Peritoneal mesothelioma is a rare cancer that is similar to pleural mesothelioma (a cancer of the lining of the lung). It is believed to be caused primarily by asbestos exposure and if you can demonstrate prior asbestos exposure you might be entitled to compensation from the Dust Diseases Board in your state. In our unit we recommend peritonectomy and HIPEC as the standard treatment.
- Mesothelioma is a highly aggressive primary neoplasm of the serosal lining of the pleura, peritoneum, pericardium, or tunica vaginalis.
- Asbestos is the main cause however it has been less association with peritoneal than pleural.
- Australia previously had the highest per capita rate of asbestos use in the world and therefore higher incidence of mesothelioma.
- Approximately 13,000 known cases of mesothelioma in Australia since 1980.
- Incidence is expected to peak in 2020 due to prolonged latency.
- Peritoneal mesothelioma accounts for 25–33 % of all mesotheliomas.
- Highly resistant to chemotherapy treatment resulting in high mortality rates and poor prognosis 5 year survival <1% without treatment.
Histological classifications are :
- Biphasic (mixed)
- Well diff papillary
Peritoneal mesothelioma patients usually presented with the following symptoms:
- Abdomen Pain
- Ascites Anorexia
- Vomiting and weight loss
- Bowel obstruction
- Urinary problems
- Fever and or abdominal mass
What are the alternatives?
The median survival of patients with peritoneal mesothelioma who underwent systemic chemotherapy as only treatment is 9-15 month. However, CRS and HIPEC for patients with peritoneal mesothelioma showed that the Median Survival 53 months and 50% of our patients are alive after 5 years.
Adjuvant systemic chemotherapy appears to delay recurrence and seems to offer survival benefit. However, upfront cytoreduction surgery and HIPEC appears to be preferable to Neoadjuvant chemotherapy in patients amenable to complete CRS.
There important prognostic factors that could affect patients with peritoneal mesothelioma survival like
- Lymph node status
- Histopathology type
- Completion of cytoreduction
- Completion cytoreduction
Our indication for CRS and HIPEC Periotneal mesothelioma are:
- Able to do complete cytoreduction
- No extra-abdominal disease
- Recurrent Mesothelioma
- NO PCI limit
What are the reasons for recommending Peritonectomy?
Based on our results, chances of living 5 years after peritonectomy and HIPEC for peritoneal mesothelioma are approximately 50%. The HIPEC used for mesothelioma is mitomycin C and cisplatin.
What are the alternatives?
The alternative treatment is chemotherapy with pemetrexed and cisplatin. We expect about 20% of individuals to get a response to this chemotherapy. The chances of living 5 years with chemotherapy alone are less than 20%. There are no randomised trials comparing treatments.