Treatment options for peritoneal mesothelioma

Treatment options for peritoneal mesothelioma include:

chemotherapy
surgery
supportive treatments to control symptoms of advanced cancer

Mesothelioma usually starts in the tissue covering the lung (the pleura). Less often, it can start in tissue in your tummy (peritoneum). This page is about treatment options for peritoneal mesothelioma.

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The treatment you have depends on:

where your cancer is
how far it has grown or spread (the stage)
the type of cancer
your general health and level of fitness
your personal wishes

Your doctor will discuss your treatment, its benefits and the possible side effects with you.

The main treatments

Unfortunately mesothelioma can be difficult to treat. It is often diagnosed at an advanced stage. So, nearly all treatments aim to control the mesothelioma for as long as possible. And keep symptoms under control.

Treatment options include:

surgery, if you are well enough
chemotherapy into your tummy or bloodstream
supportive treatments to help control symptoms

Surgery

Surgery is not a common treatment. It is only an option for a small number of people with peritoneal mesothelioma. Unfortunately, surgery can't usually get rid of the mesothelioma for good. And you need to be very fit for this type of major operation.

You might have an operation to control and relieve symptoms. The surgery might also help you live longer. Doctors sometimes call this operation cytoreductive surgery or debulking surgery.

Your surgeon might remove:

part or all of the lining of the abdomen (peritoneum) - this is called a peritonectomy

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells.

You might have chemotherapy:

into a vein (intravenous chemotherapy) to shrink the cancer and control your symptoms
directly into your tummy (abdomen) at the same time as surgery - this is called hyperthermic intraperitoneal chemotherapy (HIPEC)

Common intravenous chemotherapy drugs for mesothelioma are pemetrexed and cisplatin.

Supportive care (palliative care)

Unfortunately, peritoneal mesothelioma is often diagnosed when it is quite advanced. Some people may be too ill to cope with intensive chemotherapy. But you can still have treatment to try to relieve symptoms such as pain, weight loss and fluid in the abdomen.

This is called palliative care. It’s managed by a team of doctors and nurses who are experts in controlling symptoms of advanced cancer. The team may also include a physiotherapist and dietician.

Draining fluid from your abdomen (abdominal paracentesis)

Fluid might collect inside your abdomen. This is called ascites. If too much fluid collects, it makes your abdomen swell. This can be uncomfortable and heavy.

The doctor can drain off this fluid. This treatment is called abdominal paracentesis or an ascitic tap.

Diagram showing fluid (ascites) being drained from the abdomen

Clinical trials

Cancer treatments do not always work well for mesothelioma. Doctors and researchers are working to improve mesothelioma treatment all the time.

Your doctor might ask if you’d like to take part in a clinical trial. Trials make existing treatments better and develop new treatments.

Your choices

Your doctor might offer you a choice of treatments. Discuss each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. You also need to think about the other factors involved in each treatment, such as:

whether you need extra appointments
if you need more tests
the distance you need to travel to and from hospital

You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.