Recommendations for Diagnosing Peritoneal Mesothelioma

Despite continual effort to find early diagnostic methods and treatment for malignant mesothelioma, the outcome for those diagnosed with asbestos related cancers remains poor.  Indeed, survival times are usually less than a year, with treatments only able to focus on improving quality of life.  Establishing ways to diagnose mesothelioma earlier and novel therapies that are more effective at treating mesothelioma is imperative.

Researchers at the Osaka Medical Center for Cancer and Cardiovascular Diseases (OMCCCD) in Japan have ongoing investigations into ways to diagnose and improve treatment for advanced cancers.   OMCCCD is not only a hospital but also has a Research Institute and Department of Cancer Control and Statistics.  The Research Institute explores the molecular and genetic aspects of advanced cancer and diseases and then, in collaboration with the Hospital, completes trials to improve intervention methods.

Recently, a report was published regarding a case of a 58 year old Japanese woman who was diagnosed with peritoneal malignant mesothelioma (PMM).  All mesotheliomas are highly aggressive cancers, with pleural mesothelioma being the most common and PMM being less common, accounting for 6-10% of all malignant mesotheliomas.  Exposure to asbestos is the primary cause of mesothelioma.  Men, whose occupations are more likely to put them into contact with asbestos, are more likely to develop the cancer than women.  Women who do develop mesothelioma are on average ten years younger than the median age of men who do, 50 versus 60 years old. 

In this case, the mesothelioma was discovered after the woman was admitted to the hospital for ongoing abdominal discomfort that had lasted more than 2 months and was getting worse.   As the symptoms of mesothelioma can be very non-specific, several tests were performed to make the diagnosis:

• Hematological and blood chemistry tests, which identified elevated serum levels of selected tumor markers
• Abdominal ultrasonography, which revealed a huge mass in the liver as well as pleural effusion
• Abdominal computed tomography (CT) scan, a test not sufficient enough to establish positive diagnosis of mesothelioma but helpful in performing biopsy of peritoneal masses and thickening
• Liver needle biopsy, which provided expanded immunohistochemical panels, demonstrated clear evidence of peritoneal mesothelioma.

The report discussed the importance of using different tests for diagnosis of mesothelioma in spite of any known history of exposure to asbestos or if there is apparent invasion into surrounding tissues and sites, such as the liver in this case.

Research centers that focus on advanced cancers are important resources for anyone affected by mesothelioma since it is almost always discovered only after it has reached advanced stages.  Hopefully, such centers will develop more effective ways of diagnosing, treating and ultimately curing mesothelioma.