Peritoneal 24pp A5 Booklet_17.12.20:Layout 2 17/12/20 12:34 Page 1

Peritoneal Mesothelioma

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Peritoneal Mesothelioma

What is Peritoneal the lining of the ribcage Mesothelioma? (pleural mesothelioma), in some people peritoneal The peritoneum is the mesothelioma can be lining of the abdomen. It caused by exposure to has two layers: the inner , although the (visceral) layer, which is links with asbestos are next to the abdominal less clear and a number of organs, and the outer patients have no history of (parietal) layer, which lines asbestos exposure. the abdominal wall. The Peritoneal mesothelioma peritoneum helps to is much less common than protect the contents of pleural mesothelioma and the abdomen and keep though the precise figures them in place. It also are unknown, peritoneal produces fluid that acts as mesothelioma probably a lubricant and helps the represents no more than abdominal organs move 7-10% of all smoothly against each . other. Peritoneal mesothelioma is a primary Peritoneal tumour in the peritoneum, Mesothelioma Types that is the tumour Peritoneal mesothelioma originates from the is categorised into three peritoneal lining. Like groups. Diffuse malignant mesothelioma arising in peritoneal mesothelioma

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(DMPM),low-grade Epithelioid is slow to peritoneal mesothelioma spread and patients (LGPM) and localised may not experience malignant mesothelioma. severe symptoms until a The three groups have later stage of disease. different treatment ● Sarcomatoid is less regimes. common. It tends to Diffuse Malignant progress more quickly Peritoneal Mesothelioma and has a poorer outcome from DMPM includes treatment. epithelioid, sarcomatoid and biphasic. Malignant ● Biphasic (mixed means that the tumour is epithelial-sarcomatoid) made of cancer cells. They is uncommon. It’s more are abnormal and grow aggressive than uncontrollably. DMPM is epithelioid but grows likely to spread more slowly than throughout the abdomen. sarcomatoid The majority of DMPM’s mesothelioma. are treated with palliative Low Grade Peritoneal systemic anti-cancer Mesothelioma treatments. LGPM includes multicystic ● Epithelioid is the most mesothelioma and well- common subtype. differentiated papillary

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Peritoneal Mesothelioma

mesothelioma. Low grade tenderness, swelling, cells look more like normal constipation and cells and tend to grow and infertility. MM spread more slowly than predominantly affects high grade cancer cells. women of reproductive LGPM does not invade age but it also affects nearby tissues or spread men and can occur at to other areas of the body any age. The disease is and these are the less slow growing in the aggressive forms of majority of cases and it peritoneal mesothelioma. is generally ● Multicystic recommended that patients have a Mesothelioma (MM) is systematic clinical an uncommon tumour, follow-up, possibly for estimated to account life, to monitor the for 3-5% of all cases of disease (surveillance). peritoneal For disease which is mesothelioma. MM are extensive a surgical fluid-filled cysts that approach combining have thin translucent cytoreductive surgery walls. These tumours (CRS) and hyperthermic can fill the abdominal intraperitoneal cavity and cause chemotherapy (HIPEC) symptoms. The can be used. common symptoms for MM are abdominal ,

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● Well-differentiated without any treatment papillary peritoneal to systemic anti-cancer mesothelioma (WDPM) treatment. is rare. It is often Localised Malignant discovered incidentally. Mesothelioma WDPM predominantly affects women of Very rarely, a solitary reproductive age. The tumour otherwise disease is generally resembling typical indolent but in some malignant mesothelioma patients has malignant may be found. Called potential. Clinical "localised malignant details and radiological mesothelioma", it is not images are used often seen and is not together with a tissue classed as a diffuse biopsy to gain a disease. diagnosis and to rule It can be treated with an out malignant features. operation to remove the They tend not to spread tumour. This aims to give to the lymph nodes or a cure (the mass is via the blood stream. removed with clear Symptoms experienced margins on the histology can be abdominal pain report). Histology alone and ascites. Treatment cannot be used to for WDPM can vary diagnose localised from surveillance malignant mesothelioma.

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Peritoneal Mesothelioma

Other evidence is needed, specific, and because the such as radiological history of exposure to imaging reporting no asbestos may have been diffuse thickening or many years previously, diffuse nodularity seen there is often a delay and surgical notes. If before the diagnosis of there is evidence in the peritoneal mesothelioma future to suggest a is suspected. Occasionally recurrence or metastases patients will have had then it would be re- symptoms for several classified as diffuse months or even years malignant mesothelioma. before the diagnosis is How is peritoneal confirmed. mesothelioma diagnosed? A CT scan of the abdomen will probably be advised to People who develop help with the diagnosis. peritoneal mesothelioma This can show the may often have mild, thickening of the wall of vague symptoms including the abdomen. abdominal pain, sometimes with An ultra-sound scan may abdominal swelling, be used to find the best constipation or diarrhoea, place to put a needle in the tiredness, loss of appetite abdomen to draw off some and weight loss. Because fluid. the symptoms are non- If the diagnosis is still

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uncertain, it may be to the laboratory to be necessary to have a looked at under a further test called a microscope by a laparoscopy. pathologist. A laparoscopy is a surgical Treatment procedure that allows the doctor to look inside the The choice of treatment abdomen. The procedure for peritoneal is referred to as “minimally mesothelioma depends on invasive” or “keyhole” a number of factors surgery. The surgeon including general fitness, makes one or two small other illnesses, which cuts in the skin but the subtype of peritoneal patient has to have a mesothelioma and how general anaesthetic as the advanced the disease is. abdomen has to be filled There are various with gas to see inside. treatments options which A small flexible tube that include chemotherapy, contains a light source and surgery, surveillance and a camera called a medication. laparoscope can be passed Chemotherapy through the abdominal wall and the surgeon can Chemotherapy is the use look inside and take of anti-cancer (cytotoxic) samples of tissue. These drugs to destroy cancer samples are then sent off cells. They work by

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Peritoneal Mesothelioma

disrupting the growth of The Macmillan Cancer the cancer cells. Support website contains Chemotherapy for information about mesothelioma is used in an individual chemotherapy attempt to shrink the drugs including how each disease but it will not cure drug is given and possible the cancer. It can help to side effects that may be improve symptoms for experienced with each some people and delay the drug. progression of the disease. Surgery Like all chemotherapy treatments, there are A small number of several potential side selected cases may benefit effects and it is important from surgery for to be well enough to peritoneal mesothelioma tolerate these. and this is performed in a specialist centre. It is The chemotherapy drugs called complete that may be used for the Cytoreduction Surgery treatment of (CRS). Hyperthermic mesothelioma include Intraperitoneal Cisplatinum (Platinol), Chemotherapy (HIPEC, Carboplatin (Paraplatin), heated chemotherapy) is Gemcitabine (Gemzar), sometimes put in the Pemetrexed (Alimta) and abdominal space at the Vinorelbine (Navelbine). same time as the surgery.

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The aim of the surgery is nor have extensive disease to remove all of the visible will usually be monitored disease. Palliative tumour by regular clinical follow- “debulking” surgical up and scanning at their procedures can be done to . relieve symptoms where Clinical Trials complete CRS is not indicated. Some treatments are Symptom Management available through clinical trials. Ask your consultant Peritoneal mesothelioma or specialist nurse for is often diagnosed when information. the disease is quite A clinical trial is a research advanced. It is important study designed to evaluate therefore to try to help new or existing manage and control treatments. People who symptoms. Doctors and enter a clinical trial are nurses who specialise in among the first to receive symptom management new treatments before (Palliative Care Teams) are they become widely recommended for all available. Because this patients. research often leads to Surveillance improved treatments, clinical trials play a key The LGPM groups which role in advancing the are not causing symptoms treatment for

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Peritoneal Mesothelioma

mesothelioma. Symptoms and Immunotherapy how to manage them

Immunotherapy is now a The symptoms of standard treatment for peritoneal mesothelioma some cancers such as can include discomfort or melanoma and lung pain, swollen abdomen, cancer. Early studies constipation or diarrhoea, indicate it is also a useful feeling sick (nausea) or treatment for being sick, indigestion, loss mesothelioma. There are of appetite, weight loss various clinical trials open and night sweats. You may in the UK that include also feel more tired and immunotherapy. less inclined to do things, For further information on therefore making you less this, see the Mesothelioma active and sometimes low UK booklet in mood. “Immunotherapy”. Pain Pain in peritoneal mesothelioma varies from person to person, and often depends on the causes of the pain. Some words used to describe pain can include

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“discomfort”, “aching”, acupuncture can also help “soreness”, “a twinge”, with pain. Your local nurse, “sharp”, “stabbing”, cancer information centre, “tightness” or “bloating”. hospice or support group You may be asked to may be able to give you describe your pain by your more information about doctor or nurse, as this can this. help them work out the For further information on type of pain you are having this, see the Macmillan and suggest the best type booklet “Managing Cancer of treatment for it. Pain”. Generally, most types of cancer pain can be Ascites reduced, so let your Peritoneal mesothelioma doctor, nurse or causes thickening of the pharmacist know if you membranes surrounding are in pain. They can the abdominal organs and assess your pain and often a collection of fluid suggest ways to help, for in the abdomen. The example pain killing collection of fluid is called medication. ascites and causes Some complementary swelling of the abdomen. therapies, such as The symptoms of ascites relaxation, massage, can be distressing. The reflexology or abdomen may become

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Peritoneal Mesothelioma

very swollen and it is known as a procedure distended, which can be called paracentesis. The uncomfortable or painful. drain is usually inserted by It can also cause difficulty a doctor and the in getting comfortable, procedure can be done in sitting up or walking. It can the ward or in the clinic. make you feel tired Sometimes a small amount (lethargic) and breathless. of fluid can be drained in It may cause you to feel the clinic. If there is a large nauseous or may make you amount of fluid however, physically sick. It may give the procedure may need you indigestion and you to be carried out in may lose your appetite. hospital under the supervision of the doctors Draining ascites can often and nurses and the drain help relieve pain and may stay in place for a discomfort in the period of 2–3 days. It is abdomen. It can also possible for the ascites to reduce the risk of bowel build up again and obstruction. The fluid is drainage may need to be normally drained with the carried out more than help of an ultrasound scan once. which guides the doctors to where the fluid is If the fluid becomes very located. Putting a tube troublesome and builds up into the abdomen to drain on a regular basis, it may

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be possible to insert a Bowel Changes permanent drainage tube Obstruction under the skin of your abdomen which will stay in Your “normal” bowel habit for as long as needed and may change. With can be looked after at peritoneal mesothelioma, home. This can reduce the this can be caused by a number of times you have number of things. Extra to come to the hospital, pressure in your abdomen and usually involves a caused by tumour or extra district nurse coming in fluid can alter the way once or twice a week to your bowels work. drain the fluid. Sometimes it can cause a blockage in your bowel, Alongside draining the causing a bowel fluid, water tablets obstruction. Obstruction (diuretics), chemotherapy means that you cannot and other types of cancer have a bowel motion, and therapies can also help it can be painful. It can control the fluid. cause sickness and make For further information on you feel out of breath. The this, see the Mesothelioma obstruction can be caused UK booklet “Ascites”. by the mesothelioma itself or in some cases by very advanced ascites (the fluid that accumulates in your

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Peritoneal Mesothelioma

abdomen). If any of these chemotherapy have things happen it is diarrhoea as a side-effect. important that you seek Let your doctor or nurse medical advice straight know if you have away from your doctor or diarrhoea, so that they can nurse. If your bowel is send a sample off for obstructed, then you will testing if necessary. have to go into hospital so Diarrhoea can cause you that it can be investigated to become dehydrated, so further. try to drink plenty of fluids Diarrhoea containing salt, water and sugar. These can include, Diarrhoea is when you mixed fruit juice and pass loose stools or have water, flavoured drinks or your bowels open more soups. You can also use than is normal for you. In special hydration liquids the same way as the but speak to your doctor, mesothelioma in the nurse or pharmacist about abdomen can cause these. If the diarrhoea is constipation by disrupting caused by your the way the bowel works, mesothelioma and is an it can also cause you to ongoing problem, have diarrhoea. Diarrhoea medications can be used can also be caused by an to slow the bowel down. infection or a parasite, and Your doctor can prescribe some medications or these for you.

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Constipation ● Eat regular meals even if they are small. This Poor fluid and food intake encourages your bowels and lack of roughage such to keep moving as bran or fibre (which is contained in beans, ● Try to include some cereals, fruit, vegetables fibre in your diet, such or dried fruits) can all as fruit and vegetables make constipation worse. with their skins on, Lack of exercise can also bananas, dried fruits slow down your bowels. such as prunes or apricots, brown bread, Some suggestions to help brown rice or whole- with these problems can wheat pasta include: ● Do not ignore the urge ● Drinking eight to ten to go to the toilet glasses of fluid a day. This can be any type of Some medications can fluid, but drinks without cause constipation. In this caffeine and alcohol are case it might be best, as both of these recommended that you try can increase the a regular laxative to help, amount you urinate, as well as increasing your meaning that you fibre intake. There are absorb less fluid to help different types of laxatives your bowels work that work in different ways. Which one you use

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Peritoneal Mesothelioma

depends on the problems abdomen can squash the you are experiencing. internal organs including Therefore it is advisable to the stomach. This can discuss it with your doctor, make you feel nauseous or nurse or pharmacist. it can make you feel as if Nausea and Vomiting you have indigestion. Being constipated can also The feeling of sickness make you feel sick, as can (nausea) or being sick some chemotherapy drugs (vomiting) can happen for and other medication such a number of reasons. as antibiotics or Finding the reason for the painkillers. sickness is usually the best Advise your doctor or way to treat it, either by nurse immediately if you relieving the problem if are being very sick as you this is possible, or by may need help to replace working out the best type the fluid that you are of anti-sickness losing. You may also need medication to try. It is further investigations such always worth discussing as an X-ray or scan of your this with your doctor, abdomen to make sure nurse or pharmacist so that the tumour is not that they can advise you. obstructing your bowel. With peritoneal Your doctor may want to mesothelioma, the tumour do a blood test to see if and ascites in the

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there is another reason for depending on the cause of your nausea, as sometimes it, so ask for advice. the salts in your blood can Loss of Appetite and be affected by the Weight Loss mesothelioma or the treatments you are on, Nausea, constipation and causing you to feel sick. diarrhoea can all contribute to weight loss. Indigestion is pain or Sometimes, if you have discomfort in your upper extra pressure in your abdomen or a burning pain abdomen, you will feel full behind your breastbone. It much sooner than normal can make you bring up and this will also make you wind and feel nauseous. It eat less. The can also be described as mesothelioma you can “acid” or “reflux”, and food cause weight loss even if or fluid may come up into you are eating normally. your gullet. Some medications and foods can For further information on make indigestion worse, this, see the Mesothelioma so it is worth asking your UK booklet doctor, nurse or “Mesothelioma and Diet”, pharmacist about this. or ask your doctor or Anxiety can also be a nurse if you can see a factor. There are . medications that can help with indigestion

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Peritoneal Mesothelioma

Fatigue do all the things you would like to do. It can make you Fatigue is another word feel less good about for feeling tired and yourself and your role lacking energy. It is very within your family group. common in people with mesothelioma, affecting as Activity can help with many as nine out of ten. fatigue along with a Fatigue can be acute number of things. It can (short lived and strengthen your muscles, reversible), or it can be joints and bones, help with chronic (longer lasting and your balance and look caused by an underlying after your heart, it can illness). Fatigue can be due improve your mood, to many reasons. reduce anxiety, help you Mesothelioma can cause eat and sleep better and changes in your body that decrease your chances of can lead to tiredness. Not becoming constipated. eating very well, lack of Activity does not always sleep and exercise, certain mean going to the gym, pain killers, chemotherapy running long distances or and anxiety can all generally doing intensive contribute to fatigue. exercise, it can be simple things like going for a Fatigue can be very short walk or even staying frustrating for you and out of bed longer than your family, as you cannot normal.

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You can get advice about fairly common with exercise from a mesothelioma and can physiotherapist, an have a big impact on daily occupational therapist or life. They can soak your nurse, although you may bedclothes and bed linen need to ask for a referral and disturb your sleep, for this. You can ask if making you feel more there is a local exercise tired. scheme for people with Different medications are cancer, or a local support thought to help, and this group. Your hospice will can be discussed with your also often have access to doctor or nurse. physiotherapists and Chemotherapy treatments occupational therapists. can sometimes help to For further information on control the sweating. this, see the Macmillan Things that can help booklet “Coping with include: Fatigue (Tiredness)”. ● Sweating Using a fan in the bedroom, opening the Why and how excessive windows. sweating occurs in people ● Using only bed linen with mesothelioma is not and nightclothes made exactly clear. Sweating of natural fibres, such as particularly at night is cotton.

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● Trying temperature Your Feelings regulating pillow and For many people, having a mattress covers. diagnosis of mesothelioma ● Having a lighter quilt or can be overwhelming, and other bedding. will affect their lives in many ways. This can be in ● Avoiding drinks with a practical, everyday way, caffeine, especially if but it can also affect how sweating is worse at you feel about your life, night. your relationships, your If you are having work and your finances. chemotherapy, make sure All of these can lead to that you do not have a high uncertainty, fear, a loss of temperature or fever if control, and can affect you are sweating as this your ability to cope with could indicate that you your mesothelioma might have an infection. If diagnosis. The feelings you do have a high can be so overwhelming temperature, you will need that they may prevent you to contact your cancer managing day to day. You centre immediately. may want to be alone, you may want your family and For further information on friends around you. There this, see the Mesothelioma is no right or wrong way to UK booklet “Sweating”. react, and that reaction

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will be individual to you. support groups. These are groups where you can Talking about your feelings meet other people with is usually a good place to mesothelioma who may be start. Talking about how able to understand how you feel, what worries or you are feeling. These frightens you, can groups are usually open to sometimes help you carers, partners and practically and families as well. They often emotionally. For a lot of include practical people, talking to friends education on related and family is enough, but issues, but also provide a for some, talking to a social space where you professional is easier and can meet other people in a feels safer. Professionals similar situation to you. include your doctor and They are often run by local nurse, counsellors, Asbestos Victim Support physiotherapists, Groups and specialist occupational therapists, or mesothelioma nurses. The people who provide Mesothelioma UK website complementary therapies has an up to date list of such as massage, support groups on their reflexology or relaxation. website and there is an Ask your nurse or your online virtual support cancer information centre group specifically for if there are any local peritoneal mesothelioma.

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Peritoneal Mesothelioma

For further information References on this, see the Macmillan ● British Nutrition booklet “Coping with Foundation: your Emotions”. www.nutrition.org.uk

● Macmillan Cancer Support: www.macmillan.org.uk – Booklets: Managing Cancer Pain, Coping with Fatigue (Tiredness), Coping with your Emotions, Maintaining a Healthy Lifestyle, Move More, Physical Activity and Cancer Treatment ● NHS: www.nhs.uk – Constipation, laxatives. ● Cancer Research UK: www.cancerresearch uk.org – About Mesothelioma, Coping with Cancer, Bowels, Blocked Bowel.

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Further Useful Information

10 Steps to an Active You Leaflet www.bdct.nhs.uk/wp- content/uploads/ 2019/06/Leaflet- 10StepstoActiveYou Walking_PHE.pdf

Macmillan Move More: Your Complete Guide to Becoming More Active www.macmillan.org.uk/ documents/cancerinfo/ physicalactivity/ movemore.pdf

Public Health England “One You” www.nhs.uk/oneyou/for- your-body/

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Reviewed by: Mesothelioma UK | Review Date: December 2022

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