Peritoneal Mesothelioma

Peritoneal mesothelioma forms in the lining of the abdomen (peritoneum) and makes up around 10% of all mesothelioma cases. Symptoms include abdominal pain, bloating, and fluid buildup in the abdomen. Although mesothelioma often has a poor health outlook (prognosis), peritoneal mesothelioma patients may live 5 years or longer in many cases. Treatment options can help patients live longer.

Fact-Checked and Medically Reviewed By: Dr. Mark Levin

What Is Peritoneal Mesothelioma?

Malignant peritoneal mesothelioma is a type of cancer that develops in the peritoneum. The peritoneum is a thin membrane that covers the abdominal cavity and the organs inside of it, including the stomach, liver, spleen, and intestines.

This type of mesothelioma is rarer than pleural mesothelioma (affecting the lung lining or pleura) and affects around 600 Americans each year. Peritoneal mesothelioma has a more favorable prognosis than pleural, testicular, and pericardial mesothelioma. Patients who undergo treatment may live 5 years or more in most cases.

A person may develop peritoneal mesothelioma after breathing in asbestos fibers. Over time, these fibers can damage healthy cells, leading to malignant mesothelioma of the peritoneal.

Who Is At Risk of Peritoneal Mesothelioma?

Asbestos is the only known cause of peritoneal mesothelioma. Individuals with a high risk of asbestos exposure are more likely to develop peritoneal mesothelioma. High-risk groups include blue-collar workers, veterans, and those who live near asbestos mines or natural deposits.

Family members and friends of those who worked around asbestos may be at risk of developing abdominal mesothelioma through secondhand exposure. This can occur when individuals transmit stray asbestos fibers to others through their skin, hair, clothes, shoes, and more.

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Causes of Peritoneal Mesothelioma

Peritoneal mesothelioma is caused by asbestos fibers harming normal, healthy cells in the abdominal lining.

Learn more about how mesothelioma develops below.

  1. Exposure: Asbestos fibers are swallowed or inhaled and become trapped in the stomach lining.
  2. Buildup: Over time, the fibers irritate healthy cells and damage cell DNA, causing cancer cells to grow and the peritoneum to thicken.
  3. Damage: Mesothelial cells continue to grow and spread, eventually forming tumors.
  4. Cancer: The peritoneal tumors grow rapidly until treatments help to slow their growth by destroying cancer cells.

Peritoneal Mesothelioma Symptoms

The symptoms of peritoneal mesothelioma may not appear until 20-50 years after an individual’s initial exposure to asbestos.

This occurs because asbestos fibers can stay dormant for years, then initiate cancerous change decades after the initial exposure.

Abdominal mesothelioma symptoms tend to be vague and mild, so many patients are not diagnosed until after the cancer has widely spread.

Common symptoms of peritoneal mesothelioma include:

  • Abdominal fluid buildup
  • Abdominal (belly) pain
  • Bloating (abdominal distention)
  • Blood clots
  • Constipation
  • Excessive sweating or night sweats
  • Fatigue
  • Fever
  • Loss of appetite
  • Nausea and vomiting
  • Swelling or fluid in the abdomen (ascites)
  • Unexplained weight loss

If you have been exposed to asbestos and are experiencing any of the symptoms listed above, contact a doctor as soon as possible. The sooner you get a diagnosis, the sooner you can get life-extending treatment. Use our free Doctor Match tool to find a mesothelioma specialist today.

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Peritoneal Mesothelioma Diagnosis

Peritoneal mesothelioma is often diagnosed through a series of tests. Common mesothelioma diagnosis methods include imaging tests, blood tests, and biopsies. Peritoneal mesothelioma does not yet have a formal staging system.

A computed tomography (CT) scan is often the first test used to diagnose peritoneal mesothelioma. Doctors order CT scans to check for abnormalities when a patient first complains of abdominal issues.

The only way to confirm a peritoneal mesothelioma diagnosis is through a biopsy. Doctors will take fluid or tissue samples through a needle from the affected area and use a microscope to look for cancer cells.

Because abdominal mesothelioma symptoms can be vague, mild or go undetected, it is often misdiagnosed. Doctors may misdiagnose the cancer as irritable bowel syndrome (IBS), Crohn’s disease, gallstones, hernias, or ovarian cancer in women.

If you believe you have peritoneal mesothelioma and have been misdiagnosed, it is important to get a second opinion to get an accurate diagnosis.

Prognosis for Peritoneal Mesothelioma

Although mesothelioma is known to have a poor prognosis, peritoneal mesothelioma has the best prognosis of all types of this cancer.

This can vary based on several prognostic factors such as a patient’s overall health, cell type, spread of cancer, available treatment options, and more.

For example, a patient in good overall health will be able to withstand more aggressive treatment options to kill peritoneal mesothelioma cancer cells.

Mesothelioma has three cell types that can greatly impact an individual’s prognosis. Epithelioid cells account for 75-90% of peritoneal mesothelioma cases, and are generally easier to treat compared to sarcomatoid or biphasic cells.

A patient with epithelial peritoneal mesothelioma will likely have a better prognosis and survival time than patients with sarcomatoid or biphasic cells.

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Peritoneal Mesothelioma Life Expectancy

There have been several studies conducted to analyze the life expectancy of peritoneal mesothelioma patients.

A 2009 multi-institutional study found that 405 peritoneal mesothelioma patients that underwent cytoreduction with HIPEC (procedure that involves surgery and heated chemotherapy) had a median overall survival rate of 53 months and a 5-year median life expectancy of 47%.

According to a 2020 study from Rutgers Cancer Institute of New Jersey, the median overall survival (OS) of peritoneal mesothelioma without treatment is 6 months to 1 year.

It is important to keep in mind that life expectancy is not definitive. The best way to improve your prognosis and increase life expectancy is to receive curative mesothelioma treatment.

Peritoneal Mesothelioma Treatment

There are several peritoneal mesothelioma treatment options available to kill cancer cells and prevent cell growth (metastasis). Generally, the best treatment methods for this type of mesothelioma involve surgery and heated chemotherapy drugs to destroy cancer cells in the abdomen.

Your doctor will be able to determine which type of treatment will work best for your specific case.

Learn more about abdominal mesothelioma treatment options below.

Cytoreduction with HIPEC

One of the most effective peritoneal mesothelioma treatment options is cytoreduction with HIPEC, also called the “Sugarbaker Technique.” This surgery was invented by Dr. Paul Sugarbaker to eliminate cancer cells and increase the odds of remission in peritoneal mesothelioma patients.

This two-part process has been proven to effectively treat peritoneal mesothelioma.

Cytoreduction with HIPEC involves two steps:

  1. Perform invasive surgery to remove all visible tumors through a process called debulking. The abdominal lining may also be removed.
  2. Flush the abdominal cavity with hyperthermic (heated) intraperitoneal chemotherapy (HIPEC) to eliminate any leftover cancer cells.

Patients with early-stage mesothelioma in generally good overall health qualify for the cytoreduction with HIPEC procedure.


Chemotherapy aims to shrink abdominal tumors and kill cancer cells. This treatment method is often used for patients that do not qualify to undergo cytoreduction with HIPEC.

Chemotherapy is most effective for peritoneal mesothelioma patients when using pemetrexed in combination with either cisplatin or carboplatin.

Patients with late-stage peritoneal mesothelioma generally receive chemotherapy through an IV drip through the arm.

Palliative Care

Palliative care aims to keep late-stage peritoneal mesothelioma patients comfortable towards the end of their life. This treatment plan is generally used to relieve symptoms and pain.

Radiation can be used to target the mesothelioma and ease uncomfortable symptoms. Unfortunately, radiation can be a risky option since it can damage the abdominal organs.

Another palliative care option for late-stage peritoneal mesothelioma is a fluid drain. Uncomfortable abdominal swelling from the buildup of excess fluid can be managed by draining the fluid through paracentesis or an ascitic tap.

Although radiation can be risky for peritoneal mesothelioma as it can damage the abdominal organs, it may be used in late-stage peritoneal mesothelioma cases to ease symptoms.

Emerging Peritoneal Mesothelioma Treatments

Peritoneal mesothelioma has traditionally been treated with chemotherapy and surgery. However, researchers continue to study this cancer to find new treatment options — and hopefully a cure. Clinical trials of novel drugs are ongoing in mesothelioma.

The most recent advancement in peritoneal mesothelioma treatment is a combination of immunotherapy drugs. A combination of atezolizumab and bevacizumab targets the PD-L1 gene to slow the growth of new blood vessels and cancerous mesothelioma tumors.

The phase II clinical trial by the University of Texas MD Anderson Cancer Center found atezolizumab plus bevacizumab to be well-tolerated for patients with advanced malignant peritoneal mesothelioma. About 61% of patients were progression-free, and 85% had survived for one year.

New and effective treatments such as atezolizumab plus bevacizumab will become available to the general public as researchers continue to refine these emerging methods.

Our team can help you connect with clinical trail programs. Call (866) 608-8933 today.

Top Doctors for Peritoneal Mesothelioma

One of the best ways to improve your diagnosis is to be treated by a top mesothelioma specialist. These doctors have decades of experience to give the best treatment possible to help peritoneal mesothelioma patients live long, healthy lives.

One of the world’s most renowned peritoneal mesothelioma specialists is Dr. Paul Sugarbaker. Dr. Sugarbaker pioneered the cytoreduction with HIPEC procedure and treated over 1,500 cancer patients before his retirement in 2021.

Some top peritoneal mesothelioma specialists currently practicing include:

  • Dr. James Pingpank

    Dr. James Pingpank

    Pittsburgh, PA

    Dr. James Pingpank is a top surgical oncologist specializing in peritoneal mesothelioma. He has dedicated his career to researching this rare disease since there is a lack of available information on how to treat it.

    Dr. Pingpank is currently a surgical oncologist at the University of Pittsburgh Medical Center in Pittsburgh, PA. He is also an associate professor of surgery for the University of Pittsburgh’s School of Medicine.

  • Dr. Hedy Lee Kindler

    Dr. Hedy Lee Kindler

    Chicago, IL

    Dr. Hedy Lee Kindler is a renowned peritoneal mesothelioma specialist that conducts many clinical trials to develop new therapies, improve current therapies, and find a cure for mesothelioma. In addition to her studies, Dr. Kindler is an editor for several oncology publications.

    Dr. Kindler is currently the Director of the Mesothelioma Program and the Director of Gastrointestinal Oncology at the University of Chicago Comprehensive Cancer Center in Chicago, IL.

  • Dr. Richard Alexander

    Dr. Richard Alexander

    New Brunswick, NJ

    Dr. Richard Alexander is a well-known peritoneal mesothelioma surgeon. He chose to specialize in peritoneal mesothelioma after noticing how negative doctors were about its prognosis. Dr. Alexander has published over 250 peer-reviewed articles as well as 50 book chapters in various publications.

    Dr. Alexander is currently the Chief Surgical Officer at Rutgers Cancer Institute in New Brunswick, NJ.

  • Dr. Mecker Möller

    Dr. Mecker Möller

    Miami, FL

    Dr. Mecker Möller is an experienced surgical oncologist and is one of the world’s leading experts in heated chemotherapy. She has conducted several clinical trials throughout her career and has treated patients in Italy, Ireland, and Nicaragua.

    Dr. Möller is currently the developer and leader of the HIPEC peritoneal malignancies program at University of Miami Hospital. She is also an associate professor of surgery at the University of Miami Hospital, Sylvester Cancer Center, and Jackson Memorial Hospital.

Our team can help you connect with a mesothelioma specialist in your area. Use our free doctor match program to get started on your treatment journey.

Support Options for Peritoneal Mesothelioma Victims

A peritoneal mesothelioma diagnosis may leave patients and their families feeling scared for their future. Many families may be worried about paying for costly cancer treatment.

Fortunately, there are several financial support options available for peritoneal mesothelioma victims to help them pay for the treatment they need to improve their health.

Support options for peritoneal mesothelioma victims include:

These support options can hold negligent companies accountable and help you access the treatment you deserve. Asbestos manufacturers knew about the dangers of their products, but chose to hide it from millions in order to make a profit. Mesothelioma victims should not have to suffer due to these companies and their negligence.

Download our free mesothelioma symptoms checklist to keep track of your symptoms and share with your doctor to get an accurate diagnosis.

Common Questions About Peritoneal Mesothelioma

What are the symptoms of peritoneal mesothelioma?

The main symptoms of peritoneal mesothelioma are abdominal pain, bloating, constipation, fatigue, nausea, vomiting, weight loss, and fluid buildup in the abdomen.

If you are experiencing any of these symptoms and may have been exposed to asbestos, it is important to contact a doctor to get an early diagnosis. Getting an accurate diagnosis early on can improve your chances of getting life-extending treatment.

What are common treatment methods for peritoneal mesothelioma?

The most effective treatment for peritoneal mesothelioma is cytoreduction with HIPEC. This procedure removes all visible tumors, and bathes the area with heated chemotherapy drugs to destroy any leftover cancer cells.

Patients that are not able to undergo surgery may also be treated with heated chemotherapy drugs through an IV in the arm or receive palliative care to ease their symptoms.

What are the final stages of peritoneal mesothelioma?

Patients with late-stage peritoneal mesothelioma may experience a lot of pain from abdominal swelling and thickening as well as other symptoms. Doctors will generally give palliative care to relieve any pain for patients in the final stages of cancer.

Can peritoneal mesothelioma go into remission?

Yes. There are peritoneal mesothelioma patients that have reached full or partial remission. Peritoneal mesothelioma patients treated with cytoreduction with HIPEC have the best chance of remission due to the effectiveness of the procedure.

Has anyone survived peritoneal mesothelioma?

Yes, there are many peritoneal mesothelioma survivors. For example, Alexandra was diagnosed with peritoneal mesothelioma at 42 years old. She underwent surgery to remove tumors and part of her diaphragm, and is still living more than 5 years later.

Reviewed by:Dr. Mark Levin

Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Mark Levin, MD has over 30 years of experience in academic and community hematology and oncology. In addition to serving as Chief or Director at four different teaching institutions throughout his life, he is also still a practicing clinician, has taught and designed formal education programs, and has authored numerous publications in various fields related to hematology and oncology.

Dr. Mark Levin is an independently paid medical reviewer.

  • Board Certified Oncologist
  • 30+ Years Experience
  • Published Medical Author

Mesothelioma Hope was founded by a team of passionate health advocates to educate people about this aggressive form of cancer. Mesothelioma affects thousands of people each year. Our team works tirelessly to give hope to those impacted by mesothelioma. Learn more about operating principles and our Editorial Guidelines.

18 References
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  2. Alexander, H., Turner, K. M., & Varghese, S. (2011, June). Surgery for peritoneal mesothelioma. Retrieved August 04, 2021, from

  3. Alexander, R., Jr. (n.d.). Malignant peritoneal mesothelioma: Epidemiology, risk factors, clinical presentation, diagnosis, and staging (1445317598 1048571138 K. K. Tanabe & 1445317599 1048571138 D. M. Savarese, Eds.). Retrieved August 04, 2021, from

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  5. Drug combination shows meaningful responses for malignant peritoneal mesothelioma patient. (2021, July 14). Retrieved August 04, 2021, from

  6. Faig, J., Howard, S., Levine, E., Casselman, G., Hesdorffer, M., & Ohar, J. (2015, March 03). Changing pattern in malignant mesothelioma survival. Retrieved August 10, 2021, from

  7. Kim, J., Bhagwandin, S., & Labow, D. M. (2017). Malignant peritoneal mesothelioma: A review. Annals of Translational Medicine, 5(11), 236-236. doi:10.21037/atm.2017.03.96

  8. Lie, C. Y., & Alexander, H. (2018, July). Peritoneal metastases from MALIGNANT MESOTHELIOMA. Retrieved August 04, 2021, from

  9. Magge, D., Zenati, M. S., Austin, F., Mavanur, A., Sathaiah, M., Ramalingam, L., . . . Choudry, H. A. (2013). Malignant peritoneal mesothelioma: Prognostic factors and Oncologic OUTCOME ANALYSIS. Annals of Surgical Oncology, 21(4), 1159-1165. doi:10.1245/s10434-013-3358-y

  10. Marinaccio, A., Corfiati, M., Binazzi, A., Di Marzio, D., Scarselli, A., Ferrante, P., . . . Iavicoli, S. (2017). The epidemiology of malignant mesothelioma in women: Gender differences and modalities of asbestos exposure. Occupational and Environmental Medicine, 75(4), 254-262. doi:10.1136/oemed-2016-104119

  11. Munkholm-Larsen, S. (2009). Malignant peritoneal mesothelioma. World Journal of Gastrointestinal Surgery, 1(1), 38. doi:10.4240/wjgs.v1.i1.38

  12. Risk factors for malignant mesothelioma. (n.d.). Retrieved August 04, 2021, from

  13. Shavelle, R., Vavra-Musser, K., Lee, J., & Brooks, J. (2017, January 23). Life expectancy in pleural and peritoneal mesothelioma. Retrieved August 04, 2021, from!po=35.0000

  14. Staging & prognosis for peritoneal mesothelioma. (2020, May 27). Retrieved August 04, 2021, from

  15. Treatment for Peritoneal Mesothelioma. (2021, April 20). Retrieved August 04, 2021, from

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  17. What causes malignant Mesothelioma? (n.d.). Retrieved August 04, 2021, from

  18. Shavelle R, Vavra-Musser K, Lee J, Brooks J. Life Expectancy in Pleural and Peritoneal Mesothelioma. Lung Cancer Int. 2017;2017:2782590. doi:10.1155/2017/2782590

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