Peritoneal Cancer

John Porter asked:


The Mesothelioma cancer that affects your abdominal cavity is precisely known as the Peritoneal Mesothelioma cancer or Abdominal Mesothelioma cancer. Peritoneum is basically the envelope that covers your abdominal region including the intestines and the stomach. The cancerous cells initially grow in this region and then affect the abdomen directly. The person suffering from the peritoneal cancer will never get well because no possible treatment can yet recover him completely. You cannot apprehend the death’s approach. It may come anytime.

How does the asbestos dust get into the body?

According to the Medical Science there are two probably ways for the asbestos dust to get inside your abdominal outline of Mesothelium or peritoneum. The first process is related to ingestion that happens when a person works in a surrounding filled with asbestos dust for a long period. Also through the process of respiration, asbestos dust reaches your lungs and from that location through the lymph nodes the dust passes down to the abdominal lining.

Conventional treatment procedures

Surgical method of treatment is applied when tumors have grown around the peritoneum. Otherwise the radiation therapy is very helpful in removing the cancerous cells and keeping your body out of pain.

Another important treatment procedure is chemotherapy. Here the medicine called anti-carcinogen is directly inserted in the body with the help of the needle to kill the cancerous cells. But chemotherapy has an effect on the healthy cells too.

Modern treatment procedures

In the recent times a few other cancer treatments have been researched and they are being widely used even in treating Peritoneal Mesothelioma. The new therapeutic technique known as the Intraopeartive Photodynamic therapy has a promising side to heal the cancer patient quicker and with positive effects. The therapy is done through some special kind of drugs and by using light rays to destroy the cells affected by cancer.

Another such modern therapy to heal the cancer patient is popularly known as the Immunotherapy. Here the whole emphasis is put on the enhancing of the body’s immunity so that the bosy can make its own resistance against the spreading of the cancer cells.

The third new treatment method is the gene therapy where a genetic reformation is being brought up to make corrections in those genes that are leading to the spread of Mesothelioma in the body.

All these novel treatment procedures are giving better results but still the ultimate curable treatment has to be researched.



Carmen

Medical Opinion asked:


second opinion - Peritoneal Carcinosis of Undefined Nature

This is a summary of 57 years old patient that was interested with receiving an expert second opinion. When the patient was 2 years old he had appendectomy, at 9 years old - intestinal invagination operation affecting the right side and iliac fossa, with subsequent hardening of the scar and the appearance of a sub-scar asymptomatic mass, interpreted as a cicatricial reaction. When the patient was 38 Years old - Dupuytren and at 50 years old - Laparoscopic Cholecystectomy.

On December 2004 and several months later the patient suffered from intestinal sub-occlusion ileus. A colonoscopy was performed which was negative. On November 2005, a surgical intervention took place with the finding of an adhesion mass in mid right abdomen. 700 cc of brown exudates was drained. Right Hemi-Colectomy was preformed.

The sections that were macroscopically tested was an adhesive mass in the size of 8*10*6 cm found that consisted of the terminal iliem and the cecum at a length of 18 cm.

Microscopically the sections of the intestines were diagnosed (by the Histopathological and Cytodiagnostic laboratory at the Riunit hospital of Trieste) as Carcinoma of low grade differentiation. Same findings were found in adipose tissue with pseudo glandular aspects. Other parts of intestine showed the same microscpical appearance also with papillar aspects. Markers - negative (CEA-2.10, Ca19.-2.5, Ca125-5.4).

On CT: small amount of fluid. Modest evidence of peritoneal inflammation and some adhesions on abdominal wall.

Re-examination of the surgical material on Januarys 5th by the National Tumor Institute suggested the diagnosis of malignant Mesothelioma monophasic of epithelial type.

Conclusion: Patient with Epithelia Peritoneal Mesothelioma that experienced his first episode of intestinal sub-occlusion on 2004.

On the 01.10.06, the patient has undergone a new examination at the Clinical Pharmacology and New Pharmaceuticals Division of the European Institute of Oncology, whose anamnesis reports an. In December 2004 a sub-occlusive episode is reported, affecting the small intestine, which spontaneously healed. A CAT scan is performed, with irrelevant results. During summer 2005, the abovementioned episodes occur again and the patient undergoes a colonoscopy with irrelevant results.

In November 2005 he undergoes the examinations and operation we have mentioned in the previous report.

In light of the information above, the specialist suggests to await the results from new histology analyses and to repeat a thorax, abdomen and pelvis CAT scan.

Should the hypothesis of a mesothelioma be confirmed, it is suggested to consult the opinion of a colleague surgeon who is expert in peritonectomy and intraperitoneal hyperthermic treatments, as this is considered the most efficient approach.

In the alternative, it is suggested to monitor the clinical trend throughout time (CAT and PET scans after 3 months); however, only when presenting an evolving situation or if a clear pathology is denounced via the CAT scan, the specialist would suggest a systemic chemotherapy treatment.

On the other hand, should the histology be different, it is suggested to nonetheless repeat a CAT and a PET scan in a month, and, in absence of a clear primitiveness, it is advised to still consult the colleague surgeons for a peritonectomy.

The new histopathology examination performed at the European Institute of Oncology on the 01.11.2006 reports: “Evidence compatible with a malignant epithelial mesothelioma infiltrating the small intestine’s wall. Immunophenotype of the neoplastic population: positive as per calretinin, cytokeratin 5/6 and WT1; negative as per CDX-2, CEA 5 and desmin.”

Another histology examination performed at the Milan Cancer Institute on the 01.13.2006 reports: “Morphological and immunophenotypic pictures coherent with an epithelial type of malignant mesothelioma. Immunoreactivity: Calretinin +, CK 5/6 +, WT 180 +, CD31 -.”

The thoracic-abdominal CAT scan with contrast performed on the 01.16.2006 reports: “In the thorax area neither parenchymal nor pleural alterations are reported, nor mediastinal lymphadenopathies. In the abdominal region no focal hepatic lesions are appreciated, nor signs of dilation of the bile-duct subsequently to a cholecystectomy. A minimal perihepatic and perisplenic liquid layer is at all times appreciable, with a modest and homogeneous peritoneal inspissation of the suprahepatic and suprasplenic zones; pancreas, adrenal glands and kidneys in normal conditions (30mm cortical cyst with greater diameter between the middle third and the lower third of the right kidney); lymph nodal granules (with dimensions not exceeding one centimeter) in periaortocaval area and along the iliac femoral axis. Diffused and modest inspissation of the months, with ansae that appear slightly conglutinated and adhering to the abdominal wall and with a minor reduction in the transparency of the mesenterial adipose tissue, in a situation that could also be compatible with the sequence of repeated sub-occlusive episodes and the consequent surgical actions. In the pelvic hole, normally extended bladder, with regular walls; no abnormal tumefaction is evident.”

On the 01.20.2006, the patient finally visited the surgeon he had addressed to by the medical doctor who had examined him on the 01.10.2006, and the former procured the following conclusion:

“Patient with peritoneal epithelial mesothelioma that, by interpreting the first sub-occlusive episode in 2004 as secondary to such pathology, seems to date back to some time ago and appears with a low degree of biological malignity. The CAT scan seems to show diaphragmatic involvement and a significant adhesion syndrome between ansae and abdominal wall. In order to apply a precise surgical indication, an interview with the surgeon who operated the patient in November 2005 seems indispensable, so as to evaluate the involvement of the visceral peritoneum and above all of the small intestine, the latter being a true contraindication to a surgical approach.

The cytoreduction via chemo-hyperthermia, followed by systemic chemotherapy seems to be the best option (even though experimental). Should there be, on the other hand, doubts about the surgical indication, one would opt for systemic chemotherapy, eventually with neoadjuvant intention.

It is very important for the patient to know if there are other diagnostic procedures. Assuming the histological diagnosis is Peritoneal Mesothelioma, what is the recommended therapy and if there are experimental protocols, including immunotherapy.

The case was sent to Medical Opinion (www.m-opinion.com) for second opinion evaluation. The case was sent to senior professor from Tel Aviv University to review the case.

The professor assumed that the diagnosis was mesothelioma according to the various pathological reports. It is important to have immunohistochemical staining for c-kit, EGFR, VEGFR, PDGFR-alpha for possible targeted therapies.

The best treatment option for mesothelioma is radical surgery: peritonectomy + hyperthermic intra-operative administration of chemotherapy. However, it is hard to imagine the real intra-abdominal involvement by the tumor according to the descriptions given by the radiologists. It is recommended to review the CT scans and perform a PET -CT with FOG to locate all tumor sites.

If the tumor is inoperable, it is better to go for chemotherapy: cisplatin + pemetrexed (Alimta), or cisplatin + gemcitabine, as a palliative treatment or as a neo-adjuvant therapy.



Gilbert

Muna wa Wanjiru asked:


Peritoneal mesothelioma is also referred to as abdominal mesothelioma and it is a form of rear cancer that affects the lining of the abdomen making fluid to build up. In the United States, only 100 to 500 cases of this illness are reported. Some of the signs that you can look out for to recognize this disease are weight loss, swelling or pain in the abdomen, fever, anemia and bowel obstruction. Some other symptoms may be minor and you may not realize them. The major cause of this diseased is believed to be the exposure to asbestos which can be ingested in the intestines or inhaled. However, there is no conclusive evidence that these is the cause and therefore nothing official.

If you suspect to have peritoneal mesothelioma, you are advised to see a doctor immediately to avert an imminent crisis. It has been reported that 70% to 80% of people who suffer from the illness have been exposed to asbestos at some point in their lives. Patients are advised to mention if they have come into contact with the substance. It is very difficult to diagnose the illness. The first thing a doctor orders is a chest and an abdomen x ray. Then the lungs are tested because the tumor forms near the organs to cause shortness of breath. Usually a thoracoscopy is performed. This is a test that is done that sees an object called a thoracoscope inserted in the chest cavity to search for the disease. The patient is under local anesthesia and the procedure is usually painless.

In the same way, the doctor may look inside the abdomen but, this procedure is called peritoneoscopy. Also the patient is put under local anesthesia. Both procedures are done in a hospital. During these procedures, a biopsy is usually done. A biopsy is the testing of a sample tissue under a microscope, to find out whether there are cancer cells. Therefore, some tissues of the affected area are usually cut to provide the samples. There are a lot of mis diagnosis for peritoneal mesothelioma because of the complex nature in diagonizing it. Peritoneal mesothelioma is fatal depending on the size of the cancer. There are treatments available and with the right follow up, a patient can recover totally.

There are several treatment options and, they include surgery, radiation, chemotherapy, immunotherapy, gene therapy and others. Surgery is one of the best way to cure a malignant tumor and, there are several ways to do it with surgery. There are over 5 surgical procedures to treat peritoneal mesothelioma. High energy gamma rays and x rays are used to treat the disease and this therapy is called radiation. There are several kinds of radiation treatments and according to the uniqueness of each case, many treatments are administered. A patient can be treated using drugs to kill the cancer and this is called chemotherapy. The drugs can be administered orally or through injections. Some of these treatments can leave a patient very weak. Another side effect is loss of hair.



Donald

Robert Granger asked:


Mesothelioma is a type of cancer that is found usually among men who are advanced in years. This type of cancer is caused from the effects of exposure to asbestos ad as a result affects the membranes of our vital organs such as the heart and lungs. Mesothelioma cancer is not very easy to diagnose due to the fact that the symptoms this type of cancer presents are very similar to other diseases that are much more common.

Pleural Mesothelioma

Pleural Mesothelioma is the most common form of this disease and as a direct result accounts for around 75% of all cases of this disease. This type of cancer (Pleural Mesothelioma) attacks and affects the lining of the lungs and presents common symptoms such as shortness of breath, coughing and wheezing, chest pains, difficulty in swallowing and even weight loss. As we have said, these symptoms are very common to other diseases but anyone who has any of them we would strongly suggest consulting their doctor right away just to be on the safe side.

Peritoneal Mesothelioma

One of the less common forms of Mesothelioma is called Peritoneal Mesothelioma and this type of cancer affects the abdomen. Peritoneal Mesothelioma cancer affects the abdominal lining and frequently found in people who have been exposed to asbestos and accounts for around 20% of all Mesothelioma cases. Symptoms of Peritoneal Mesothelioma are as follows: abdominal pains, abdominal swelling, weight loss, loss of appetite, weakness and nausea.

The importance of early diagnosis

People who have worked with asbestos or have been exposed to the substance are at risk of developing the disease. One of the most important things that we should remember when dealing with this type of cancer is speed. Early diagnosis of the disease is of utmost importance so that it can be treated quickly. With time being of importance when dealing with Mesothelioma, the earlier it is discovered the more chance we have of success in its treatment.

 



Charles