Extraovarian Primary Peritoneal Cancer Article

Peritoneal Mesothelioma.

Peritoneal mesothelioma is a tumour arising from the peritoneal lining of the abdomen. This lining is along the inner part of the abdominal cavity (parietal) and the organs inside the abdomen (visceral). It accounts for 30% of mesothelioma and most have a documented past history of asbestos exposure. It is more common in men and the common age of diagnosis is between 50 and 60 years.

Peritoneal mesothelioma can affect both the parietal and visceral peritoneum. As the tumour progresses invasion of neighbouring organs occur. Lymph and blood borne spread to form mestastatic cancers in other organs happens in 50 to 70% of patients.
Patients with peritoneal mesothelioma complain of cramp-like abdominal pain, fullness and constipation. Weight loss and bowel obstruction develop as the tumour progresses. There may well be fluid in the abdomen (ascites).  Often this tumour is discovered incidentally during appendectomy or hernial repair.

X-ray may show areas in hollow viscera. Chest X-ray may show asbestosis or pleural plaques. Ultrasound and CT scan may give some idea of the extent of the tumour.
Diagnosis is by biopsy but this poses a problem in itself because the tumour can invade the scars from the biopsy and the needle tracts. Biopsy can be obtained during exploratory laparatomy. Examination of fluid from the ascites may or may not be helpful.

Prognosis of peritoneal mesothelioma is not good. Less than 20% survive 2 years. Treatment is removal of the tumour by laparatomy. Very rarely is the entire tumour resected. Post operative chemotherapy and radiotherapy can improve survival but the survival rare remains poor.

Cystic Mesothelioma.

Cystic mesothelioma is a benign tumour that occurs almost always in women. No one knows a causative factor, and it is not related to asbestos exposure. It can appear as one single tumour or multiple tumours usually in the pelvic part of the abdomen.
Patients with cystic mesothelioma often present with a mass in the abdomen. Sometimes there is pain associated with the mass. Ultrasound and CT scan will show up the cystic tumour.
Surgical excision is the treatment of choice for cystic mesothelioma. Local recurrence is found in 25% of patients following treatment.