Q1. Which of the following are not true about peritoneal mesothelioma?
a) This disease is asscoiated with residents of lower income countries
b) Asbestos exposure is a notable cause
c) Females are more affected than males
d) Risk factor remian after exposure even if the cause is removed
Answers
1) a
Mesothelioma is seen in higher income countries because of the history of asbestos exposure and better facilities to diagnose it. It is most commonly seen in females and mortality occurs by an average of 66 years.
Risk of abdominal mesothelioma increases throughout life after asbestos exposure even when the offending agent is removed.
Introduction to mesothelioma
The most common primary malignant peritoneal neoplasm is malignant mesothelioma. The median survival rate for patients with this rare tumor is 4 to 12 months. This poor prognosis is due to the very advanced stage of the disease at the time of presentation. Patients present with abdominal pain, ascites, and weight loss.Omentum may be thickened and present as an epigastric mass. Fifty to 70 percent of patients will have a history ofasbestos exposure.
CT Scan Of Abdomen
CT will demonstrate mesenteric thickening, peritoneal studding, hemorrhage within the tumor, and ascites.
Laparoscopy/Laparotomy
At laparotomy the ascitic fluid ranges from a serous transudate to a viscous fluid rich in mucopolysaccharides. The neoplasm tends to involve all peritoneal surfaces producing large masses of tumor. In contrast to pseudomyxoma peritonei, local invasion of intra-abdominal organs, such as the liver, intestine, bladder, and abdominal wall, is the rule.
Differential Diagnosis
Secondary Carcinomatosis
Pseudomyxoma peritoneii
Treatment
Operative intervention is used to provide palliation for intestinal obstruction. Radiation therapy alone, whether using open field techniques, intraperitoneal instillation of radioactive agents, or external-beam radiation therapy, has had very limited success and significant associated morbidity. Intraperitoneal chemotherapy, including the use of cisplatin and mitomycin C, have been reported, but with very limited success.Even in those patients with complete response, relapse is generally rapid.
Median survival at best is 24-30 months