Malignant Peritoneal Mesothelioma

Malignant peritoneal mesothelioma can be difficult to diagnose. A CT scan may suggest the presence of cancer in the abdominal cavity, but cannot confirm the diagnosis of MPM. A biopsy is always required for confirmation. Sometimes, a repeat biopsy is required and may need to be reviewed by a pathologist with expertise in mesothelioma.

Your doctor may plan for you to have any of the following to confirm a diagnosis:

• CT scan (short for computerized tomography scan): Takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these images into a detailed, cross-sectional view 3-dimensional or 3-D that shows any abnormalities or tumors. CT scan images provide more-detailed information than X-rays do.
• Biopsy: A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Your team will work with you to create the best personalized care plan based on your situation. This may include any of the following:

• Updated imaging: This could include repeat CT scans or other forms of imaging if current imaging is outdated.
• Pathology review: If you had a previous surgery or biopsy at another hospital, we may ask for a sample of this tissue to be sent to Mount Sinai Hospital for review by one of our pathologists to confirm your diagnosis.
• Surveillance: Patients who have had most or all of their cancer removed. CT scans will be done on a schedule set by your surgeon for monitoring.
• Paracentesis: If a large amount of ascites builds up in the abdomen, a procedure called paracentesis can be used to remove the fluid. This involves inserting a needle into the abdomen to allow the fluid to be drained.
• Systemic chemotherapy: This type of chemotherapy gets into the bloodstream to reach cancer cells throughout the body. This can be done using an intravenous (IV) tube, which is a tube placed into a vein using a needle or in a pill that is swallowed (orally). This may be recommended if surgery is not possible or as a first step before surgery.
• Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CRS with HIPEC): This is a very specialized surgical technique used in the treatment of some cases of cancers. Intraperitoneal chemotherapy is chemotherapy that is given directly into the abdominal cavity. Typically, the surgeon will try to remove as much of the tumor as possible and then insert a tube in the abdomen through which chemotherapy can be given after the operation. The chemotherapy is warmed above body temperature to increase its ability to penetrate the tissue that may be lined with tumor cells; this is called hyperthermic (or heated) intraperitoneal chemotherapy (referred to as HIPEC). Once chemotherapy is completed, the tube is removed. Mount Sinai Hospital is one of the few centres in Canada that offers this treatment.

Want more information about MPM:

• Mesothelioma Applied Research Foundation provides treatment support and education for patients and their families.

Looking for more information about community resources for those living with cancer? See the community resources page.