Peritoneal Mesothelioma

Peritoneal mesothelioma forms in the lining of the abdomen, which is also known as the peritoneum. It makes up around 10% of all mesothelioma cases. Symptoms include abdominal pain, bloating, and fluid buildup. Although mesothelioma usually has a poor prognosis, some peritoneal mesothelioma patients have lived 5 years or longer with treatment.

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 (which affects the lung lining, or pleura). Between 300 and 500 Americans are diagnosed with peritoneal mesothelioma each year. Peritoneal mesothelioma has a more favorable prognosis than pleural, testicular, and pericardial mesothelioma. Patients who undergo treatment can live 5 years or more.

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.

Who Is At Risk of Peritoneal Mesothelioma?

Asbestos is the most common risk factor for peritoneal mesothelioma. Individuals who have been exposed to asbestos are more likely to develop peritoneal mesothelioma later in life. 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 also be at risk of developing peritoneal mesothelioma through secondhand asbestos exposure. This can occur when individuals transmit stray asbestos fibers to others through their skin, hair, clothes, shoes, and more.

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Peritoneal Mesothelioma Causes

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: 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 10 to 50 years after an individual’s initial exposure to asbestos.

This occurs because asbestos fibers remain in the body for years while irritating healthy tissue, which can initiate cancerous change decades after exposure to asbestos took place.

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

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 potentially life-extending treatment. 

Download our Free Symptoms Checklist to track any signs of mesothelioma and share them with your doctor so you can get an accurate diagnosis.

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How Is Peritoneal Mesothelioma Diagnosed?

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 symptoms of peritoneal mesothelioma can be vague, mild, or go undetected, this type of cancer is often misdiagnosed. Doctors may misdiagnose peritoneal mesothelioma as irritable bowel syndrome (IBS), Crohn’s disease, 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.

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.

The prognosis for peritoneal mesothelioma depends on several factors, including the patient’s overall health, how far their cancer has spread, cell type,  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.

Additionally, there are three types of mesothelioma cancer cells that can greatly impact an individual’s prognosis. Epithelioid cells account for roughly 70% 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.

Peritoneal Mesothelioma Life Expectancy

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

The peritoneal mesothelioma survival rate in a 2009 multi-institutional study found that 405 peritoneal mesothelioma patients who underwent cytoreduction with HIPEC (a procedure that involves surgery and heated chemotherapy) had a median overall life expectancy 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 your life expectancy is not set in stone. The best way to improve your prognosis and increase your life expectancy is to receive curative mesothelioma treatment.

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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 peritoneal 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 developed by Dr. Paul Sugarbaker to eliminate cancer cells and increase the odds of remission in peritoneal mesothelioma patients.

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 effectively treat peritoneal mesothelioma.

Cytoreduction with HIPEC involves two steps:

  1. The surgeon will remove all visible tumors through a process called debulking. The abdominal lining may also be removed.
  2. The patient’s peritoneal cavity will be flushed with hyperthermic (heated) intraperitoneal chemotherapy (HIPEC) to kill any remaining cancer cells.

Patients with early-stage peritoneal mesothelioma who are in good overall health may qualify for cytoreduction with HIPEC.

To learn more about this procedure and determine whether you’re a candidate for surgery, reach out to our Patient Advocates today at (866) 608-8933.


Chemotherapy is used to shrink abdominal tumors and kill cancer cells. This treatment method is often used for patients who are unable 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 in the arm.

Palliative Care

The goal of palliative care is to help keep late-stage peritoneal mesothelioma patients comfortable toward the end of their life. This treatment plan is generally used to relieve symptoms and pain.

Radiation therapy can be used to target cancer cells and ease uncomfortable symptoms. However, radiation can be a risky option for peritoneal mesothelioma patients 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 a slender needle during a process known as paracentesis (also called an ascitic tap).

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

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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. Ongoing clinical trials are testing the use of novel drugs and targeted therapies to treat mesothelioma.

The most recent advancement is in immunotherapy for peritoneal mesothelioma. New treatments combine the immunotherapy drugs atezolizumab and bevacizumab to target the PD-L1 gene and slow the growth of new blood vessels and cancerous mesothelioma tumors.

A phase II clinical trial conducted 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% 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 Patient Advocates can help you find active clinical trials. Get started by calling (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 doctor. These specialists 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 leads the HIPEC peritoneal malignancies program at the University of Miami Miller School of Medicine. She is a surgical oncologist at the Sylvester Comprehensive Cancer Center.

We can help you find leading specialists and cancer centers in your area. Use our Free Mesothelioma Doctor Match to get started.

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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 them from millions in order to make a profit. Mesothelioma victims should not have to suffer due to these companies and their negligence.

No matter where you are in your journey with peritoneal mesothelioma, we’re ready to meet you there.

Start now by requesting your Free Mesothelioma Care Package, which includes:

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Peritoneal Mesothelioma FAQs

What are the symptoms of peritoneal mesothelioma?

The main symptoms of peritoneal mesothelioma include:

  • Abdominal pain
  • Bloating, constipation
  • Fatigue
  • Fluid buildup in the abdomen
  • Nausea
  • Vomiting
  • Weight loss

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 cytoreductive surgery and 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, a patient named 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
Written by:

Lead Editor

Laura Wright is a journalist and content strategist with more than 15 years of professional experience. She attended college at the University of Florida, graduating magna cum laude with a bachelor’s degree in journalism in 2008. Her writing has been featured in The Gainesville Sun and other regional publications throughout Florida.

18 References
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  2. Alexander, H., Turner, K. M., & Varghese, S. (2011, June). Surgery for peritoneal mesothelioma. Retrieved from: Accessed on December 30, 2022.

  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 from: Accessed on December 30, 2022.

  4. Chemotherapy for peritoneal mesothelioma. (2021, July 20). Retrieved from: Accessed on December 30, 2022.

  5. Drug combination shows meaningful responses for malignant peritoneal mesothelioma patient. (2021, July 14). Retrieved from: Accessed on December 30, 2022.

  6. Faig, J., Howard, S., Levine, E., Casselman, G., Hesdorffer, M., & Ohar, J. (2015, March 03). Changing pattern in malignant mesothelioma survival. Retrieved from: Accessed on December 30, 2022.

  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 from: Accessed on December 30, 2022.

  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 from: Accessed on December 30, 2022.

  13. Shavelle, R., Vavra-Musser, K., Lee, J., & Brooks, J. (2017, January 23). Life expectancy in pleural and peritoneal mesothelioma. Retrieved from:!po=35.0000. Accessed on December 30, 2022.

  14. 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

  15. Staging & prognosis for peritoneal mesothelioma. (2020, May 27). Retrieved from: Accessed on December 30, 2022.

  16. Treatment for Peritoneal Mesothelioma. (2021, April 20). Retrieved from: Accessed on December 30, 2022.

  17. Treatment options for peritoneal mesothelioma. (2021, June 23). Retrieved from: Accessed on December 30, 2022.

  18. What causes malignant Mesothelioma? (n.d.). Retrieved from: Accessed on December 30, 2022.

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