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Peritoneal mesothelioma grows in the lining of the abdomen, causing swelling, pain and fluid. Unlike its pleural cousin it is often treated with major surgery to strip the lining followed by heated chemotherapy washed through the abdomen, which can give long survival in fit patients with epithelioid disease.
Peritoneal mesothelioma presents with abdominal distension from ascites, pain, weight loss or a mass found at surgery, and is diagnosed by laparoscopic biopsy with the same immunohistochemistry as pleural disease. Asbestos exposure is found in only a minority; BAP1 germline mutations account for some cases, and the disease is commoner in women than pleural mesothelioma. For fit patients with epithelioid histology and disease that can be removed, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard in specialist centres and gives median survival of five years or more in series, though no randomised trial exists. Patients who are not candidates receive platinum-pemetrexed chemotherapy, with immunotherapy increasingly used on the basis of small trials and the pleural data. Well-differentiated papillary and multicystic forms behave almost benignly and are managed separately.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
About one in ten mesotheliomas; a few hundred cases a year in the US. The asbestos link is weaker than in the pleura, it affects more women and younger people, and selected patients live many years after surgery.
Right-sided tumours behave differently from left-sided and rectal ones; the colon drains along its mesenteric vessels, the rectum into the mesorectum and pelvic side wall.
Same organ: Colon cancer (adenocarcinoma of the colon), Micropapillary adenocarcinoma of the colon and rectum, Adenoma-like adenocarcinoma of the colon and rectum, Lynch syndrome-associated colorectal cancer, Familial adenomatous polyposis-associated colorectal cancer, Mucinous adenocarcinoma of the colon and rectum, Signet ring cell carcinoma of the colon and rectum, Medullary carcinoma of the colon, Serrated adenocarcinoma of the colon and rectum, Colorectal cancer, Rectal cancer, Mismatch-repair deficient (MSI-high) colorectal cancer, BRAF V600E-mutant colorectal cancer, HER2-amplified colorectal cancer, KRAS G12C-mutant colorectal cancer, Early-onset colorectal cancer (under 50), Anal cancer (squamous cell carcinoma), Appendiceal cancer and pseudomyxoma peritonei, Small intestine cancer (small bowel adenocarcinoma), Small intestinal neuroendocrine tumours, Anal high-grade squamous intraepithelial lesions (precursor), Localised anal squamous cell carcinoma (stage I to III), Metastatic and recurrent anal squamous cell carcinoma, Low-grade appendiceal mucinous neoplasm and pseudomyxoma peritonei, Appendiceal adenocarcinoma (mucinous and non-mucinous, including signet ring cell), Goblet cell adenocarcinoma of the appendix, Localised small bowel adenocarcinoma (stage I to III, resected), Advanced and metastatic small bowel adenocarcinoma
CT, laparoscopy with biopsy and scoring of disease extent; germline BAP1 testing when young or with a family history.
Cytoreductive surgery with HIPEC in an experienced centre; long-term survival in a substantial fraction.
Platinum-pemetrexed chemotherapy; nivolumab plus ipilimumab or pembrolizumab combinations extrapolated from pleural trials and small peritoneal series.
Well-differentiated papillary and multicystic tumours: surgical removal and surveillance; systemic therapy rarely needed.
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Immunotherapy combinations, largely extrapolated from pleural trials, now have direct supporting data in peritoneal mesothelioma and are used after or instead of chemotherapy in unresectable disease.
Nivolumab-ipilimumab is the preferred first-line treatment for non-epithelioid pleural mesothelioma and an option in epithelioid disease alongside chemo-immunotherapy.
Cytoreductive surgery with HIPEC in an experienced centre is the standard for fit patients with resectable epithelioid peritoneal mesothelioma, a disease that had a median survival of about a year on chemotherapy alone.
Platinum-pemetrexed remains the chemotherapy backbone in mesothelioma, now combined with pembrolizumab or bevacizumab, or replaced by dual immunotherapy in non-epithelioid disease.
Query for this cancer: (TITLE:"Peritoneal mesothelioma" OR ABSTRACT:"Peritoneal mesothelioma" OR TITLE:"Malignant peritoneal mesothelioma" OR ABSTRACT:"Malignant peritoneal mesothelioma" OR TITLE:"MPeM" OR ABSTRACT:"MPeM" OR TITLE:"Diffuse malignant peritoneal mesothelioma" OR ABSTRACT:"Diffuse malignant peritoneal mesothelioma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Peritoneal mesothelioma, not a curated reading list.
Among the earliest descriptions of a primary tumour of the peritoneum.
Peritonectomy procedures and heated intraperitoneal chemotherapy applied to peritoneal surface malignancy.
Yan and colleagues report median survival of 53 months after cytoreduction and HIPEC.
Early phase 2 and retrospective data for nivolumab plus ipilimumab and for atezolizumab plus bevacizumab.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Not recommended for CrCl below 45.
Immunotherapy can attack hormone-producing glands: most often the thyroid (usually ending in an under-active thyroid needing lifelong tablets), and less often the pituitary (hypophysitis) or adrenal glands, which can be life-threatening if missed.
Inflammation of the bowel caused by immunotherapy releasing the immune system against the gut lining, producing diarrhoea that can be severe. It is the commonest serious side effect of CTLA-4 antibodies and is treated with steroids and, if needed, infliximab.
See all on the product pages:IpilimumabNivolumabPembrolizumabPemetrexed·Printable cards in the navigator
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