Survival Rate: Survival rate is the percentage of people who survive for a certain period of time. These rates are usually measured in one-, three- and five-year increments. For example, the one-year survival rate for pleural mesothelioma is approximately 38 percent. That means more than one-third of all patients will live one year or longer after their diagnosis.

Prognosis: A qualified physician is the only person who can offer a prognosis — or prediction of the likely result of your cancer. Doctors base your cancer prognosis on statistics gathered from others with your type of cancer and stage of disease.It is only an assessment. There are people who have outlived their prognosis, and you might be able to improve yours, too, by discussing it with your doctor or our Patient Advocates.

Mesothelioma Symptoms

Symptoms or signs of mesothelioma may not appear until 20 to 50 years (or more) after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space (pleural effusion) are often symptoms of pleural mesothelioma. The most common symptoms of peritoneal mesothelioma are abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity).
Other features may include weight loss, fever, night sweats, poor appetite, vomiting, constipation, and umbilical hernia. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

These symptoms may be caused by mesothelioma or by other, less serious conditions:

Mesothelioma that affects the pleura can cause these signs and symptoms:

1. Chest wall pain
2. Pleural effusion, or fluid surrounding the lung
3. Shortness of breath
4. Fatigue or anemia
5. Wheezing, hoarseness, or cough
6. Blood in the sputum (fluid) coughed up (hemoptysis)

In severe cases, the person may have many tumours masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread to other parts of the body.

1. Abdominal pain
2. an abnormal buildup of fluid in the abdomen
3. A mass in the abdomen
4. Problems with bowel function
5. Weight Loss

 

What is mesothelioma

A layer of specialized cells called mesothelial cells lines the inside of the chest, the abdomen, and the space around your heart. These cells also cover the outer surface of most of your internal organs. The lining formed by these cells is called the mesothelium

Malignant mesothelioma is a cancer that starts in cells in the linings of certain parts of the body, especially in the linings of the chest or abdomen.

The mesothelium helps protect your organs by making a special lubricating fluid that allows organs to move against each other. For example, this fluid makes it easier for your lungs to move (expand and contract) inside the chest when you breathe. The mesothelium has different names in different parts of the body:

A cancerous tumor of the mesothelium is called a malignant mesothelioma, although this is often shortened to just mesothelioma. Mesotheliomas can start in 4 main areas in the body.

Benign (non-cancerous) tumors can also start in the mesothelium. These tumors are typically removed by surgery, and there is often no need for additional treatment.

This type of benign tumor can form in the pleura surrounding the lungs. It used to be called benign fibrous mesothelioma, but doctors now know that this tumor actually does not start in mesothelial cells. This disease is usually benign, but about 1 in 10 are cancerous. A similar condition that starts in the peritoneum is called solitary fibrous tumor of the peritoneum.

This benign tumor can develop in the mesothelium of certain reproductive organs. In men, it often starts in the epididymis (ducts that carry sperm cells out of the testicle). In women, this tumor can begin in the fallopian tubes (tubes that carry eggs from the ovaries to the uterus).

Mesothelioma, more precisely known as malignant mesothelioma is a rare cancer of the mesothelial cells,

Mesothelioma

        Mesothelioma (or, more precisely, malignant mesothelioma) is a rare form of cancer that develops from cells of the mesothelium, the protective lining that covers many of the internal organs of the body. Signs and symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall), chest wall pain and constitutional signs such as unexplained weight loss.

        The diagnosis may be suspected based on chest X-ray and CT scan findings, but must be confirmed either by examining serous effusion cytology or with a biopsy (removing a sample of the suspicious tissue). A thoracoscopy (inserting a tube with a camera into the chest) can be used to acquire biopsy material, and allows the introduction of substances such as talc to obliterate the pleural space (a procedure called pleurodesis), preventing more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, mesothelioma carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.

Mesothelioma is most commonly caused by exposure to asbestos. Most people who develop mesothelioma have worked in careers such as mining, where they inhaled or ingested asbestos fibers, or were exposed to airborne asbestos dust and fibers in other ways. Washing the clothing of a family member who worked with asbestos also creates a risk for developing mesothelioma.The most common anatomical site for mesothelioma is the pleura (the outer lining of the lungs and internal chest wall), but it can also arise in the peritoneum (the lining of the abdominal cavity), the pericardium (the sac that surrounds the heart).

       Asbestos was known in antiquity, but it was not mined and widely used commercially until the late 19th century. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among naval personnel (e.g., Navy, Marine Corps and Coast Guard), shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople.