Peritoneal mesothelioma: New insights about causes and treatment

Peritoneal mesothelioma makes up between 10 to 30% of all the reported cases for this rare type of cancer.

The condition thought to be caused by exposure to asbestos is most dangerous due to the subtle symptoms which could go undetected or mistaken as signs of a less severe problem. Until now, the diagnosis was mostly associated with middle-aged and old men. Also, it was primarily considered a professional hazard. The emergence of cases in young women who have never been in contact with asbestos makes way for new questions about this disease, which up to now has been insufficiently researched.

The Stories of Two Women’s Nightmares
A recent article from The George Washington University describes the case of a 21-year-old woman who had no history of exposure to asbestos and yet was suffering from peritoneal mesothelioma. This case is remarkable first due to the patient’s age, as only a few people in their teens and 20s had ever been diagnosed. The patient’s gender is also less common, as men are 4.6 times more likely to develop this type of cancer. The lab tests and CT scans confirmed the diagnosis and highlighted an associated ascites out of which four liters were aspirated. This was a release after 4 months of abdominal swelling and almost 2 months of pain and intermittent vomiting.

Another odd story is that of a 75-year old woman who had also never exposed to asbestos. She also developed ascites and confused the doctors who were initially reluctant to give a mesothelioma diagnosis. The situation was made even more complicated by the fact that radiological detection did not function. Her condition was the starting point in a new view of looking at connected complications to ascites. The story the doctors learned was that although rare, they should not rule out mesothelioma.

A Robot Portrait of The Patient and the Disease
Why are these particular cases so important?

The motivation resides in the general portrait of the mesothelioma patient. These are most likely older men, mostly over 60, who have worked in factories, industrial environments or the military sector.

It usually takes decades since the asbestos exposure until the appearance of symptoms, rapid evolution in a young female is unlikely and could signal the existence of different triggers and mechanisms.

The other case is noteworthy because it taught specialists the valuable lesson of investigating instead of assuming. For mesothelioma patients, time usually works against them, and there is a short opportunity window when the cancer is in the early stages and can be treated to enhance survival rates and life expectancy.

Mesothelioma could be considered a very discrete and silent killer, as the symptoms are rarely warnings of the magnitude of the damage. Most could even be overlooked for a few months. The bad news is that the survival expectancy without treatment usually does not exceed one year.

To understand the danger, consider that the symptoms include any combination, in different degrees on the intensity of:

· loss of appetite & weight loss,
· fatigue,
· chills,
· fever,
· abdominal swelling or fluid retention,
· some pain,
· night sweats.

In just a few cases these are noteworthy and can determine if the patient has to undergo further investigations.

Other Possible Causes of Mesothelioma Except Asbestos
The emergence of cases such as the aforementioned and similar ones raises the question if asbestos are the only cause of mesothelioma. Research so far has unveiled that other causes could be at the root of this cancer type, and therefore not always directly linked to asbestos. The study about the young woman cites other research articles indicating an SMV40 virus, radiation exposure, genetics, heavy metals, chronic inflammations and even other, non-asbestos fibers as likely causes of peritoneal mesothelioma.

Best Treatment Methods
Paul Kraus is a patient who survived mesothelioma for more than 20 years. He dedicated his life to educating others on the idea that this is a diagnosis, not a death sentence. In this article, he lists the four primary treatment methods:

· Cytoreductive surgery;
· Heated intraperitoneal chemotherapy (HIPEC);
· Radiation therapy;
· Paracentesis.

In the case of peritoneal mesothelioma, cytoreductive surgery, which eliminates bits of the compromised tissue is not only invasive but sophisticated. Most affected areas are small in size but scattered in the abdominal cavity. Studies show that performed on patients with the low-grade disease, this surgery ensures excellent survival outcomes (over 97%). The downside of this method is that it can take up to 10 hours to perform and it does not guarantee complete removal.

The surgery is usually associated with HIPEC, which comes as a support method to destroy the small remaining cancerous cells of microscopic dimensions. Research is in favor of performing HIPEC multiple times since it has been associated with longer survival times.

Radiation is also a support treatment for pain relief for the later stages and helping patients in the early stages of the disease in conjunction with the previously discussed treatment methods.

As highlighted by the cases of the two women, peritoneal mesothelioma is often associated with ascites. To help patients relieve pain, through paracentesis the fluid is drained out and the pressure disappears. This is not a treatment for mesothelioma, but a useful practice for associated medical conditions.

Is Peritoneal Mesothelioma Different?
A recent study showed that by comparing pleural and, peritoneal cells affected by mesothelioma concerning the proteins uncovers specific patterns. This indicates that there is a different susceptibility to asbestos for pleural and peritoneal cells. It can even be implied that each of them has unique protein signatures. Future research aims to identify biomarker candidates.

Final Thoughts
Peritoneal mesothelioma, a rare form of cancer thought to be caused by asbestos exposure still needs to be thoroughly studied. The occurrence of cases in female patients who have never been in contact with asbestos or are too young to develop the disease as it has been documented until now serve as indicators that there might be other causes such as genetics or even environmental triggers.

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