Surgical biology for the clinician: peritoneal mesothelioma: current understanding and management

Our plain-English summary of Surgical biology for the clinician: peritoneal mesothelioma: current understanding and management, by T.C. Chua, T.D. Yan, D.L. Morris (Canadian Journal of Surgery. Journal Canadien de Chirurgie, 2009).

The study

• Authors: T.C. Chua, T.D. Yan, D.L. Morris
• Journal: Canadian Journal of Surgery. Journal Canadien de Chirurgie
• Published: 2009;52(1):59-64
• Type of article: Review
• Cited by: 37 articles, as counted by NIH iCite
• Read it: PubMed · Free full text

Abstract

Mesothelioma is an asbestos-related tumour. Mesothelioma in the thorax occurs on the pleura and is known as pleural mesothelioma. It is the more common form of mesothelioma, accounting for 70% of cases. The other form occurs in the abdomen. It accounts for much of the remaining 30% and is known as peritoneal mesothelioma. Early diagnosis of peritoneal mesothelioma is often difficult because the early symptoms are often overlooked as being a benign ailment of the gastrointestinal tract. Therefore, diagnosis often occurs at an advanced stage when disease is widespread throughout the peritoneal cavity. Treatment approaches have evolved in the last decade from systemic chemotherapy and palliative surgery to aggressive cytoreductive surgery and perioperative intraperitoneal chemotherapy. This has led to a marked increase in survival among patients who were once classified as "preterminal." We update on the current understanding of peritoneal mesothelioma from a clinical perspective in hope that greater clinician awareness will promote best practice management of this condition.

In plain English

This article was a narrative review of peritoneal mesothelioma, the form of mesothelioma that arises in the lining of the abdomen. It reported no new patient data. The authors described asbestos as the primary carcinogen implicated in peritoneal mesothelioma and called the role of the virus SV 40 still unclear. Citing other studies, they reported that the time from asbestos exposure to disease averaged about 20–30 years, shorter than the 30–40 years for pleural mesothelioma. At one treatment centre, patients typically first had abdominal pain (33%) or increasing abdominal girth (31%). The blood marker CA 125 had a diagnostic sensitivity of 53.5%. The authors stated that systemic chemotherapy led to a median survival of only about 1 year. Studies found in a MEDLINE search suggested a median survival of 28–35 months with cytoreductive surgery (removing visible tumour and diseased lining) plus chemotherapy given inside the abdomen. They noted that this surgery carries risks of complications and death. The authors concluded that this approach should be considered the standard of care for all patients with peritoneal mesothelioma, and that avoiding asbestos exposure is of utmost importance.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review (continuing medical education article) of peritoneal mesothelioma: causes, symptoms, diagnosis, pathology and treatment
• Who was studied: No study population of its own. The authors summarized published studies on patients with peritoneal mesothelioma, including studies of surgery plus intraperitoneal chemotherapy found through a MEDLINE search.
• Exposure: Asbestos in general (no fiber type specified in the text). It is described as the primary carcinogen implicated in peritoneal mesothelioma.
• Main results:
  • Citing another study, the review gave an average latent period of about 20–30 years for peritoneal mesothelioma. This is shorter than the 30–40 years for pleural mesothelioma.
  • A study from the Washington Cancer Institute, cited by the review, found that patients typically presented with abdominal pain (33%) or increasing abdominal girth (31%).
  • The review reported that the tumour marker CA 125 was the most useful marker, with a diagnostic sensitivity of 53.5% (from a cited study).
  • The review stated that systemic chemotherapy for peritoneal mesothelioma still led to a median survival of only about 1 year.
  • The review reported that intraperitoneal cisplatin used as the sole treatment gave a median survival of 9 months in a cited study.
  • Studies of cytoreductive surgery with perioperative intraperitoneal chemotherapy, found through a MEDLINE search, suggested a median survival of 28–35 months.
  • The authors reported that their own unit performed over 250 peritonectomies (for peritoneal surface cancers) with a mortality of 2% in the last 4 years.
  • The authors stated that this surgical approach carries risks of morbidity and mortality, and that it should be offered only to carefully selected patients.
• The authors' conclusion: The authors concluded that cytoreductive surgery with perioperative intraperitoneal chemotherapy should be considered the standard of care for all patients with peritoneal mesothelioma. They also concluded that avoiding asbestos exposure is of utmost importance as primary prevention.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Mesothelioma, Thorax, Pleura, Pleural Mesothelioma, Peritoneal Cavity, Chemotherapy, Palliative Care.

Related studies

• Surgical treatment of peritoneal carcinomatosis: current treatment modalities — Y. Kulu, B. Müller-Stich, et al. (2014)
• Current Management and Future Opportunities for Peritoneal Metastases: Peritoneal Mesothelioma — H.R. Alexander, C.Y. Li, et al. (2018)
• Current trends in the management of malignant peritoneal mesothelioma — J.T. Miura, F.M. Johnston, et al. (2014)
• Current management strategies for peritoneal mesothelioma — K.K. Turaga, M. Deraco, et al. (2017)
• Evaluation of the cost-effectiveness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (peritonectomy) at the St George Hospital peritoneal surface malignancy program — T.C. Chua, S. Martin, et al. (2010)
• Peritoneal mesothelioma: current status and future directions — T.C. Chua, C.H. Chong, et al. (2012)

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