Peritoneal Mesothelioma (Mesothelioma Malignant) || ICD-10
Peritoneal mesothelioma is a malignant tumor emanating from the cells of the mesothelium of the serous lining of the abdominal cavity. Clinically, peritoneal mesothelioma is manifested by abdominal pain, nausea, vomiting, weight loss, ascites. Diagnosis of mesothelioma is based on the data of ultrasound and MSCT of the abdominal cavity; the decisive diagnostic criterion is the detection of atypical cells in the ascitic fluid or biopsy obtained during a diagnostic laparoscopy. Peritoneal mesothelioma can be treated surgically, with radiation therapy, or chemotherapy. The prognosis for mesothelioma is poor.
Peritoneal mesothelioma is a fairly rare form of malignant neoplasms affecting the peritoneal tissue. Malignancy occurs due to the degeneration of the mesothelium, which belongs to the serous layer of cells that covers the abdominal cavity.
Mesothelioma (endothelioma, carcinosarcoma) is a primary tumor growing from mesothelial cells present in the serous membranes lining the body cavities. Depending on the localization, peritoneal mesothelioma, pleural mesothelioma , less often – pericardial mesothelioma are distinguished . Among tumors of this type, peritoneal mesothelioma accounts for 10-20% of cases. Peritoneal mesothelioma develops mainly in men over 40 years old.
Causes and forms of peritoneal mesothelioma
It is believed that the development of peritoneal mesothelioma and other localizations is directly related to prolonged and intense human contact with asbestos. Asbestos is a fine-fiber silicate-class mineral commonly used in the construction, metal, glass, automotive and other industries. Asbestos dust is very dangerous; inhalation of it can cause lung cancer , asbestosis , mesothelioma and other diseases. At the same time, tens of years can pass from the moment of contact with asbestos-containing materials to the onset of the disease. Among other factors, the influence of ionizing radiation, viral infection, contact with silicates, paraffins is not excluded.
Depending on the type of growth, peritoneal mesothelioma can be localized (nodular) or diffuse. In the first case, mesothelioma looks like a limited node emanating from the parietal or visceral layer of the peritoneum. In the diffuse form, mesothelioma has an infiltrative growth without clear boundaries and spreads over the entire surface of the peritoneum. Diffuse peritoneal mesotheliomas make up about 75% of all cases and are characterized by a more malignant course.
The progression of peritoneal mesothelioma is usually accompanied by the accumulation of serous or hemorrhagic exudate in the abdominal cavity and the development of ascites . When pleural mesothelioma detected effusion , pericardial mesothelioma – pericarditis .
According to the histological structure, epithelioid (50-70%), sarcomatoid (7-20%) and mixed (20-35%) forms of peritoneal mesothelioma are distinguished. Rare types of mesothelioma include the multicystic form, which occurs in women and affects the pelvic peritoneum, mainly in the Douglas space. Taking into account the localization of mesothelioma, its treatment can be carried out by oncologists in the field of pulmonology (thoracic surgery), cardiology , gastroenterology , gynecology .
Symptoms of peritoneal mesothelioma
In the initial stages, the manifestations of peritoneal mesothelioma are not very specific. There may be discomfort and pain in the abdominal cavity that do not have a clear localization, weakness, weight loss. Dyspeptic disorders appear: nausea, loss of appetite, vomiting, intermittent diarrhea and constipation. In the future, as the accumulation of exudate in the abdominal cavity, there is an increase in the size of the abdomen , shortness of breath, edema. With nodular mesothelioma of the peritoneum, a mobile tumor formation can be determined during palpation. In some cases, there are signs of partial intestinal obstruction .
Peritoneal mesothelioma and other localizations are characterized by constant subfebrile condition, arthralgia – pain in small joints of a volatile nature. Mesothelioma of the peritoneum is rapidly disseminated by lymphogenous, contact, implantation. Metastases of peritoneal mesothelioma can be found in regional lymph nodes, heart, lungs, liver, intestines, brain, bone marrow.
Physicians, according to the shape of the tumor and the extent of its spread, distinguish between two different types of the disease under consideration: nodular (or local) tissue damage and diffuse pathology. A tumor formation of the first type is presented in the form of a node, which is mainly located in the parietal and / or visceral zone of the peritoneum.
The diffuse type of tumor, which occurs most often, captures the entire inner layer of the abdominal cavity, enveloping it, as it were, in a kind of case. If an empty tumor is observed in the abdominal cavity, then hemorrhagic or fibrino-serous fluid (exudate) begins to accumulate in it.
The results of histology most often show the adenocarcinoma nature of the structure of the tumor.
At an early stage of pathology, the symptomatology of the disease in question is not very specific. Over time, when the disease progresses significantly, the symptoms of peritoneal mesothelioma begin to appear, which include:
- Abdominal (abdominal) pain.
- The onset of the urge to vomit.
- Ascites (or as it is also called peritoneal dropsy) is the accumulation of free fluid in the peritoneal cavity.
- The patient begins to lose weight.
- There are disturbances in the desire to eat (loss of appetite).
- Gradually, the exudate accumulates in the peritoneum, increasing its size, which leads to an increase in the dimensional parameters of the abdomen.
- There is a violation of digestion: constipation is killed by loosening of the stool and vice versa.
- Shortness of breath appears.
- Swelling becomes noticeable.
- If the patient suffers from nodular mesothelioma, the oncologist, by palpation, is able to recognize a very mobile tumor neoplasm.
- Sometimes there are signs of partial intestinal obstruction.
- There are known cases of exacerbation of arthralgia – an isolated pain symptomatology that occurs in small joints.
- With an advanced clinical picture, metastases can be found both in nearby lymph nodes and in the bone or brain, liver, heart, lungs, intestines.
- Permanent subfebrile condition is a persistent increase in body temperature.
Diagnosis of peritoneal mesothelioma (Radiology)
To make a diagnosis (or Radiology), a comprehensive instrumental examination and laboratory confirmation of peritoneal mesothelioma are required. A gastroenterologist or oncologist should always be alarmed by the patient’s life history indicating contact with asbestos (work at a construction site, living in the area of asbestos-cement factories, the presence of asbestos materials in the house, etc.).
If peritoneal mesothelioma is suspected, abdominal ultrasound and MSCT are performed to detect the presence of ascites and signs of a tumor process. For accurate confirmation of the diagnosis (or Radiology), it is necessary to conduct laparocentesis in order to collect and study ascitic fluid. If malignant cells are not detected in the exudate, they resort to diagnostic laparoscopy ( laparotomy ) and taking a biopsy sample with its subsequent morphological examination. Determination of the histological type of peritoneal mesothelioma is important for the prognosis and selection of antitumor treatment.
With the manifestation of a certain complex of symptoms, the doctor may suspect the presence of the disease in question in the patient’s history. Diagnosis of peritoneal mesothelioma is a fairly extended comprehensive examination, which includes both instrumental techniques and laboratory studies.
- The first thing that is prescribed to such a patient is a consultation with an oncologist and a gastroenterologist.
- The patient’s anamnesis is being studied, the specialist is especially alarmed by the fact if the patient has had prolonged contact with asbestos. This may apply to both working with this material, living near an asbestos-cement enterprise, the presence of asbestos material in the home environment, and the like.
- An ultrasound examination (ultrasound) of the abdominal cavity is mandatory.
- Multispiral computed tomography (MSCT) is a method of non-destructive layer-by-layer examination of the abdominal cavity. It makes it possible to establish the presence of tumor signs and the presence of ascites in the patient’s body.
- Laparoscopy is a surgical method of treatment, as well as visual examination and removal of biological material for analysis, carried out through a small opening in the peritoneum. The result of the study is the detection (or not finding) of atypical cells that may be present both in tissue layers (biopsy) and in ascitic fluid.
- A biopsy is performed – an intravital extraction of small areas of tissue for subsequent examination under a microscope (morphological analysis of the contents).
- Laparocentesis is a puncture of the peritoneal wall, the purpose of which is to extract the pathological contents of the abdominal cavity.
- Paracentesis is the drainage of fluid in the abdominal cavity.
- Standard laboratory analyzes of urine, feces, and blood are also carried out.
Correct recognition of the histological nature of peritoneal mesothelioma is essential for the adequate selection of treatment methods, as well as the short and long-term prognosis of the patient’s life.
Treatment of peritoneal mesothelioma
The optimal method of treatment of nodular forms of peritoneal mesothelioma is radical surgical removal of the tumor. In order to evacuate ascitic fluid, medical paracentesis procedures are performed.
For diffuse processes, radiation therapy , chemotherapy, or a combination of both is indicated . Chemotherapy drugs in various combinations (doxorubicin, methotrexate, cisplatin, vinorelbine, etc.) are administered both intravenously and directly into the abdominal cavity – intraperitoneally. Radiation therapy can be carried out as a self-treatment, palliative care, ancillary treatment after surgery to suppress the growth of tumor cells.
The predominant method of treating the nodular type of the disease under consideration is surgical excision of the cancerous growth. In the absence of metastases, this method gives an excellent result, after the operation and subsequent restorative therapy, the patient is quite normally able to continue his life after this terrible diagnosis (or Radiology).
The situation is more complicated when diagnosing a diffuse tumor. Treatment of peritoneal mesothelioma with this type of disease is much more difficult and less predictive.
Having received a complete clinical picture of the disease, the oncologist – gastroenterologist raises the question of the effectiveness of the surgical intervention. The doctor may decide to prescribe an operation on the basis of a set of facts:
- Cancer of the peritoneum is not so significant.
- Metastases are absent or occupy a limited area.
- The age of the patient. The old age of the patient may become the refusal of the operation.
- “Bouquet” of concomitant diseases. For example, if a patient suffers from severe heart damage, then he simply misses the anesthesia.
And yet, predominantly with a diffuse nature of pathological changes, surgical intervention is not performed. Such a patient is prescribed chemotherapy and / or radiation therapy.
For chemotherapy in peritoneal mesothelioma, pharmacological agents such as vinorelbine, cisplatin, methotrexate, doxorubicin and some others are mainly used.
A cytostatic drug of the vinca alkaloids group, vinorelbine differs from similar alkaloids by the structural modification of the catharanthine residue.
This drug is injected from the patient’s body intravenously (or directly into the peritoneum – intraperitoneally). The procedure itself must be performed by an experienced healthcare professional. Before you put the dropper on the injection of the drug, you should make sure that the injection needle is in the vein. This warning is due to the fact that even with a slight ingress of the medicinal fluid into the adjacent tissues, the patient begins to feel a strong burning sensation and necrosis begins to develop in a fairly short period of time – the cells affected by the drug die off.
If the health care provider observes signs of extravenous fluid intake, the drug should be stopped and the remaining amount of the drug is gently injected through another vein.
The dosage of the drug is selected purely individually in each case.
If the treatment protocol involves monotherapy with vinorelbine, the recommended starting dose is prescribed in the range of 25 to 30 mg per square meter of the patient’s body surface. The injection is performed once a week.
Before starting the procedure, the drug is diluted with 125 ml of isotonic sodium chloride solution. Vinorelbine is injected into a vein very slowly; the whole procedure takes 15 to 20 minutes.
If the treatment protocol provides for polychemotherapy and, therefore, includes several diverse pharmacological agents, the dosage is adjusted, and the frequency of administration of the drug depends on the scheduled schedule of anticancer treatment, which depends on the stage of the disease, the level of hematopoiesis.
If the patient has a history of impaired hepatic and renal function, the dosage of the drug is prescribed slightly lower than the recommended one.
An anticancer solution of vinorelbine and sodium chloride is prepared immediately before the procedure and subsequently does not lose its pharmacological characteristics for the next 24 hours after preparation. Store the diluted drug at room temperature.
Medical therapy using vinorelbine, or its analogs, is carried out under the constant supervision of the attending physician, who strictly monitors the blood count, hemoglobin level and the quantitative component of granulocytes and leukocytes.
This control is mandatory before each drug administration.
If the level of granulocytes has fallen below the figure of 2000 mm3 units, the oncologist does not allow the patient to receive the next drug administration, but prescribes restorative therapy, carried out until the number of neutrophils is normalized. The general condition of the patient is also monitored.
A contraindication to the use of the drug in question is an individual intolerance to the constituents of the drug, a severe form of liver failure, in the event of a patient’s pregnancy and if a woman is breastfeeding her newborn baby. There are also recommendations for the very handling of drugs in this pharmacological category.
- The fact already mentioned above, when a drug must be injected with extreme caution into a vein, avoiding an unintended inflow of a medicinal fluid, in order to avoid the formation of necrosis.
- During the procedure, you should protect your eyes, if drugs get into them, you must very quickly rinse them thoroughly in clean running water.
- Before the procedure and during the treatment, constant monitoring of the state of the peripheral blood is required.
- It is also necessary to constantly monitor the biochemical characteristics of the liver.
- With a decrease in the level of neutrophils below the critical level, the procedure for administering a chemotherapy drug is not carried out and is postponed until the normal parameters are restored.
- In order to avoid the development of a hepatotoxic effect, it is forbidden to take the drug against the background of radiation therapy affecting the area of the kidneys and liver.
- Medical personnel who work with these drugs used for chemotherapy are obliged to comply with all personal protection requirements that are imposed on close contact with toxic chemical compounds.
To extract the ascitic fluid that collects in the abdominal cavity, the doctor prescribes paracentesis, in which a drainage system is brought to the place of accumulation of exudate, this substance is evacuated with the help of drainage.
Radiation therapy can be prescribed by a doctor as an independent treatment method, or it can be a postoperative stage of auxiliary treatment, which inhibits the growth of cancer cells that have not been excised.
Considering all the complexity, insidiousness and danger of this disease, even with minor suspicions of poor health, it is necessary to seek advice from your local therapist. Having become familiar with the situation and having established themselves in suspicions, it becomes necessary to consult an oncologist, gastroenterologist and surgeon.
Prevention and prognosis for peritoneal mesothelioma
To prevent the development of peritoneal mesothelioma, it is recommended to avoid contact with asbestos at work and at home.
The prognosis for detecting peritoneal mesothelioma is unfavorable due to the rapid dissemination of the tumor. Patients usually live no more than 1–2 years after diagnosis (or Radiology). The best prognosis is observed in the epithelioid type of peritoneal mesothelioma; the worst – with sarcomatous and mixed.
In order to maximally protect yourself and your health from the appearance and development of the disease in question, the prevention of peritoneal mesothelioma primarily requires completely excluding contact with asbestos.
- Move to another place of work.
- Change your place of residence.
- Make repairs in the house by removing material such as asbestos from it.
- Do not ignore preventive examinations by narrowly focused specialists.
If, for whatever reason (professional activity and the person does not want to change jobs), this cannot be avoided, it is necessary to take all the necessary measures for the individual protection of the body.
Peritoneal mesothelioma prognosis
When the question of predicting tumor therapy arises, doctors are somewhat restrained in their conclusions. In view of the rather rapid dissemination of the degeneration process, the prognosis of peritoneal mesothelioma is unfavorable.
On average, patients who have been diagnosed with this terrible diagnosis (or Radiology), after its establishment, live no more than one to two years. The prognosis is somewhat more optimistic for the local type of pathology, less for diffuse pathology.
There are differences with different histology results. If an epithelioid type of mesothelioma affecting the peritoneum is established, then the patient is given a longer period of time before the onset of death. If a sarcoma is diagnosed or a mixed type of disease is observed, then oncologists state the most rapid development of the disease.
From the first words of the article, where peritoneal mesothelioma is described, you begin to understand how insidious, dangerous and complex the pathology under consideration is. Therefore, in order to protect yourself and your loved ones, it is necessary to choose a place of residence with special attention, avoiding settling near asbestos factories. You should also remove this material from your home. If your professional activity is related to this material, it is advisable to change jobs by removing it from your contact. If the catalyst is running, and pathological transformations have already begun, you should not neglect the preventive examinations of specialists. The earlier this disease is detected, the more chances the patient has to live as long as possible.