Early diagnosis of Peritoneal mesothelioma

I have a dear friend (66 year old female) recently diagnosed with Peritoneal mesothelioma. It was discovered incidentally when a urologist was preparing to remove a kidney due to a mass (not biopsied) found on a CT scan. When the camera was inserted into the abdominal cavity numerous flat, white leions were found on her peritoneum. The kidney removal was aborted and a biopsy was taken. The biopsy,after much confusion, was determined to be malignant Peritoneal mesothelioma (low grade, epithelial). The pleura (chest cavity) was also biopsied and determined to have similar mesothelioma lesions.

After seeing two experts in Peritoneal mesothelioma we have two differing opinions on what course of action to take.

-1. As the patient is healthy and exhibiting no symptoms, the recommendation was to wait 3 months and then scan for any changes in the chest and abdominal areas.

-2. The second recommendation was to schedule surgery on the peritoneum, remove the kidney and then apply the HIPEC heated chemotherapy. Follow up procedure would be performed in the lung cavity after recovery from the abdominal procedure.

The case is very unusual and we will seek a third expert opinion. Our concern is that if we wait, the disease might only get worse as we have no idea of the rate at which it is developing.

On the other hand we might opt for the aggressive surgery and chemotherapy and treat her unnecessarily.

I’m looking for anyone with any experience similar to this case who would share their experience/ knowledge.