Diagnosis of mesothelioma and staging for peritoneal mesothelioma


As with all mesotheliomas, the diagnosis of peritoneal mesothelioma can be challenging. CT findings may help differentiate between the two clinical types of peritoneal mesothelioma, termed “dry” or “wet”, since their appearances are very different upon imaging. In the “dry” type, CT may reveal multiple small masses or a single dominant localized mass. There is normally little or no ascites. In the “wet” type, CT may reveal widespread small nodules, but no dominant mass. Ascites is usually present.

If fluid is present, it may be removed in a procedure called paracentesis. Unfortunately, as is the case with pleural mesothelioma, fluid analysis offers limited diagnostic value. It is normally a tissue biopsy obtained in a laproscopic exploratory that will yield a definitive diagnosis.


There is currently no established staging system for peritoneal mesothelioma, and if the disease is staged, it is normally done in accordance with the TNM system, the most common general cancer staging system. This system refers to the status of the tumor (T), lymph nodes (N) and metastases (M). There are general categories which may also be somewhat helpful in determining stage.
The first category shows a localized lesion able to be completely resected (entirely removed). In the second category, the disease is contained within the abdominal cavity on peritoneal and organ surfaces where debulking (the removal of as much, but not all of the tumor) is possible. Category three shows disease contained within the abdominal cavity with invasion of organs such as the colon or liver. Category four shows disease extending outside the abdominal cavity.

Mesothelioma specialist Clare Verschraegen wrote that she categorizes peritoneal mesothelioma into four categories. The least developed is when the tumor has not spread and can be removed with surgery. This is equivalent to stage I in the Butchart classification.

The next is when the cancer has spread to the periconal and organ surfaces and surgery will result only in a debulking of the tumor, not removal of all malignant tissue. The next stages are when the cancer metasticises to other organs, and when it gets into the lymph nodes.

Related Links :

  • Symptoms of peritoneal mesothelioma
  • What are symptoms and treatment of mesothelioma

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