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Peritoneal MesotheliomaPeritoneal mesothelioma, a cancer of the lining of the abdominal cavity, is less common than
the pleural form, comprising approximately one-fifth to one-third of the total number of mesothelioma cases diagnosed. According to the SEER (Surveillance,
Epidemiology, and End Results) database, these diagnoses are approximately 54.7 per cent male versus 45.3 per cent female, with the median age being 65-69.
The latency period appears to be shorter for asbestos-exposed individuals with symptoms appearing 20-30 years after exposure rather than the 30-40 year
latency more commonly associated with pleural mesothelioma.
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SymptomsClinical symptoms at the time of presentation may include abdominal pain, abdominal mass, increased abdominal
girth, distention of the abdomen, ascites (fluid in the abdomen), fever, weight loss, fatigue, anemia and digestive disturbances. Some patients complain
of more non-specific symptoms for a number of months prior to a confirmed diagnosis. In a percentage of cases, peritoneal mesothelioma is found incidentally
when the patient has sought help for another health problem such as gallbladder, hernia or pelvic mass.
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DiagnosisOne way doctors diagnose peritoneal mesothelioma is by looking inside the abdominal cavity with an instrument
called a peritoneoscope. In this procedure, a cut is made through the abdomen wall and the peritoneoscope is placed into the abdomen. This test, called a
peritoneoscopy, is usually performed in the hospital. Some patients develop excessive fluid in the abdomen. This is called an effusion or ascites. A
doctor may take a sample of such fluid to diagnose peritoneal mesothelioma.
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TreatmentYour choice of treatment for peritoneal mesothelioma will depend on a number of factors. These include
- The stage of your cancer
- Any other medical conditions you may have
- Your general fitness
Unfortunately mesothelioma
does not always respond to cancer treatments. Doctors and researchers are working to improve mesothelioma treatment all the time. You may be offered
treatment as part of a clinical trial and not as a standard treatment. The results of the trials will be used to improve treatment in the future. There
is information about taking part in a clinical trial in CancerHelp UK.
Mesothelioma treatment is designed to treat the immediate
area of the primary mesothelioma growth or the whole body. Whole body treatments are called systemic treatments. Localised treatments include surgery and
radiotherapy. Systemic treatments act on cancer cells no matter where they may be in the body and include chemotherapy.
SurgerySurgery is not possible for
everyone with peritoneal mesothelioma. If surgery is possible, the operation is called a peritonectomy. This means removing the peritoneum (the lining of the abdomen)
where the mesothelioma has started growing. In recent years some doctors have been developing a technique known as cytoreductive surgery for peritoneal mesothelioma.
Cytoreductive surgery involves the surgeon carrying out up to 6 different peritonectomy procedures, to remove as much of the cancer as possible. At the same time, or shortly
after, chemotherapy may be given straight into the peritoneal cavity. Doctors have achieved some promising results using these techniques; in one review, about half of the
patients who had been treated in this way were still alive 5 years after. But this is still very experimental treatment and, if it is available, may only be so as part of a clinical
trial.
ChemotherapyChemotherapy uses anti-cancer drugs, which are usually injected into a vein. For mesothelioma, chemotherapy may be given directly into
the abdomen. Depending on the type of chemotherapy drugs used, this treatment can be given weekly or every two to three weeks. Usually the treatment is given
as an outpatient. But it can be given at the same time as cytoreductive surgery, or soon after. The doctor has to make a small cut in the wall of your
abdomen. Then the doctor puts a tube called a catheter through the opening and into your tummy (abdomen). The chemotherapy is given into your
abdominal cavity through the catheter. Some studies have suggested that this can work better if it is heated to a few degrees above body temperature first. This
is called hyperthermic intraoperative intraperitoneal chemotherapy (HIIC). But this is still very experimental treatment and, if it is available, may only be so as part of
a clinical trial. Chemotherapy for peritoneal mesothelioma is given to help control symptoms and to try to slow the cancer down.
Supportive care (Palliative care)
Unfortunately peritoneal mesothelioma is often diagnosed when it is quite advanced. Some people may be too ill to cope with intensive chemotherapy. But you can still
have treatment to try to relieve symptoms such as pain, weight loss and other symptoms such as fluid in the abdomen.
With more advanced peritoneal mesothelioma,
fluid may collect inside your abdomen. If too much fluid collects, it makes your abdomen swell. This can be uncomfortable and heavy.
You can have the fluid drained
off. This is called abdominal paracentesis. It is sometimes called an ascitic tap.
Your care will be managed by a palliative care team. This is a
team of doctors and nurses who are expert in controlling the symptoms of advanced cancer. The team may also include a physiotherapist and a dietician.
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