Malignant peritoneal mesothelioma is a rare and highly aggressive tumor of the peritoneum. Given its unclear etiology and complex symptoms, early diagnosis and proper treatment are essential.
Malignant peritoneal mesothelioma is a relatively primitive precursor cell originating from mesothelial cells or mesothelium, which can occur on any coelomic epithelium covered by mesothelial cells. Pleural mesothelioma is the most common, followed by peritoneum, while pericardial and testicular tunica vaginalis are extremely rare. Studies have shown that many factors may be related to its morbidity. Environmental factors such as long-term exposure to hazardous substances such as asbestos and silica dust are known triggers. In addition, biological factors such as certain viral infections, genetic factors such as family history and radiotherapy may also increase the risk of the disease. In terms of presentation, malignant peritoneal mesothelioma in its early stages is often difficult to detect, with most patients showing only mild abdominal pain or distension. As the disease progresses, intermediate manifestations may include significant weight loss, persistent abdominal pain, and abdominal mass. In the late stage, patients may have intestinal obstruction, severe abdominal pain, abdominal distension and a large number of ascites, thrombocytosis and so on. The vast majority of patients have serous and bloody ascites, which grows rapidly, especially diffuse ascites. Abdominal pain is diverse, which can be burning or dull pain without clear location, or severe spasmodic abdominal pain, aggravated by urination and defecation, often accompanied by fatigue, emaciation, loss of appetite and other systemic symptoms. These symptoms are gradually aggravated, affecting the quality of life and daily activities of patients.
Malignant peritoneal mesothelioma requires a combination of medical history, physical signs, auxiliary examinations, and histopathological diagnosis to confirm the diagnosis. First, the doctor will conduct a detailed medical history inquiry and physical examination to make a preliminary judgment by understanding the patient’s clinical signs and specific conditions. Next, imaging tests such as B-ultrasound, CT scan and MRI imaging can provide detailed abdominal images to help find the distribution and size of tumors. Laboratory tests, such as blood tests, are used to find specific tumor markers. The diagnosis of malignant peritoneal mesothelioma also depends on ascites puncture to find tumor cells, laparoscopy, exploratory laparotomy and histopathological confirmation. When it is difficult to differentiate by traditional light microscopy, it is necessary to combine immunohistochemistry and electron microscopy to make a more correct diagnosis. In addition, before the diagnosis of malignant peritoneal mesothelioma, the clinical signs of patients should be combined to exclude metastatic tumors from digestive tract, breast, lung, ovary and other parts.
There are many ways to
treat malignant peritoneal mesothelioma. According to the patient’s condition and physical condition, the doctor will formulate an individualized treatment plan. Surgical treatment is the main treatment method, which is to remove the tumor tissue to reduce the lesion. Whether localized or diffuse, surgical exploration should be performed if there is no contraindication to surgery. If there is no intestinal obstruction, it is better to carry out 1-2 courses of intraperitoneal chemotherapy first to understand the response of the tumor to chemotherapy, reduce the size of the tumor and create conditions for surgery. Tumor cytoreductive surgery should be performed about 3 weeks after chemotherapy, and the operation should be performed as completely or basically as possible. However, due to the highly aggressive nature of the disease, the recurrence rate after surgery is high, and adjuvant therapy is usually needed. Adjuvant therapy, including chemotherapy, peritoneal hyperthermic perfusion therapy and radiotherapy, can further eliminate the residual cancer cells. At present, the effect of intraperitoneal or systemic chemotherapy after surgery is not ideal, and the effect of intraperitoneal chemotherapy is better than that of intravenous chemotherapy. Intraperitoneal hyperthermic perfusion therapy has been highly praised in recent years, and a large number of literature reports show that intraperitoneal hyperthermic perfusion therapy can greatly improve the survival rate of patients.
To sum up, malignant peritoneal mesothelioma is challenging because of its difficulty in early detection and high recurrence rate. Therefore, timely identification of symptoms, early diagnosis and standardized and individualized treatment play a very important role in the prognosis of patients, which can prolong the survival time of patients and improve their quality of life.
Malignant neoplasm of peritoneum
