Staging is a way to describe how far the disease has spread in the body. Using the results from the tests taken to diagnose mesothelioma, your medical team will discuss with you how far it has spread.
Understanding the available treatment and possible side effects can help you weigh up the pros and cons of different options. You may want to get a second opinion from another specialist to confirm or clarify your doctor’s recommendations.
For most people treatment for peritoneal mesothelioma is given to control symptoms and to slow its growth. Occasionally, more aggressive treatment is offered if a better outcome is considered possible.
Your doctor will recommend the best treatment for you, depending on:
As well as being used to diagnose mesothelioma, paracentesis can also provide pain relief in patients with ascites. A small tube is inserted to allow fluid to flow out of the abdomen into a bottle.
For many people peritoneal mesothelioma is diagnosed at an advanced stage, when it is aggressive or has spread through the body. This means surgery is not suitable for most people.
If you have advanced mesothelioma, you may be offered debulking surgery. During this procedure, as much of the cancer is removed as possible in the hope of stopping the spread of disease and relieving pressure on vital organs.
Debulking surgery is generally regarded as palliative treatment, which means it helps to reduce symptoms and improve quality of life, but does not aim to cure the cancer.
If the cancer is not widespread, it is possible for some people to have an operation called a peritonectomy (or cytoreductive surgery). During this procedure, a surgeon removes the parts of the peritoneum where the mesothelioma is growing.
The aim is to achieve the complete removal of the cancer to reduce symptoms, improve quality of life and increase life expectancy.
For a small number of carefully selected people, peritonectomy may be combined with heated intraoperative intraperitoneal chemotherapy (HIPEC). This is when chemotherapy drugs are heated to 42°C and inserted into the abdomen for 60-90 minutes during the operation.
After surgery, a course of chemotherapy may be delivered directly into the abdomen through a thin tube, called early postoperative intraperitoneal chemotherapy (EPIC).
Peritonectomy surgery is complex and has an extended recovery time. It is performed by a limited number of surgeons in Australia. It is recommended you seek an opinion from one of these surgeons if considering this surgery. For more information call Cancer Council 13 11 20.
Chemotherapy may be offered as part of a treatment plan. This is a way to treat cancer using anti-cancer (cytotoxic) drugs. It aims to kill off or shrink the mesothelioma and keep it under control for as long as possible.
Chemotherapy can be delivered through a vein (intravenously). In this case, it is given on a regular basis (weekly or every 2-3 weeks) over a period of time. Chemotherapy can also be injected directly into the abdomen, through a thin tube called a catheter. This is called intraperitoneal chemotherapy.
Chemotherapy may be given on its own or before, during or after surgery.
Doctors and researchers are working to improve the diagnosis and treatment of mesothelioma. You may be offered treatment as part of a clinical trial. Over the years, trials have improved treatments and led to better outcomes for people diagnosed with cancer.
It may be helpful to talk to your specialist or clinical trials nurse, or to get a second opinion. If you decide to take part in a trial, you can withdraw at any time.
Palliative treatment helps to improve a person’s quality of life by reducing pain and managing other physical and emotional symptoms. Treatment may include paracentesis, debulking surgery, chemotherapy or other medicines.
Because palliative treatment is not intended to cure the cancer, it is often assumed that it is only for people at the end of life. However, it is beneficial for people at any stage of a mesothelioma diagnosis. Contacting the palliative care team soon after diagnosis gives them the opportunity to get to know you, your family and your circumstances.
Although other professionals will be responsible for your treatment in the earlier part of your diagnosis, the palliative care team can become involved when needed and manage your care when active medical management becomes less effective.
Reviewed: Prof Paul Moroz, Professor of Surgery, University of Western Australia and Director of the Western Australian Peritonectomy Service, Joondalup Health Campus, WA; Carole Arbuckle, 13 11 20 nurse, Cancer Council Victoria, VIC; Sharyn Fenech, consumer; Dr Vinod Ganju, Head of Translational Research, Monash Cancer Centre, VIC; Vicki Hamilton, CEO, Asbestos Council of Victoria-GARDS, VIC; Dr Tom John, Medical Oncologist, Austin Hospital, VIC; Victoria Keena, Executive Officer, Asbestos Diseases Research Institute, NSW; Prof David Morris, University of New South Wales, Department of Surgery, St George Hospital, NSW; Evelyn Ramirez, consumer; Rod Smith, Bernie Banton Foundation; Elaine Spellman, Peritonectomy, Clinical Nurse Specialist, Joondalup Health Campus, WA; Prof Nico van Zandwijk, Director of the Asbestos Diseases Research Institute and Professor of Medicine, University of Sydney, NSW and A/Prof Winston Liauw, Cancer Services Stream Director, South Eastern Sydney Local Health District, NSW. Note to reader Always consult your doctor about matters that affect your