Online Second Opinion - Peritoneal Carcinosis of Undefined Nature

On the 01.20.2006, the patient finally visited the surgeon he had addressed to by the medical doctor who had examined him on the 01.10.2006, and the former procured the following conclusion:

"Patient with peritoneal epithelial mesothelioma that, by interpreting the first sub-occlusive episode in 2004 as secondary to such pathology, seems to date back to some time ago and appears with a low degree of biological malignity. The CAT scan seems to show diaphragmatic involvement and a significant adhesion syndrome between ansae and abdominal wall. In order to apply a precise surgical indication, an interview with the surgeon who operated the patient in November 2005 seems indispensable, so as to evaluate the involvement of the visceral peritoneum and above all of the small intestine, the latter being a true contraindication to a surgical approach.

The cytoreduction via chemo-hyperthermia, followed by systemic chemotherapy seems to be the best option (even though experimental). Should there be, on the other hand, doubts about the surgical indication, one would opt for systemic chemotherapy, eventually with neoadjuvant intention.

It is very important for the patient to know if there are other diagnostic procedures. Assuming the histological diagnosis is Peritoneal Mesothelioma, what is the recommended therapy and if there are experimental protocols, including immunotherapy.

The case was sent to Medical Opinion (www.m-opinion.com) for second opinion evaluation. The case was sent to senior professor from Tel Aviv University to review the case.

The professor assumed that the diagnosis was mesothelioma according to the various pathological reports. It is important to have immunohistochemical staining for c-kit, EGFR, VEGFR, PDGFR-alpha for possible targeted therapies.

The best treatment option for mesothelioma is radical surgery: peritonectomy hyperthermic intra-operative administration of chemotherapy. However, it is hard to imagine the real intra-abdominal involvement by the tumor according to the descriptions given by the radiologists. It is recommended to review the CT scans and perform a PET -CT with FOG to locate all tumor sites.

If the tumor is inoperable, it is better to go for chemotherapy: cisplatin pemetrexed (Alimta), or cisplatin gemcitabine, as a palliative treatment or as a neo-adjuvant therapy.

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