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Peritoneal Mesothelioma

Malignant peritoneal mesothelioma is a rare cancer that forms in the abdominal lining (peritoneum) caused by asbestos exposure. Symptoms include belly pain, bloating, and fluid buildup (ascites). Peritoneal mesothelioma patients often have the best prognosis with many becoming survivors, living for more than 15 years after treatment.

Medically reviewed by: Mark Levin, MD

Last updated:

What Is Peritoneal Mesothelioma?

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

This type of mesothelioma is rarer than pleural mesothelioma, which affects the tissue covering the outside of the lungs and the inside of the chest cavity (pleura).

Some patients undergo peritoneal mesothelioma surgery in combination with heated chemotherapy to extend their lives.

Quick Facts About Mesothelioma in the Abdomen
  • About 300-500 cases are diagnosed each year in the United States, as per MD Anderson Cancer Center.
  • The biggest risk factor is a history of asbestos exposure.
  • Women are more likely than men to develop this cancer.
  • Peritoneal mesothelioma has a more favorable prognosis than other types of mesothelioma.
  • This cancer is also known as mesothelioma of the peritoneum or mesothelioma of the stomach.

Learn more about peritoneal mesothelioma — and the latest treatment options — in our Free Mesothelioma Guide.

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Causes of Abdominal Mesothelioma Cancer

The only proven cause of peritoneal mesothelioma is asbestos exposure. When these (cancer-causing) fibers are inhaled or swallowed, they can harm normal, healthy tissue.

Learn how asbestos causes peritoneal mesothelioma to develop.

  1. Exposure: A person inhales or swallows microscopic asbestos fibers.
  2. Buildup: These fibers become trapped in the tissue of the abdominal lining and begin to irritate healthy cells.
  3. Damage: Cell DNA mutations cause cancerous mesothelial cells to grow. The peritoneum begins to thicken, and fluid accumulates.
  4. Cancer: Mesothelial cells grow and spread, eventually leading to tumor growth.
An illustration of asbestos fibers in the lining of the abdomen (peritoneum) causing the formation of mesothelioma cancer cells
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 peritoneum.

Mesothelioma Peritoneal Cancer Symptoms

Peritoneal mesothelioma symptoms may not appear until 10 to 50 years after a person was first exposed to asbestos.

Symptoms tend to be vague and mild, so many patients are not diagnosed until after the cancer has spread to organs in the abdomen.

Common symptoms include:

  • Abdominal fluid buildup (peritoneal ascites)
  • Abdominal (belly) pain
  • Bloating (abdominal distention)
  • Constipation or bowel blockage (obstruction)
  • Fever or night sweats
  • Loss of appetite
  • Nausea and vomiting
  • Unexplained weight loss

If you have been exposed to asbestos and are experiencing any of these symptoms, contact a doctor as soon as possible. The sooner you get a diagnosis, the sooner you can get potentially life-extending treatment.

We offer a Free Doctor Match service to help you connect with experienced mesothelioma specialists. Take the first step toward a healthier future now.

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Peritoneal Mesothelioma Diagnosis

Peritoneal mesothelioma is diagnosed through a series of tests. Common mesothelioma diagnosis methods include imaging tests, blood tests, and biopsies.

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

Did You Know?

A biopsy is the only way to confirm a peritoneal mesothelioma diagnosis.

Doctors will use surgical tools to remove and examine a tissue sample for cancer cells.

However, because symptoms of abdominal mesothelioma can be mild or vague, this type of cancer is often misdiagnosed as irritable bowel syndrome (IBS), gallstones, hernias, or ovarian cancer.

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

Our team can help you connect with a top peritoneal mesothelioma specialist for a second opinion. Call our Patient Advocates at (866) 608-8933 right now.

Peritoneal Mesothelioma Staging

Mesothelioma staging refers to how far the cancer has advanced. Peritoneal mesothelioma does not have a formal staging system.

However, doctors use the peritoneal cancer index (PCI) to analyze this cancer. The PCI divides the abdomen into 13 sections, giving each of those sections a number from 0-3. Zero means there is no cancer, while 3 indicates that an area has cancer present.

Here are the 4 PCI stages:

  1. Stage 1: PCI score of 1-10
  2. Stage 2: PCI score of 11-20
  3. Stage 3: PCI score of 21-30
  4. Stage 4: PCI score of 31-39

Peritoneal Mesothelioma Prognosis

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

Many patients can live for years with aggressive treatments. Some patients even become long-term survivors, living for 15 years or more.

A patient’s individual prognosis depends on several factors, including their overall health and how far their cancer has spread.

Other prognostic factors include:

  • Cell type: Patients with epithelioid cells, the most common mesothelioma cell type, have a better prognosis than those with sarcomatoid or biphasic cells.
  • Sex: Women and individuals assigned female at birth usually have more positive survival outcomes than their male counterparts.
  • Treatment success: People have a better prognosis when their mesothelioma specialist can remove all tumors.

Peritoneal Mesothelioma Survival Rate and Life Expectancy

Mesothelioma prognosis is usually measured by survival rate (percentage of patients alive after a period of time) and life expectancy (average length of time patients live after a diagnosis).

Here are some statistics on peritoneal mesothelioma survival rates:

  • The median overall survival (OS) of patients who do not receive treatment is 6 months to 1 year, according to a 2020 study from Rutgers Cancer Institute of New Jersey.
  • Cleveland Clinic reports that patients who receive a surgery-chemotherapy combination known as cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) live 2-6 years after diagnosis.
  • Research cited in Cancer Management and Research noted that the 5-year survival rate (percentage of patients who were living 5 years after diagnosis) was 47% for a group of 405 patients who underwent cytoreduction with HIPEC. The median OS was 53 months.

It’s important to remember that peritoneal mesothelioma life expectancy is not carved in stone. Some patients have lived for over a decade after their diagnosis, becoming mesothelioma survivors and symbols of hope and inspiration for others battling this cancer.

For example, Julie Gundlach was diagnosed in 2006 at age 35, and Alexis Kidd was diagnosed in 2007 at age 37. Both are still alive today — nearly two decades after learning that they had this devastating disease.

“That is, without a doubt, a miracle. Getting to see a life that I never thought I’d see.”

- Quote from Julie Gundlach, 17+ year mesothelioma survivor

The best way to improve your prognosis and increase your life expectancy is to receive curative mesothelioma treatment from a specialist.

Learn more about Julie, Alexis, and other mesothelioma patients who beat the odds in our Free Survivors Guide.

Treatment for Malignant Peritoneal Mesothelioma

Several peritoneal mesothelioma treatment options are available to kill cancerous cells and prevent them from spreading (metastasis). While pleural mesothelioma often spreads to the lymph nodes, resulting in a faster metastasis (spread), peritoneal mesothelioma tends to stay confined in the abdomen, endangering the local tissue and organs there.

The most common treatment for this type of mesothelioma involves surgery and heated chemotherapy.

“The heat causes the dose to be much stronger than standard chemotherapy.”
– Cleveland Clinic

Learn more about the top treatment options for peritoneal mesothelioma below.

Cytoreduction With HIPEC

One of the most effective peritoneal mesothelioma treatment options is cytoreduction with HIPEC. In the 1980s, Dr. Paul Sugarbaker developed this surgical treatment, which has been nicknamed the “Sugarbaker Procedure,” to increase the odds of remission in patients. Today, the procedure is still considered the premier treatment for the disease.

An illustration of the two steps involved in cytoreduction with HIPEC: Surgical removal of tumors in the lining of the abdomen (peritoneum) followed by heated chemotherapy liquid introduced into the abdomen through a catheter tube. The liquid chemo therapy solution is then drained from the abdomen.
This two-part process has been proven to treat peritoneal mesothelioma effectively.

Cytoreduction with HIPEC has 2 steps:

  1. The surgeon removes all visible malignant cancer tumor tissue through a process called debulking and parts of the peritoneum and organs where the cancer has spread.
  2. The patient’s peritoneal cavity is flushed with hyperthermic (heated) intraperitoneal chemotherapy (HIPEC) to kill any remaining cancer.

A doctor specializing in mesothelioma can determine which type of treatment will work best for your specific circumstance.

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In addition to surgery for peritoneal mesothelioma, there are many other types of treatment that can be utilized to extend life and improve symptoms.

Chemotherapy for Peritoneal Mesothelioma

Chemotherapy is used to shrink abdominal tumors and kill cancerous cells. Patients who are unable to undergo cytoreduction with HIPEC often receive systemic chemotherapy (chemotherapy that travels throughout the body).

Studies have found that the chemotherapy drug pemetrexed (Alimta) alone or combined with cisplatin gives peritoneal mesothelioma patients the best chance of survival.

Did You Know?

One woman with advanced peritoneal mesothelioma achieved full remission after chemotherapy, according to a 2023 case study published in BMJ Case Reports. The patient had 18 rounds of chemotherapy with pemetrexed and bevacizumab over 13 months.

Immunotherapy

Immunotherapy for peritoneal mesothelioma is a promising new treatment option. Immunotherapy drugs help a person’s immune system locate and kill tumor growth. They have fewer side effects than chemotherapy.

A research study in the March 2023 edition of Oncology reported on 24 patients treated with the immunotherapy drug pembrolizumab. Of the participants, 21% had a decrease in cancer and 53% had stable disease (tumors that didn’t grow or shrink). The median overall survival was 20.9 months.

Peritoneal Mesothelioma Palliative Care

Palliative care aims to help keep late-stage peritoneal mesothelioma patients comfortable toward the end of their lives by relieving symptoms and pain.

Radiation therapy can be used to target a tumor and ease uncomfortable symptoms. However, radiation can be risky for this type of mesothelioma because it can damage the organs in the stomach.

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 a slender needle during a process known as paracentesis (also called an ascitic tap).

Learn more about which peritoneal mesothelioma treatment options may be right for you in our Free Mesothelioma Guide.

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Peritoneal Mesothelioma Clinical Trials and Emerging Therapies

Clinical trials allow researchers to test cutting-edge treatments for mesothelioma of the abdomen.

One new treatment is pressurized intraperitoneal aerosol chemotherapy (PIPAC), which uses gas to deliver chemotherapy to the abdomen.

A 2019 study found that PIPAC allowed the chemotherapy to penetrate deeper into the body, resulting in positive outcomes. One patient in the study achieved full remission.

In a phase II clinical trial, MD Anderson Cancer Center researchers combined the immunotherapy drug atezolizumab with the chemotherapy drug bevacizumab to treat patients with advanced malignant peritoneal mesothelioma. In 40% of the cases, tumor shrinkage occurred, and 85% of the patients were still alive after 1 year.

“This data shows that [immunotherapy combined with chemotherapy] is a reasonable treatment option and reiterates the importance of clinical trials for rare cancers to extend patient survival.”
– Dr. Kanwal Raghav, MD Anderson Cancer Center

Our Patient Advocates can help you find active clinical trials. Get started by calling (866) 608-8933 today.

Peritoneal Mesothelioma Doctors

One of the best ways to improve your prognosis is to be treated by a top mesothelioma doctor. These specialists have decades of experience treating mesothelioma and are best suited to help patients live longer.

Some top specialists currently practicing include:

Dr. James Pingpank

Dr. James Pingpank

15+ years of experience

Surgical Oncologist at the University of Pittsburgh Medical Center in Pittsburgh, PA, and Associate Professor of Surgery for the University’s School of Medicine

Dr. Hedy Lee Kindler

Dr. Hedy Lee Kindler

25+ years of experience

Director of the Mesothelioma Program and Medical Director of Gastrointestinal Oncology at the University of Chicago Comprehensive Cancer Center

Dr. Richard Alexander

Dr. Richard Alexander

25+ years of experience

Chief Surgical Officer at Rutgers Cancer Institute in New Brunswick, NJ, and System Director of Surgical Oncology at RWJBarnabas Health in West Orange, NJ

Dr. Mecker Möller

Dr. Mecker Möller

15+ years of experience

Associate Professor of Surgery and Leader of the HIPEC Peritoneal Malignancies Program at the University of Miami Miller School of Medicine in Miami, FL

If you need help selecting a doctor or connecting with one near you, use our Free Doctor Match Program to get the care you need.

Financial Assistance Options for Peritoneal Mesothelioma Cancer Victims

A peritoneal mesothelioma diagnosis may leave patients feeling scared for their future, wondering how it will affect their families and loved ones. Many families are worried about paying for costly cancer treatment for this disease.

Fortunately, several financial support options are available to help victims pay for the treatment they need to improve their health:

Asbestos Trust Funds

Bankrupt asbestos companies were court-ordered to set aside money to compensate victims, and more than $30 billion is currently available in these asbestos trust funds.

Mesothelioma Lawsuits

Peritoneal mesothelioma patients and their families can file lawsuits to pursue compensation from manufacturers of asbestos-containing products. On average, most mesothelioma lawsuits settle for $1 million to $1.4 million.

VA Benefits and Health Care

Military veterans with peritoneal mesothelioma can file for VA benefits through the U.S. Department of Veterans Affairs (VA). These benefits include 100% VA disability payments of almost $4,000 per month in many cases plus medical care from the VA health care system.

Request your Free Mesothelioma Guide now to get more information about financial and medical assistance that may be available to you.

Peritoneal Mesothelioma Cancer FAQs

How do people get peritoneal mesothelioma?

The only known cause of malignant peritoneal mesothelioma is asbestos exposure.

When people inhale or swallow the carcinogenic fibers, the fibers become embedded in stomach tissue and irritate healthy cells. Over time, the damage can cause cancerous cells to grow and spread.

What are the symptoms of peritoneal mesothelioma cancer?

Symptoms of peritoneal mesothelioma cancer include abdominal pain or swelling, nausea, and unexplained weight loss.

If you are experiencing any of these symptoms and may have been exposed to asbestos, you should see a doctor as soon as possible.

What is the survival rate of peritoneal mesothelioma?

Patients who undergo a treatment option called cytoreductive surgery with HIPEC have a 5-year survival rate of about 50%. That means that half of these patients live 5 years or more after surgery.

Patients who do not receive treatment usually have less favorable outcomes. In most cases, these individuals live less than 1 year.

How long can you live with peritoneal mesothelioma?

Peritoneal mesothelioma patients live for 53 months on average with cytoreductive surgery. However, some patients — like 17+ year peritoneal mesothelioma survivor Julie Gundlach — have lived for over 10 years. 

Early diagnosis and treatment can greatly improve your life expectancy. If you or someone you know has been diagnosed with peritoneal mesothelioma, make sure to visit a specialist as soon as possible to discuss your treatment options.

Is peritoneal mesothelioma curable?

Sadly, there is no cure for this cancer. However, some treatments have been able to help patients live longer and even become mesothelioma survivors.

Patients tend to have more positive outcomes when they are treated before tumor spread has occurred.

Call our Patient Advocates at (866) 608-8933 to connect with top mesothelioma doctors near you.

Dr. Mark LevinReviewed by:Mark Levin, MD

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 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
Jenna TozziWritten by:

Director of Patient Advocacy

Jenna Tozzi, RN, is the Director of Patient Advocacy at Mesothelioma Hope. With more than 15 years of experience as an adult and pediatric oncology nurse navigator, Jenna provides exceptional guidance and support to mesothelioma patients and their loved ones. Jenna has been featured in Oncology Nursing News and is a member of the Academy of Oncology Nurse & Patient Navigators & the American Nurses Association.

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References
  1. Cancer Research UK. “Chemotherapy for peritoneal mesothelioma.” Retrieved February 2, 2024, from https://www.cancerresearchuk.org/about-cancer/mesothelioma/treatment/chemotherapy/peritoneal
  2. Cleveland Clinic. (n.d.) “Peritoneal Mesothelioma.” Retrieved February 2, 2024, from https://my.clevelandclinic.org/health/diseases/23973-peritoneal-mesothelioma
  3. Enomoto, L. M., Shen, P., Levine, E. A., & Votanopoulos, K. I. (2019). Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma: patient selection and special considerations. Cancer management and research, 11, 4231–4241. Retrieved February 2, 2024, from https://doi.org/10.2147/CMAR.S170300
  4. Kim, J., Bhagwandin, S., & Labow, D. M. (2017). Malignant peritoneal mesothelioma: a review. Annals of translational medicine, 5(11), 236. Retrieved February 2, 2024, from https://doi.org/10.21037/atm.2017.03.96
  5. Lee, J., Turetsky, J., Nasri, E., & Rogers, S. C. (December 2023). Complete clinical remission of malignant peritoneal mesothelioma with systemic pemetrexed and bevacizumab in a patient with a BAP1 mutation. BMJ Case Reports. Retrieved February 2, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10749116/
  6. Lie, C. Y., & Alexander, H. (2018, July). Peritoneal metastases from MALIGNANT MESOTHELIOMA. Retrieved on February 2, 2024, from https://pubmed.ncbi.nlm.nih.gov/29935688/
  7. Marmarelis, M. E., et al. (2023). Clinical Outcomes Associated With Pembrolizumab Monotherapy Among Adults With Diffuse Malignant Peritoneal Mesothelioma. JAMA network open, 6(3), e232526. Retrieved February 2, 2024, from https://doi.org/10.1001/jamanetworkopen.2023.2526
  8. MD Anderson Cancer Center. (2021, September 15) “6 things to know about peritoneal mesothelioma.” Retrieved on February 2, 2024, from https://www.mdanderson.org/cancerwise/what-is-peritoneal-mesothelioma-diagnosis-and-treatment.h00-159464001.html
  9. MD Anderson Cancer Center. (2021, July 14) “Atezolizumab and bevacizumab show meaningful responses for malignant peritoneal mesothelioma patients.” Retrieved February 2, 2024, from https://www.mdanderson.org/newsroom/atezolizumab-and-bevacizumab-show-meaningful-responses-for-malignant-peritoneal-mesothelioma-patients.h00-159462423.html
  10. Mesothelioma Applied Research Foundation. “Treatment for Peritoneal Mesothelioma.” Retrieved February 2, 2024, from https://www.curemeso.org/mesothelioma-treatment-plan/treatment-overview/treatment-for-peritoneal-mesothelioma/
  11. Shavelle, R., Vavra-Musser, K., Lee, J., & Brooks, J. (2017, January 23). Life expectancy in pleural and peritoneal mesothelioma. Retrieved on February 2, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292397/#!po=35.0000
  12. Somashekhar, S. P., et al. (2019). Pressurized intraperitoneal aerosol chemotherapy procedure for nonresectable peritoneal carcinomatosis: First Indian study. South Asian journal of cancer, 8(1), 27–30. Retrieved February 2, 2024, from https://doi.org/10.4103/sajc.sajc_92_18
  13. Verma, V., et al. (2018). Malignant Peritoneal Mesothelioma: National Practice Patterns, Outcomes, and Predictors of Survival. Annals of surgical oncology, 25(7), 2018–2026. Retrieved February 2, 2024, from https://doi.org/10.1245/s10434-018-6499-1
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