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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Peritoneal mesothelioma grows in the lining of the abdomen, causing swelling, pain and fluid. Unlike its pleural cousin it is often treated with major surgery to strip the lining followed by heated chemotherapy washed through the abdomen, which can give long survival in fit patients with epithelioid disease.
Peritoneal mesothelioma presents with abdominal distension from ascites, pain, weight loss or a mass found at surgery, and is diagnosed by laparoscopic biopsy with the same immunohistochemistry as pleural disease. Asbestos exposure is found in only a minority; BAP1 germline mutations account for some cases, and the disease is commoner in women than pleural mesothelioma. For fit patients with epithelioid histology and disease that can be removed, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard in specialist centres and gives median survival of five years or more in series, though no randomised trial exists. Patients who are not candidates receive platinum-pemetrexed chemotherapy, with immunotherapy increasingly used on the basis of small trials and the pleural data. Well-differentiated papillary and multicystic forms behave almost benignly and are managed separately.
| Setting | Approach | Guideline |
|---|---|---|
| Diagnosis | CT, laparoscopy with biopsy and scoring of disease extent; germline BAP1 testing when young or with a family history. | not mapped |
| Resectable epithelioid disease, fit patient | Cytoreductive surgery with HIPEC in an experienced centre; long-term survival in a substantial fraction. | not mapped |
| Unresectable or unfit | Platinum-pemetrexed chemotherapy; nivolumab plus ipilimumab or pembrolizumab combinations extrapolated from pleural trials and small peritoneal series. | not mapped |
| Indolent variants | Well-differentiated papillary and multicystic tumours: surgical removal and surveillance; systemic therapy rarely needed. | not mapped |