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Peritoneal Mesothelioma

Peritoneal mesothelioma is a rare cancer of the abdominal lining caused by asbestos exposure. While it accounts for 15–20% of all mesothelioma cases, breakthrough treatments like cytoreductive surgery with HIPEC have dramatically improved outcomes, with five-year survival rates now exceeding 50% for eligible patients.

15–20% Of All Mesothelioma Cases
50%+ 5-Year Survival with CRS+HIPEC
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Medically reviewed and updated: • Sources: NCI, Annals of Surgical Oncology, SEER

What Is Peritoneal Mesothelioma?

Peritoneal mesothelioma is a malignant cancer that develops in the peritoneum — the thin membrane of mesothelial cells that lines the abdominal cavity and covers the abdominal organs, including the stomach, liver, intestines, and spleen. It is the second most common type of mesothelioma after pleural mesothelioma, accounting for approximately 15–20% of all mesothelioma diagnoses in the United States.

Like all forms of mesothelioma, peritoneal mesothelioma is caused by exposure to asbestos. When asbestos fibers are inhaled or swallowed, they can migrate through the body and become lodged in the peritoneal lining. Over time — typically 20 to 50 years after initial exposure — these fibers cause chronic inflammation and DNA damage to the mesothelial cells, eventually leading to malignant tumor formation. The exact mechanism by which fibers reach the peritoneum is believed to involve both ingestion of inhaled fibers that are cleared from the airways and swallowed, and direct translocation through the lymphatic system.

The peritoneum serves critical functions in the body: it produces lubricating fluid that allows abdominal organs to move smoothly against each other, provides structural support, and contains blood vessels and nerves that supply the abdominal organs. When mesothelioma develops in this membrane, it disrupts all of these functions, leading to the accumulation of fluid in the abdomen (ascites), tumor growth across the peritoneal surfaces, and progressive compression of the abdominal organs.

Peritoneal vs. Pleural Mesothelioma

While both peritoneal and pleural mesothelioma are caused by asbestos exposure, they differ in several important ways. Pleural mesothelioma develops in the lining of the lungs and accounts for approximately 75–80% of cases. It causes chest pain, shortness of breath, and pleural effusions. Peritoneal mesothelioma develops in the abdominal lining and causes abdominal pain, swelling, and ascites. Perhaps most importantly, peritoneal mesothelioma patients who are eligible for the CRS+HIPEC procedure have a significantly better prognosis than most pleural mesothelioma patients, with five-year survival rates exceeding 50% in published multi-institutional studies.

15–20% Of All Mesothelioma Cases
~500 New U.S. Cases Per Year
20–50 yr Latency Period After Exposure
C45.1 ICD-10 Diagnostic Code

Symptoms & Warning Signs

The symptoms of peritoneal mesothelioma develop gradually and are often vague in the early stages, which can make diagnosis challenging. Many of these symptoms mimic common gastrointestinal conditions such as irritable bowel syndrome, hernias, or ovarian cancer, leading to frequent misdiagnosis. Because early detection is critical for treatment eligibility — particularly for CRS+HIPEC — anyone with a history of asbestos exposure who experiences these symptoms should inform their physician immediately.

Common Symptoms of Peritoneal Mesothelioma

  • Abdominal pain and tenderness — persistent, often diffuse pain throughout the abdomen that worsens over time; may be initially mild and mistaken for indigestion
  • Abdominal swelling and distension — progressive bloating caused by tumor growth and fluid accumulation; patients may notice their clothing no longer fits
  • Ascites (fluid buildup) — accumulation of excess fluid in the abdominal cavity, one of the most characteristic signs of peritoneal mesothelioma; may require repeated paracentesis for relief
  • Nausea and vomiting — digestive disruption caused by tumor pressure on the stomach and intestines; may be persistent or intermittent
  • Changes in bowel habits — constipation, diarrhea, or alternating patterns caused by tumor compression of the intestines or bowel obstruction
  • Unexplained weight loss — significant, unintentional weight loss despite adequate food intake; often caused by cancer-related metabolic changes and malabsorption
  • Loss of appetite (anorexia) — reduced desire to eat, often accompanied by early satiety (feeling full after eating very little); may contribute to progressive weight loss
  • Fatigue and weakness — persistent exhaustion not relieved by rest; common in advanced disease and often related to nutritional deficiencies and the body's immune response to cancer

Early Detection Can Save Your Life

Because CRS+HIPEC — the most effective treatment for peritoneal mesothelioma — is only available to patients whose disease has not spread beyond the abdominal cavity, early detection is critical. If you have a history of asbestos exposure and are experiencing persistent abdominal symptoms, seek medical evaluation immediately. Inform your doctor about any asbestos exposure, even if it occurred decades ago. Early-stage peritoneal mesothelioma patients who undergo CRS+HIPEC have five-year survival rates exceeding 50%, compared to approximately 12 months for those who receive only systemic chemotherapy. Learn more about your diagnosis and treatment options.

Medically reviewed and updated: • Sources: NCI, NCCN Guidelines

Diagnosis & Staging

Diagnosing peritoneal mesothelioma typically involves a combination of imaging studies, fluid analysis, and tissue biopsy. Because the disease is rare and its symptoms resemble many common gastrointestinal conditions, the diagnostic process can be lengthy. Patients are frequently evaluated for other conditions before peritoneal mesothelioma is identified. The average time from symptom onset to diagnosis is approximately 4 to 6 months.

Diagnostic Methods

Diagnostic Method What It Reveals Role in Diagnosis
CT Scan (Abdomen/Pelvis) Reveals peritoneal thickening, tumor nodules, ascites, and organ involvement; provides detailed cross-sectional images of the abdomen Primary Imaging
MRI Provides superior soft tissue contrast; helps differentiate tumor from normal tissue and assess organ involvement Supplemental Imaging
PET-CT Scan Detects metabolically active cancer cells; helps identify extent of disease and potential spread beyond the peritoneum Staging & Assessment
Paracentesis Removes fluid from the abdomen for cytological analysis; can identify malignant mesothelial cells and provide symptom relief Initial Evaluation
Laparoscopic Biopsy Minimally invasive surgical procedure to obtain tissue samples directly from peritoneal tumors; provides definitive tissue diagnosis Definitive Diagnosis
Immunohistochemistry Laboratory analysis of biopsy tissue using antibody markers (calretinin, WT1, D2-40) to confirm mesothelioma and distinguish it from other cancers Confirmation & Typing

The Peritoneal Cancer Index (PCI) Score

Once peritoneal mesothelioma is confirmed, the extent of disease is assessed using the Peritoneal Cancer Index (PCI), a scoring system that divides the abdomen into 13 regions and rates the tumor burden in each region on a scale of 0 to 3. The total PCI score ranges from 0 to 39 and is one of the most important factors in determining treatment eligibility and prognosis.

  • PCI 0–10 (low) — limited disease; typically favorable candidates for CRS+HIPEC with the best expected outcomes
  • PCI 11–20 (moderate) — more extensive disease; CRS+HIPEC may still be possible depending on tumor distribution and patient fitness
  • PCI 21–39 (high) — widespread disease; complete cytoreduction becomes increasingly difficult; systemic therapy may be preferred

Cell Type Matters for Treatment Planning

Peritoneal mesothelioma has three histological subtypes. Epithelioid is the most common (approximately 75% of cases) and has the best response to CRS+HIPEC treatment. Sarcomatoid is the rarest and most aggressive subtype. Biphasic (mixed) contains both epithelioid and sarcomatoid cells, and prognosis depends on the ratio. The cell type identified during biopsy is a critical factor in determining the most effective treatment approach.

Treatment Options

Treatment for peritoneal mesothelioma has advanced significantly in recent decades. The development of CRS+HIPEC — cytoreductive surgery combined with heated intraperitoneal chemotherapy — has transformed the outlook for many patients, offering the possibility of long-term survival where previously the prognosis was measured in months. Treatment decisions are made based on the PCI score, cell type, patient fitness, and whether the disease can be completely removed surgically.

CRS+HIPEC: The Gold-Standard Treatment

Cytoreductive surgery with heated intraperitoneal chemotherapy (CRS+HIPEC) is widely considered the most effective treatment for peritoneal mesothelioma and has been the primary driver of improved survival rates over the past two decades. The procedure is performed at specialized cancer centers by experienced surgical oncologists.

The procedure involves two phases:

  1. Cytoreductive Surgery (CRS): The surgeon meticulously removes all visible tumor tissue from the peritoneal surfaces and affected organs. This may include stripping the peritoneal lining (peritonectomy), removing portions of the bowel, spleen, gallbladder, or other organs if necessary. The goal is complete cytoreduction — the removal of every macroscopic tumor deposit — which is the single most important factor in long-term outcomes.
  2. Heated Intraperitoneal Chemotherapy (HIPEC): Immediately after the surgical removal of visible tumors, a heated chemotherapy solution — typically containing cisplatin, mitomycin C, or a combination — is circulated directly through the abdominal cavity at a temperature of approximately 42°C (107.6°F) for 60 to 90 minutes. The heat enhances the penetration of chemotherapy drugs into any remaining microscopic cancer cells and increases drug effectiveness. The direct delivery to the peritoneal surface achieves drug concentrations 20 to 100 times higher than systemic intravenous chemotherapy.
50%+ 5-Year Survival with CRS+HIPEC
42°C HIPEC Solution Temperature
60–90 min HIPEC Perfusion Duration
20–100x Higher Drug Concentration vs. IV

Systemic Chemotherapy

For patients who are not candidates for CRS+HIPEC — due to extensive disease, poor overall health, or sarcomatoid cell type — systemic chemotherapy remains an important treatment option. The standard first-line regimen for peritoneal mesothelioma is cisplatin (or carboplatin) combined with pemetrexed. While systemic chemotherapy alone does not achieve the same survival rates as CRS+HIPEC, it can shrink tumors, slow disease progression, and improve quality of life. In some cases, neoadjuvant chemotherapy is used before CRS+HIPEC to reduce tumor burden and improve surgical outcomes.

Immunotherapy

Immunotherapy has emerged as a promising treatment for mesothelioma, including the peritoneal type. The combination of nivolumab and ipilimumab — two immune checkpoint inhibitors — received FDA approval for unresectable malignant mesothelioma in 2020. These drugs work by removing the brakes on the immune system, allowing the body's natural defenses to recognize and attack cancer cells. Immunotherapy may be used as a first-line treatment for patients who are not surgical candidates, or as a second-line option after chemotherapy.

PIPAC: An Emerging Approach

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is a newer, minimally invasive technique that delivers aerosolized chemotherapy directly into the abdominal cavity under pressure during a laparoscopic procedure. PIPAC can be repeated multiple times with relatively short recovery periods and may be appropriate for patients who are not candidates for CRS+HIPEC. Early clinical data has shown promising tumor response rates, and clinical trials continue to evaluate its effectiveness for peritoneal mesothelioma.

Seek Treatment at a Specialized Center

CRS+HIPEC is a complex procedure that should only be performed at cancer centers with specialized expertise and a high volume of peritoneal surface malignancy cases. Outcomes are significantly better at experienced centers. If you or a loved one has been diagnosed with peritoneal mesothelioma, we can help connect you with leading treatment centers and mesothelioma specialists across the country. Call us at 1-800-400-1805 for assistance.

Medically reviewed and updated: • Sources: Annals of Surgical Oncology, Multi-Institutional Registry

Prognosis & Survival Rates

Peritoneal mesothelioma has a significantly better prognosis than pleural mesothelioma, particularly for patients who undergo CRS+HIPEC. This represents one of the most important advances in mesothelioma treatment in the past two decades. While the overall median survival for all peritoneal mesothelioma patients is approximately 12 months, patients who receive CRS+HIPEC at experienced centers have demonstrated dramatically improved outcomes.

Survival by Treatment Approach

Treatment Median Survival 5-Year Survival Rate
CRS+HIPEC (complete cytoreduction) 53–92 months 50–63%
CRS+HIPEC (incomplete cytoreduction) 12–26 months 15–25%
Systemic Chemotherapy Alone 12–14 months 5–10%
Best Supportive Care 6–8 months <5%

Factors That Influence Prognosis

Several key factors determine the prognosis for an individual peritoneal mesothelioma patient:

  • Completeness of cytoreduction (CC score) — the single most important prognostic factor; complete removal of all visible tumors (CC-0 or CC-1) is associated with the best outcomes
  • Peritoneal Cancer Index (PCI) score — lower PCI scores indicate less extensive disease and correlate with longer survival; patients with PCI scores below 20 generally have significantly better outcomes
  • Cell type (histology) — epithelioid peritoneal mesothelioma has the best prognosis; sarcomatoid and biphasic subtypes are associated with shorter survival times
  • Ki-67 proliferation index — a measure of how rapidly the cancer cells are dividing; lower Ki-67 values indicate slower-growing tumors and better prognosis
  • Patient age and overall health — younger patients with good performance status tend to tolerate CRS+HIPEC better and have improved survival
  • Lymph node involvement — the absence of lymph node metastases is associated with better outcomes following CRS+HIPEC

A More Hopeful Prognosis Than Most Mesotheliomas

The data on CRS+HIPEC for peritoneal mesothelioma represents a genuine breakthrough in mesothelioma treatment. Multi-institutional studies published in the Annals of Surgical Oncology and the Journal of Clinical Oncology have consistently demonstrated five-year survival rates exceeding 50% for patients who achieve complete cytoreduction — outcomes that are unmatched by any other treatment approach for any type of mesothelioma. If you or a loved one has been diagnosed, contact us at 1-800-400-1805 to learn about treatment options and legal rights.

Legal Rights & Compensation

Peritoneal mesothelioma is caused almost exclusively by exposure to asbestos. The companies that mined, manufactured, distributed, and used asbestos-containing products knew about the health dangers for decades but failed to warn workers and the public. As a result, patients diagnosed with peritoneal mesothelioma and their families have strong legal grounds to pursue compensation for medical expenses, lost income, pain and suffering, and other damages.

Sources of Compensation

  • Asbestos trust fund claims — over $30 billion remains available in more than 60 active asbestos bankruptcy trusts established by former asbestos companies; most claims are processed within 6–12 months
  • Personal injury lawsuits — legal claims against solvent asbestos product manufacturers, distributors, and employers; may result in settlements or jury verdicts that provide significant compensation
  • Wrongful death claims — surviving spouses, children, and other family members can file claims if a loved one has died from peritoneal mesothelioma
  • VA disability benefits — veterans diagnosed with mesothelioma due to military asbestos exposure are typically rated at 100% disability by the VA, providing maximum monthly compensation and healthcare benefits
  • Workers' compensation — some states allow workers' compensation claims for occupational asbestos-related diseases, even years after the exposure occurred

The statute of limitations for asbestos claims varies by state but typically begins at the time of diagnosis, not the time of exposure. This means that even if your asbestos exposure occurred 30, 40, or 50 years ago, you may still have valid legal claims. However, because statutes of limitations impose strict deadlines — often 1 to 3 years from diagnosis — it is important to consult with an experienced mesothelioma attorney as soon as possible after receiving your diagnosis.

No Upfront Fees — We Only Get Paid if You Do

At Danziger & De Llano, we represent peritoneal mesothelioma patients and their families on a contingency fee basis. This means there are no upfront costs, no hourly fees, and no out-of-pocket expenses. We only get paid if we recover compensation for you. With over 35 years of experience and more than $2 billion recovered for asbestos-exposed clients and their families, we have the resources and expertise to handle every aspect of your legal claim while you focus on treatment and recovery.

Diagnosed with Peritoneal Mesothelioma? Get a Free Case Review

Our experienced mesothelioma attorneys have helped thousands of patients and their families recover the compensation they deserve. We will review your asbestos exposure history, identify every responsible manufacturer, and pursue all available trust funds and legal claims. There is no cost, no pressure, and no obligation.

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FAQ answers reviewed by legal team:

Frequently Asked Questions About Peritoneal Mesothelioma

What is the survival rate for peritoneal mesothelioma?

Peritoneal mesothelioma has a significantly better prognosis than pleural mesothelioma when treated with cytoreductive surgery combined with heated intraperitoneal chemotherapy (CRS+HIPEC). Multi-institutional studies have reported five-year survival rates exceeding 50% for patients who undergo CRS+HIPEC with complete cytoreduction. Without surgical intervention, median survival is approximately 12 months. Factors that influence survival include the Peritoneal Cancer Index (PCI) score, cell type (epithelioid has the best outcomes), completeness of cytoreduction, and the patient's overall health.

How is peritoneal mesothelioma different from pleural mesothelioma?

Peritoneal mesothelioma develops in the peritoneum (the lining of the abdominal cavity), while pleural mesothelioma develops in the pleura (the lining of the lungs). Peritoneal mesothelioma accounts for approximately 15–20% of all mesothelioma cases, compared to about 75–80% for pleural. The two types differ in symptoms: peritoneal causes abdominal pain, swelling, and ascites, while pleural causes chest pain and shortness of breath. Critically, peritoneal mesothelioma generally has a better prognosis because CRS+HIPEC treatment has proven highly effective, with five-year survival rates exceeding 50% — significantly higher than pleural mesothelioma.

What is CRS with HIPEC treatment?

CRS+HIPEC stands for Cytoreductive Surgery combined with Heated Intraperitoneal Chemotherapy. It is considered the gold-standard treatment for peritoneal mesothelioma. During the procedure, a surgeon first removes all visible tumor tissue from the abdominal cavity (cytoreductive surgery). Then, a heated chemotherapy solution — typically cisplatin or mitomycin C heated to approximately 42°C (107.6°F) — is circulated directly through the abdomen for 60 to 90 minutes to destroy any remaining microscopic cancer cells. The heat enhances the penetration and effectiveness of the chemotherapy drugs. This combined approach has dramatically improved survival rates for peritoneal mesothelioma patients.

Can I file a legal claim for peritoneal mesothelioma?

Yes. Peritoneal mesothelioma is caused almost exclusively by asbestos exposure, and the companies that manufactured, distributed, and used asbestos-containing products can be held legally liable. Patients and their families may be eligible for multiple sources of compensation: asbestos trust fund claims (over $30 billion available across 60+ active trusts), personal injury lawsuits against asbestos manufacturers, wrongful death claims for surviving family members, and VA disability benefits for veterans. The statute of limitations typically begins at the time of diagnosis, not the time of exposure. An experienced mesothelioma attorney can evaluate your case at no cost.

This page was last reviewed and updated on by the legal and medical team at Danziger & De Llano, LLP.

Sources & References

  1. National Cancer Institute — Mesothelioma Treatment (PDQ)
  2. Sugarbaker PH et al. — Multi-Institutional Registry of Peritoneal Mesothelioma, Annals of Surgical Oncology (2017)
  3. Yan TD et al. — CRS+HIPEC for Peritoneal Mesothelioma: Multi-Institutional Analysis, Journal of Clinical Oncology
  4. NCI SEER Program — Mesothelioma Cancer Stat Facts
  5. American Cancer Society — Mesothelioma Staging
  6. National Library of Medicine — Updates in Malignant Mesothelioma (2018)
  7. OSHA — Asbestos Standards and Regulations
  8. U.S. Environmental Protection Agency — Asbestos

Diagnosed with Peritoneal Mesothelioma?

If you or a loved one has been diagnosed with peritoneal mesothelioma after asbestos exposure, you may be entitled to significant compensation. Our attorneys have spent over 35 years helping mesothelioma patients and their families get the justice and financial support they deserve. We can also help connect you with leading CRS+HIPEC treatment centers.

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