Peritoneal Mesothelioma is a rare cancer of the abdominal lining (1 per 1,000,000). It is usually associated with asbestos exposure and is regarded as universally fatal.
The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibers from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibers may be deposited in the gut after ingestion of sputum contaminated with asbestos fibers. Approximately one fifth to one third of all mesotheliomas are peritoneal.
Peritoneal mesothelioma has two clinical types which can be differentiated with the help of CT findings, the "dry" type and the "wet". It is classified as "dry" when there are multiple tiny masses or one dominant localized mass and generally little or no ascites. The "wet" type has widespread small nodules, no dominant mass and a presence of ascites. If fluid is found, the process of eliminating it is through paracentesis; however the analysis of this fluid has limited diagnostic significance. Normally, a definitive diagnosis may be obtained through tissue biopsy.
Exposure to asbestos fibers can cause mesothelioma even years later. There is evidence that family members and others living with people exposed to asbestos have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers.
Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of Peritoneal Mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face. Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever.
Diagnosing Peritoneal Mesothelioma is often difficult; because the symptoms are often associated with other conditions. Diagnostic testing includes a review of the patient's medical history and a complete physical examination, including x-rays of the abdomen. Diagnostic imaging by CT scan and MRI suggests a diagnosis, but definitive diagnosis is via tissue sampling by CT-directed biopsy or peritoneoscopy.
Standard treatment for all but localized mesothelioma is generally not curative. However, radical resection is associated with a better prognosis and should be attempted when possible. Chemotherapy can be administered systemically or directly into the abdomen and is helpful as palliative treatment.
Delayed diagnosis of mesothelioma worsens its prognosis. In general, the prognosis of mesothelioma is poor and most studies report median survival of less than a year.
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