New Brunswick, N.J. – With warmer weather soon to arrive, home improvement projects may be on many ‘to do’ lists. With that come the usual warnings about safe removal of construction and home materials made of asbestos in much older homes, as exposure to this fibrous mineral is a known risk factor to the development of lung cancer and mesothelioma. Most people have an understanding of lung cancer – how it might develop and how it is treated. But many don’t know about mesothelioma.
According to the American Cancer Society there are an estimated 3,000 mesothelioma cases diagnosed in the United States each year, with nearly 20 percent of those cases being the peritoneal type. Peritoneal mesothelioma is a rare cancer that arises from the membrane that surrounds the organs of the abdominal cavity. It can afflict both men and women equally and although it can occur in young and older adults, the most common age group at diagnosis is between 55 and 60 years of age. The cancer is often associated with past asbestos exposure, with the disease usually developing 20 to 30 years afterward. Most patients will experience non-specific symptoms such as bloating, vague abdominal pain, and decreased energy prior to diagnosis.
Diagnosis of peritoneal mesothelioma is usually suspected when someone seeks medical attention and a diagnostic exam, such as a CT scan or an ultrasound of the abdomen, shows masses or fluid in the abdomen that is suspicious for cancer. A biopsy is necessary to make a diagnosis. Because it is such a rare cancer (most cancer specialists will only see one or two cases in their careers), the possibility of a more common cancer as the source of the problem must be considered. Generally, a colonoscopy and endoscopy are performed to eliminate the possibility of a stomach or colon cancer. A CT scan will generally show a mass in the pancreas if there is a pancreatic cancer. In women, the possibility that the condition could be ovarian cancer is usually considered and in some cases a woman will undergo initial treatment for presumed ovarian cancer and the diagnosis of mesothelioma is made afterwards. A careful evaluation of a tissue biopsy is essential and often a second opinion is helpful for confirmation. A correct diagnosis is critical as treatments for various types of cancers are very different from one another.
After diagnosis the first step is to assess the extent of disease in the body – also called cancer staging. For patients with a diagnosis of peritoneal mesothelioma, the disease remains largely confined to the abdominal cavity in many cases, and a scan that can show the abdominal tissues in detail will provide the most useful information about what treatments will be most successful. In general, a PET scan or a PET/CT scan is not the best test although it may be ordered when it is still not exactly clear what kind of cancer is present. A contrast enhanced CT scan of the chest, abdomen and pelvis, or a CT of the chest and a contrast enhanced MRI of the abdomen and pelvis are probably the best tests.
If determined that you do have peritoneal mesothelioma, it is very important to get an evaluation at a healthcare facility with expertise in the condition since it is so rare. Talk to your doctor and find out where you can go for an evaluation and recommendation on treatment. The Mesothelioma Applied Research Foundation is a not-for-profit charitable organization that can provide information about centers with expertise. At Rutgers Cancer Institute of New Jersey, the state’s only National Cancer Institute-designated Comprehensive Cancer Center, we have a comprehensive program made up of medical experts including surgical oncologists and other specialists who have internationally recognized expertise in treating this type of cancer.
H. Richard Alexander, Jr., MD, FACS
Generally, cytoreduction surgery combined with intra-abdominal chemotherapy administered at the time of operation or soon after is acknowledged as the most effective therapy which is associated with the best chance of long-term survival. It is only used in patients who are healthy enough to undergo a general anesthetic and who have disease that appears removable based on laparoscopy or imaging studies. Cytoreduction is the systematic surgical removal of tumors that have spread throughout the abdominal cavity. Occasionally, some abdominal organs that may be afflicted are also removed such as the spleen, gallbladder, or in women, the uterus. The main goal of the operation is to remove all the visible tumors completely in a way that is as safe as possible for the patient and will allow them to return to a normal and fulfilling lifestyle.
Hyperthermic intra-peritoneal chemotherapy (HIPEC) is administered during the operation after the cytoreduction surgery. It is designed to deliver heated, high dose chemotherapy to the tissues in the abdominal cavity that may be harboring microscopic cancer cells that cannot be seen or removed by surgery. Generally, the HIPEC treatment adds approximately 90 minutes to the operative time.
While rare, peritoneal mesothelioma can be managed. Talking to your healthcare provider and finding a center such as Rutgers Cancer Institute with treatment expertise in this disease are key. To learn more, visit: http://cinj.org/patient-care/adult/gastrointestinal and http://cinj.org/patient-care/surgical-oncology.
H. Richard Alexander, Jr., MD, FACS, is the chief surgical officer and member of the Gastrointestinal Hepatobiliary Oncology Program at Rutgers Cancer Institute of New Jersey. Dr. Alexander, who is also a professor of surgery at Rutgers Robert Wood Johnson Medical School, has been pioneering the development of the CRS-HIPEC procedure since its evolution over two decades ago.
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