Staging Peritoneal Mesothelioma - Peritoneal Mesothelioma Staging
Staging Peritoneal Mesothelioma
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Cytoreductive Surgery with Heated Chemotherapy.
Cytoreductive surgery, also known as a peritonectomy, attempts to remove as much cancer as possible. Then, heated chemotherapy is applied locally to the abdomen before the surgery ends. Doctors only perform this procedure on a case-by-case basis. A 2019 study reported that more than 65% of the patients who underwent this procedure lived five years or longer.
Chemotherapy.
Patients who don’t qualify for surgery with heated chemotherapy can receive systemic chemotherapy alone. Chemotherapy drugs can shrink peritoneal mesothelioma tumors and slow the growth and spread of cancer. Chemotherapy drugs that are effective against peritoneal mesothelioma include pemetrexed, cisplatin, carboplatin and gemcitabine.
U.S. Navy pilot and peritoneal mesothelioma survivor Jim Madaris decided to seek out the HIPEC procedure after his diagnosis in 2013. The surgery took 14 hours and removed his gallbladder, spleen and parts of his intestine. Madaris extended his life by four years, allowing him to find joy in the little things and see his youngest child graduate high school.
Palliative Treatment Options.
In addition to anti-cancer treatments, many peritoneal patients receive palliative care to control symptoms and improve quality of life. For example, a paracentesis procedure may be recommended to certain peritoneal patients to drain excess fluid from the abdomen.
A palliative care specialist prescribes medications to control pain and side effects. They may refer patients to physical or occupational therapy or recommend complementary therapies.
Peritoneal Mesothelioma Life Expectancy and Prognosis
The prognosis for peritoneal mesothelioma is generally poor for patients who don’t qualify for surgery. Peritoneal mesothelioma life expectancy is approximately 12 months for patients who receive chemotherapy alone. The median survival of untreated peritoneal mesothelioma patients is six months.
However, the prognosis for surgical candidates is significantly better. Surgery and heated chemotherapy can improve peritoneal survival by several years.
About half of peritoneal patients who undergo a combination of cytoreductive surgery with heated chemotherapy have a life expectancy of more than five years.
According to a 2020 study published in the American Journal of Surgical Pathology, women with peritoneal mesothelioma tend to live longer than men. In the study, 77.8% of women treated with cytoreductive surgery and heated chemotherapy at MD Anderson Cancer Center in Houston survived longer than five years.
When averaging short- and long-term survival, women live approximately 13 months on average, and men live roughly six months.
Prognostic Factors.
Stage at diagnosis.
Cell type.
Tumor grade (how fast it grows).
Gender.
Genetic mutations.
Treatments selected.
Patients with tumors containing epithelial cells have a longer life expectancy than patients with sarcomatoid or biphasic cells. Epithelial cells tend to respond better to treatments such as chemotherapy.
The tumor’s grade also impacts prognosis. Tumor grade indicates how quickly tumors are likely to grow and spread, based upon how abnormal the cells appear.
Chemotherapy Survival Rates.
Systemic (whole-body) chemotherapy combined with cisplatin and pemetrexed has the following benefits:
A response rate of about 30%.
Average progression-free survival around 11.5 months.
Median survival around 13 months.
Chemotherapy delivered directly to the peritoneum without surgery has a higher response rate of 47%. When combined with heated chemotherapy given during surgery, the response rate is 84.6%.
Is There a Cure for Peritoneal Mesothelioma?
There is no cure for peritoneal mesothelioma or any other type of mesothelioma. However, peritoneal patients eligible for surgery and HIPEC typically live longer than five years.
Some patients may be eligible for a repeat surgery with heated chemotherapy if a mesothelioma recurrence happens.
In 2017, Dr. Paul Sugarbaker reported improved survival among patients who received early post-operative chemotherapy and long-term chemotherapy after cytoreductive surgery with heated chemotherapy.
Staging Peritoneal Mesothelioma - Peritoneal Mesothelioma Staging
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