Malignant Peritoneal Mesothelioma: A Challenging Case for Palliative Care

Our plain-English summary of Malignant Peritoneal Mesothelioma: A Challenging Case for Palliative Care, by C. Vidal, I. Romero, I. Neto (Curēus, 2022).

The study

• Authors: C. Vidal, I. Romero, I. Neto
• Journal: Curēus
• Published: 2022;14(8):e27580
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare and very aggressive malignancy of serosal membranes, which typically presents with abdominal pain, distension, and ascites. Due to its rarity and nonspecific symptoms, it is usually diagnosed late, when the disease burden is extensive and the therapy is inevitably palliative. It represents a complex challenge for clinicians because the treatment options are very poor and the illness has a great impact on patients' life. We present a complex case of a young patient with MPM who was admitted to our palliative care unit.

Copyright © 2022, Vidal et al.

In plain English

This article was a case report from a palliative care unit in Portugal. It described one patient with malignant peritoneal mesothelioma, a cancer of the lining of the abdomen. The article did not mention asbestos or any other exposure history. In June 2019, a 28-year-old man, a Brazilian immigrant in Portugal, was diagnosed with stage III epithelioid peritoneal mesothelioma. The patient received chemotherapy with cisplatin plus pemetrexed until May 2020, followed by extensive surgery combined with heated chemotherapy delivered into the abdomen. In December 2020 a scan showed an 11 cm mass involving the bowel. The disease then progressed to an upper malignant bowel obstruction. The patient was admitted to palliative care on January 28th, 2021. Medicines improved pain and stomach drainage, but the patient declined and was judged not to be a candidate for more chemotherapy. The patient then developed hyperactive delirium and received palliative sedation, and died on 9 February. The authors concluded that the case supported the need for an earlier palliative care approach for patients with this cancer who have a high symptom burden.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (one patient)
• Who was studied: One 28-year-old man, a newly married Brazilian immigrant in Portugal, who first presented in June 2019 and was later cared for in a palliative care unit
• Exposure: Not reported: the article does not mention asbestos or any other exposure history for the patient
• Main results:
  • The patient was diagnosed with stage III (T4N1M0) epithelioid peritoneal mesothelioma
  • After chemotherapy with cisplatin plus pemetrexed until May 2020, the patient underwent extensive cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC)
  • On readmission in December 2020, a CT scan showed an 11 cm infiltrative mass involving the small bowel and colon
  • Disease progression led to upper malignant bowel obstruction, managed with continuous nasogastric drainage
  • On admission to the palliative care unit (January 28th, 2021), the patient could walk with assistance and scored 50-60% on the Palliative Performance Scale
  • Gastric drainage was significantly reduced with hyoscine butylbromide; diarrhea and abdominal pain were controlled with low-dose morphine
  • Because of progressive decline, the patient was judged not to be a candidate for chemotherapy; parenteral nutrition was later reduced and stopped
  • The patient developed hyperactive delirium and received palliative sedation with levomepromazine and midazolam, and died on the 9th of February
• The authors' conclusion: The authors concluded that their case supports the need for an earlier palliative care approach for malignant peritoneal mesothelioma patients with a high symptom burden

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Palliative Care, Ascites.

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• Is pleurectomy and decortication superior to palliative care in the treatment of malignant pleural mesothelioma? — I. Zahid, S. Sharif, et al. (2011)
• Clinical nurse specialist role in providing generalist and specialist palliative care: A qualitative study of mesothelioma clinical nurse specialists — C. Gardiner, M. Harrison, et al. (2022)
• Current Asbestos Exposure and Future Need for Palliative Care in India — A.V. Jadhav, N.C. Gawde (2019)
• Palliative and end-of-life care for patients with pleural mesothelioma: A cohort study — D. Wakefield, T. Ward, et al. (2025)

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