Peritoneal mesothelioma

Peritoneal mesothelioma is a relatively rare form of malignant neoplasm affecting the peritoneal tissue. Malignancy occurs due to the degeneration of the mesothelium, which is the serous layer of cells covering the abdominal cavity.

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Causes of peritoneal mesothelioma

This rare form of cancer is mainly diagnosed in the strong half of humanity, whose age has crossed the 50-year barrier. The causes of peritoneal mesothelioma, which were established, confirm their pathological impact on the body are reduced to one source of the origin and growth of a malignant tumor - this is the negative impact of asbestos vapors in its fairly close contact with the human body, and more specifically with its respiratory system.

Mainly after a man has worked with such material for a long time, oncologists diagnose pleural mesothelioma, much less often, but still they have to state such a disease as peritoneal mesothelioma.

Asbestos is a chemical mineral of the silicate series, which has a fibrous brittle structure. This material is quite actively used in many branches of national industry and construction. And everywhere people work, mainly men.

At the same time, asbestos, when worked with, releases vapors and asbestos dust. It is this that poses a particular danger to the human body and can cause mesothelioma of the peritoneum or pleura, provoke the development of cancerous lesions of the lung tissue and asbestosis (a lung disease caused by inhalation of asbestos fibers).

The danger and insidiousness of such dust is that its harmful effect on the body of a person working with it is not immediately apparent. Pathological symptoms can appear after several years or even decades.

Such a time interval between the source and development of the disease, for quite a long time did not allow doctors to understand the causes of the pathology in question. And only recently this connection was established.

Today, doctors assume that asbestos dust is not the only primary source that provokes the progression of this pathology. Suspicions are raised by:

• Paraffin fractions and other substances belonging to silicate structures.
• Ionizing radiation is an electromagnetic wave structure that is formed as a result of radioactive decay, nuclear transformations, and the deceleration of charged particles in matter.
• Infectious and viral lesions of the body.

To date, a sufficient number of facts confirming or refuting these suspicions of doctors have not yet been collected. Therefore, the answer to the question under consideration remains open.

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Symptoms of peritoneal mesothelioma

Doctors, based on the shape of the tumor and the extent of its spread, distinguish between two different types of the disease in question: nodular (or local) tissue damage and diffuse pathology. The tumor formation of the first type is presented in the form of a node, which is predominantly located in the parietal and/or visceral zone of the peritoneum.

The diffuse type of tumor, which is the most common, captures the entire inner layer of the abdominal cavity, enveloping it as if in a kind of case. If there is a void in the abdominal cavity not filled with a tumor, then hemorrhagic or fibrino-serous fluid (exudate) begins to accumulate in it.

Histology results most often show the adenocarcinoma nature of the tumor structure.

At the early stage of the pathology, the symptoms of the disease in question are not very specific. Over time, when the disease progresses significantly, the symptoms of peritoneal mesothelioma begin to appear, which include:

• Abdominal (abdominal) pain.
• Nausea.
• Weakness.
• The emergence of the urge to vomit.
• Ascites (or as it is also called peritoneal dropsy) is an 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, exudate accumulates in the peritoneum, increasing its size, which leads to an increase in the size parameters of the abdomen.
• Digestive problems occur: constipation is relieved by loose stools and vice versa.
• Shortness of breath appears.
• Swelling becomes noticeable.
• If the patient suffers from nodular mesothelioma, the oncologist is able to recognize a very mobile tumor formation by palpation.
• Sometimes signs of partial intestinal obstruction appear.
• There are known cases of exacerbation of arthralgia – isolated pain symptoms that occur in small joints.
• In advanced clinical conditions, metastases can be found in nearby lymph nodes, as well as in the bone marrow, brain, liver, heart, lungs, and intestines.
• Permanent subfebrile temperature is a persistent increase in body temperature.

Diagnosis of peritoneal mesothelioma

When a certain set of symptoms appears, the doctor may suspect the presence of the disease in question in the patient's medical history. Diagnosis of peritoneal mesothelioma is a fairly extensive comprehensive examination, which includes both instrumental methods and laboratory tests.

• The first thing that is prescribed to such a patient is a consultation with an oncologist and gastroenterologist.
• The patient's medical history is studied, the specialist is especially alarmed by the fact that the patient had long-term contact with asbestos. This may concern both work with this material, living near an asbestos-cement plant, the presence of asbestos material in the home environment, and the like.
• An ultrasound examination of the abdominal cavity is mandatory.
• Multispiral computed tomography (MSCT) is a non-destructive layer-by-layer examination of the abdominal cavity. It makes it possible to determine the presence of tumor signs and 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 non-detection) of atypical cells, which can be present both in tissue layers (biopsy) and in ascitic fluid.
• A biopsy is performed - the extraction of small areas of tissue during life 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 pathological contents from the abdominal cavity.
• Paracentesis is the drainage of fluid in the abdominal cavity.
• Standard laboratory tests of urine, feces and blood are also performed.

Correct recognition of the histological nature of peritoneal mesothelioma is essential for the adequate selection of treatment methods, as well as the short-term and long-term prognosis of the patient's life.

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Treatment of peritoneal mesothelioma

The preferred method of treating the nodular type of the disease in question is surgical excision of the cancerous neoplasm. 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.

The situation is more complicated when diagnosing a diffuse tumor. Treatment of peritoneal mesothelioma in this type of disease is much more complicated and less predictable.

Having received a complete clinical picture of the disease, the oncologist-gastroenterologist raises the question of the effectiveness of surgical intervention. The doctor can decide to prescribe an operation based on a set of facts:

• Cancerous peritoneal lesions are not so significant.
• Metastases are absent or occupy a limited area.
• Age of the patient. The patient's advanced age may be a reason to refuse surgery.
• "Bouquet" of concomitant diseases. For example, if the patient suffers from severe heart disease, then he or she simply may not tolerate anesthesia.

However, surgical intervention is not performed mainly in the case of diffuse pathological changes. Such patients are prescribed chemotherapy and/or radiation therapy.

For chemotherapy of peritoneal mesothelioma, the following pharmacological agents are mainly used: vinorelbine, cisplatin, methotrexate, doxorubicin and some others.

A cytostatic drug of the vinca alkaloid group, vinorelbine differs from similar alkaloids by a structural modification of the catharanthine residue.

This medicine is administered to the patient intravenously (or directly into the peritoneum - intraperitoneally). The procedure itself must be performed by an experienced medical worker. Before you put the IV in to administer 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 penetration of the medicinal liquid into adjacent tissues, the patient begins to feel a strong burning sensation and in a fairly short period of time, necrosis begins to develop - the cells affected by the drug die off.

If the healthcare professional observes signs of intravenous fluid ingestion, the drug administration must be stopped and the remaining amount of the drug carefully administered through another vein.

The dosage of the drug is selected strictly individually in each specific case.

If the treatment protocol includes monotherapy with vinorelbine, the recommended starting dose is 25 to 30 mg per square meter of the patient's body surface. The injection is administered once a week.

Before the procedure, the drug is diluted with 125 ml of isotonic sodium chloride solution. Vinorelbine is injected into the vein very slowly, the entire procedure takes 15 to 20 minutes.

If the treatment protocol includes polychemotherapy and, therefore, includes several different pharmacological agents, the dosage is adjusted, and the frequency of administration of the drug depends on the prescribed schedule of antitumor treatment, which depends on the stage of the disease and the level of hematopoiesis.

If the patient has a history of impaired liver and kidney function, the dosage of the drug is prescribed slightly lower than recommended.

The antitumor 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. The diluted preparation is stored at room temperature.

Therapeutic therapy using vinorelbine or its analogues is carried out under the constant supervision of the attending physician, who conducts strict monitoring of the blood count, hemoglobin level and the quantitative component of granulocytes and leukocytes.

This control is mandatory before each administration of the drug.

If the granulocyte level falls below 2000 units mm3, the oncologist does not allow the patient to take another dose of medication, but prescribes restorative therapy until the neutrophil count returns to normal. The patient's general condition is also monitored.

Contraindications to the use of the drug in question are individual intolerance to the components of the drug, severe liver failure, in case of pregnancy of the patient and if the woman is breastfeeding her newborn baby. There are also recommendations for the handling of drugs of this pharmacological category.

• The fact already mentioned above, when a medicinal product must be administered into a vein with special care, not allowing non-venous entry of medicinal fluid, in order to avoid the formation of necrosis.
• When performing the procedure, you should protect your eyes; if any preparations get into them, you should rinse them very quickly and thoroughly in clean running water.
• Before the procedure and during treatment, constant monitoring of the peripheral blood condition is necessary.
• Constant monitoring of the biochemical characteristics of liver function is also necessary.
• If the level of neutrophils decreases below the critical level, the procedure for administering the chemotherapy drug is not performed and is postponed until the normal parameters are restored.
• To avoid the development of a hepatotoxic effect, the drug is prohibited from being taken during radiation therapy affecting the kidney and liver area.
• Medical personnel who work with these drugs used for chemotherapy are required to comply with all personal protective equipment requirements that apply when in close contact with toxic chemical compounds.

To remove ascitic fluid that collects in the abdominal cavity, the doctor prescribes paracentesis, during which a drainage system is brought to the site of exudate accumulation, and the substance is evacuated using the drainage.

Radiation therapy may be prescribed by a doctor as an independent treatment method, or it may be a postoperative stage of adjuvant treatment that inhibits the growth of cancer cells that have not been excised.

Considering the complexity, insidiousness and danger of this disease, even with minor suspicions of health failure, it is necessary to seek advice from your local therapist. Having familiarized yourself with the situation and having confirmed your suspicions, there is a need to consult an oncologist, gastroenterologist and surgeon.

Prevention of peritoneal mesothelioma

In order to maximally protect yourself and your health from the occurrence and development of the disease in question, prevention of peritoneal mesothelioma primarily requires completely eliminating contact with asbestos.

• Move to another job.
• Change your place of residence.
• Make repairs in the house, removing such material as asbestos.
• Do not ignore preventive examinations by specialized specialists.

If for any reason (professional activity and the person does not want to change jobs) it is not possible to avoid this, it is necessary to take all necessary measures for individual protection of the body.

Peritoneal mesothelioma prognosis

When the question of prognosticating tumor therapy arises, doctors are somewhat reserved in their conclusions. Due to the rather rapid dissemination of the degeneration process, the prognosis of peritoneal mesothelioma is unfavorable.

On average, patients who have been given this terrible diagnosis do not live more than one to two years after its establishment. The prognosis is somewhat more optimistic for the local type of pathology, less so for diffuse pathology.

There are also differences in the results of histology. If an epithelioid type of mesothelioma affecting the peritoneum is diagnosed, the patient is given a longer period of time before death. If sarcoma is diagnosed or a mixed type of disease is observed, oncologists state that the disease is developing more rapidly.

From the first words of the article, where peritoneal mesothelioma is described, you begin to understand how insidious, dangerous and complex the pathology in question is. Therefore, in order to protect yourself and your loved ones, you need to choose your place of residence with special care, 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, removing it from your contact. If the catalyst has been launched, and pathological transformations have already begun, you should not neglect preventive examinations by specialists. The earlier this disease is detected, the greater the patient's chances of living as long as possible.

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