How Is Peritoneal Mesothelioma Staged?
Imaging scans help doctors estimate the stage of the mesothelioma. These tumors initially form on the lining of the abdomen. As the tumors grow and spread, they migrate outside the lining to lymph nodes and distant organs.
For decades, peritoneal mesothelioma experts developed their own staging system because an official one didn’t exist. Since then, researchers have proposed three stages. A fourth stage is not yet clearly defined.
It is generally accepted that patients with extensive tumor spreading are classified as stage IV.
3 Stages of Peritoneal Mesothelioma
Stage 1
Cancerous tissue is minimal and tumors are contained within the abdominal lining, and lymph nodes are free of cancer.
Stage 2
Cancerous tissue is moderate and tumors have not spread outside the lining or to lymph nodes.
Stage 3
Cancerous tissue is more extensive and tumors may have spread outside the peritoneal lining, to lymph nodes or both.
Treatment Options for Peritoneal Mesothelioma
Although an increasing number of specialists have emerged as treatment leaders for abdominal cancer in recent years, the total number of peritoneal mesothelioma specialists remains small.
If there are no peritoneal malignant mesothelioma specialists nearby, you may consider one in a neighboring state.
Treatment for this type of mesothelioma includes surgery, chemotherapy and experimental therapies such as immunotherapy.
Doctors believe combining traditional treatments often works better than any single treatment. A combination of one or more treatments is called multimodal therapy. Research shows that a multimodal treatment approach usually offers the best improvement in terms of survival.
The most promising peritoneal mesothelioma treatment is cytoreductive surgery combined with heated intraperitoneal chemotherapy (HIPEC).
While doctors only perform surgery with HIPEC on a case-by-case basis, it has extended survival and improved quality of life. In studies on small groups of patients, around half lived five years or longer.
To qualify for surgery with HIPEC, a patient’s cancer must be limited enough for doctors to completely remove with surgery and not have spread beyond the abdomen.
In addition, qualifying patients must be physically fit in order to tolerate the stress of anesthesia and surgery.
Surgery
Surgery is the most promising traditional treatment option for peritoneal mesothelioma in the abdomen, but it is only effective for early-stage cancer. Because doctors most commonly diagnose asbestos-related diseases after the cancer has spread, most surgeries only attempt to remove sections of the tumor.
Surgery can be curative or palliative. Curative surgery aims to remove as much of the tumor as possible in hopes of curing the cancer. Otherwise, doctors may perform palliative surgery, which aims to remove parts of the tumor to relieve symptoms, including bowel obstruction, extend survival and improve quality of life. Palliative therapies do not stop the cancer.
Tumor spread is usually too vast once it reaches beyond the abdomen for surgery to completely remove the cancer. Surgery with a curative intent is not recommended after the cancer has spread. However, a surgery to remove the majority of tumors may be performed to alleviate pain and improve symptoms such as abdominal distention and pain.
Typical surgeries include peritonectomy and cytoreductive surgery, bowel resection and removal of some organs.
Another minor surgical procedure, known as paracentesis, is commonly used on peritoneal mesothelioma patients. A small incision in the abdomen is made to withdraw excess peritoneal fluid, called ascites. This procedure reduces abdominal swelling and pain.
Chemotherapy
Chemotherapy drugs can shrink peritoneal mesothelioma tumors and slow the growth and spread of cancer. It can be given before, during or after surgery. In some cases, doctors offer chemotherapy as the only treatment option. Chemotherapy drugs considered effective against peritoneal mesothelioma include pemetrexed, cisplatin, carboplatin and gemcitabine.
In 2017, Dr. Paul Sugarbaker reported improved survival among patients who received early post-operative chemotherapy and long-term chemotherapy after cytoreductive surgery with HIPEC. All chemotherapy was intraperitoneal chemotherapy, meaning it was applied only to the peritoneum. No systemic chemotherapy was used in the study. Of the 29 patients who had surgery with HIPEC, post-operative chemotherapy and long-term chemotherapy, 75 percent lived longer than five years.
In appropriate patients, the main treatment will be cytoreductive surgery with HIPEC. The surgical part removes all gross tumors with residual deposits smaller than 2 mm. The HIPEC treats the residual tumor and microscopic cancer cells the surgeon can’t see.
LEARN MORE ABOUT CHEMOTHERAPY FOR MESOTHELIOMA
Radiation Therapy
Some studies show radiation therapy can improve peritoneal mesothelioma survival slightly when combined with surgery and chemotherapy. However, doctors tend not to recommend radiation for these patients.
Even though targeted radiation can shrink tumors and slow cancer growth, the procedure is risky because of the location of these tumors. The peritoneum wraps around the stomach, liver and intestines. Aiming radiation at nearby tumors could harm these organs and cause life-threatening damage.
LEARN MORE ABOUT RADIATION THERAPY
Alternative Treatments
Alternative treatments and emerging therapies are available, but these treatments have less predictable outcomes. Immunotherapy boosts the body’s immune system to help fight cancer. Research on this emerging therapy mainly focuses on the treatment of pleural mesothelioma, which develops in the lining of the lungs.
Many patients find hope in clinical trials, which are medical studies that test new and experimental treatments. Research from clinical trials helps improve treatment outcomes for future patients.
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