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Peritoneal Cancer

Peritoneal cancer, or medically referred to as "peritoneal carcinomatosis," arises in conjunction with other cancers affecting different organs. It is a challenging condition to treat and is highlighted as a condition that negatively impacts the progression of the disease. In order to treat peritoneal cancer effectively, it is essential to identify the underlying cancer. The Gastroenterology Department of Uniqacare provided information about peritoneal cancer.

What is peritoneal membrane?


The peritoneum, also known as the peritoneal membrane, is the lining that covers the inner surface of the abdominal walls and envelops all the organs within this cavity. The peritoneum is adherent to the inner surface of the abdominal wall and the organs through connective tissues.


What is peritoneal cancer?


Peritoneal carcinomatosis, also known as peritoneal cancer, refers to the condition where the malignant tumor cells affect or adhere to the thin layer covering the abdominal organs, known as the peritoneum. This type of cancer is typically diagnosed in advanced stages and occurs as a result of the spread of another cancer to the peritoneum. However, there can also be cases of primary peritoneal cancer, which is rare and not attributed to another cause.


What are the causes of peritoneal cancer?


Certain types of cancer can lead to peritoneal carcinoma. These include gynecological cancers such as ovarian, uterine, or cervical cancers, as well as gastrointestinal system cancers like colorectal, stomach, pancreas, gallbladder, and bile duct cancers. Occasionally, breast and lung cancers can also spread to the peritoneum and cause peritoneal carcinomatosis. Mesothelioma, a cancer that originates from the peritoneum itself, can also occur. Additionally, a condition called mucinous appendiceal neoplasm can sometimes contribute to the development of widespread peritoneal cancer.


How does peritoneal cancer develop?


While the exact cause of peritoneal carcinoma is not fully understood, it begins with the uncontrolled growth of cancer due to mutations in peritoneal cells. Peritoneal carcinomatosis is always an indication of advanced cancer and is associated with significantly reduced life expectancy. Tumoral involvement of the peritoneum poses a serious medical challenge as its treatment is difficult, and even impossible in some cases. Tumor cells that have infiltrated the peritoneum can spread throughout the entire peritoneal cavity and affect the organs beneath it. Individuals with peritoneal carcinomatosis often experience intense fluid accumulation in the abdomen due to the involvement of the peritoneum. While peritoneal carcinomatosis is rare in babies and children, it can also occur in some childhood cancers.


Who is at risk for peritoneal cancer?


Research suggests that certain individuals may be at risk of developing peritoneal carcinoma for reasons that are not fully understood.


  • Advanced age is a risk factor. It is more commonly observed in individuals over the age of 60.

  • Genetic factors play a significant role. A family history of peritoneal carcinoma increases the risk.

  • Having a history of breast cancer in women is an important factor.

  • Obesity and a sedentary lifestyle, which are known risk factors for other types of cancer, are also associated with peritoneal carcinoma.

  • Endometriosis, a condition in which the tissue lining the uterus grows outside the uterus and often starts with pain, has been identified as a contributing factor to the development of peritoneal carcinoma.


What are the symptoms of peritoneal cancer?


During the early stages, peritoneal carcinoma may not exhibit any symptoms. When investigating the underlying cause of the cancer, abdominal involvement of the peritoneum can be observed in the patient's imaging results, such as CT scans or PET scans. During surgery, tumor nodules resembling patches can be identified on the patient's peritoneum. As the disease progresses, the following symptoms may develop:

  • Accumulation of peritoneal fluid (ascites) in the abdomen, leading to complaints such as umbilical hernia and shortness of breath.

  • Abdominal pain and a sensation of bloating.

  • Loss of appetite and decreased interest in eating.

  • Changes in urinary and bowel habits.

  • Muscle wasting.

  • Nausea and sometimes alternating constipation and diarrhea.

  • Swelling, especially in the ankles.

  • Onset of breathing problems.

  • Unexplained weight gain or weight loss.

  • Experiencing excessive fatigue.

  • The growth of tumor cells can cause functional disruptions in other organs within the abdomen. For example, it can lead to intestinal obstructions due to narrowing, or kidney failure due to blocked urine flow.


Please note that medical information should be obtained from a qualified healthcare professional for accurate diagnosis and treatment.


What is peritoneal cancer?


In the early diagnosis of peritoneal cancer, there is no single screening test effective for individuals at high risk of developing the disease. Diagnosis is typically made based on the symptoms that arise and the physical examination conducted by expert physicians.


  1. Physical Examination by Expert Physicians: Expert doctors assess the symptoms and perform a physical examination to determine potential issues.

  2. Imaging Methods: Imaging techniques such as ultrasonography, tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) are used to examine the abdominal area. These methods are used to assess the spread and size of the cancer.

  3. Endoscopy and Colonoscopy: These internal observation methods are used to examine internal organs and the intestines.

  4. Blood Tests: Blood tests are conducted, including cancer markers, to aid in the diagnosis.

  5. Cancer Markers: Diagnostic laparoscopy, which involves examining the interior of the abdomen through surgery, is used.

  6. Collection of Tissue from Affected Cancer Areas or Peritoneal Fluid: This procedure involves taking samples from cancerous tissues in the abdomen or from peritoneal fluid accumulation, also known as ascites.


Blood Tests: The CA-125 value can be elevated in individuals with peritoneal cancer. However, CA-125 levels can also rise in various other conditions, including pelvic infections and pregnancy, as well as in other types of cancer. Careful distinction is necessary.


Imaging Tests: Oncological radiological tests are effective in evaluating peritoneal cancer. Abdominal ultrasound (and sometimes transvaginal ultrasound) is frequently used. Magnetic resonance (MR) or computed tomography (CT) scans of the abdomen and pelvis are also used in diagnosing peritoneal cancer. After diagnosis, PET-CT scans are important in assessing treatment.


Biopsy and Laparoscopy: Biopsy is a significant test to confirm the diagnosis of certain cancer types. During laparoscopy, small incisions are made on the abdominal skin to collect tissue samples. These samples are then analyzed in the laboratory to determine if they contain cancerous cells. If fluid is present, a portion of it can be drained through a procedure called paracentesis. This fluid should be examined under a microscope to confirm the presence of cancer cells.


What are the treatment methods of peritoneal cancer?


Peritoneal cancer is often an advanced form of invasive cancer that has spread from another tumor, making its treatment challenging. Most peritoneal carcinomatosis tumors do not significantly shrink in response to chemotherapy. As a result, many doctors focus on palliative care to manage symptoms, alleviate pain, and improve the quality of life. Unfortunately, there are limited treatment options available. Treating the underlying cancer causing peritoneal carcinomatosis is essential. One treatment approach that is implemented in many centers involves the removal of the affected peritoneum, excision of metastasized organs, and the administration of heated chemotherapy specifically to the abdominal cavity during the same surgery.


Cytoreductive surgery (removing all visible tumors within the abdomen) and hyperthermic intraperitoneal chemotherapy (HIPEC) have shown significant benefits for patients with ovarian cancer, appendix cancer, and peritoneal cancer. Patients with colorectal cancer benefit moderately from this treatment. However, for stomach, pancreas, and liver cancers, significant benefits have not been observed.


Hyperthermic intraperitoneal chemotherapy (HIPEC) has become increasingly common in cancer treatment in recent years. HIPEC is performed to extend the patient's lifespan and improve their quality of life. In advanced stages of peritoneal cancers, tumors spread to the peritoneum. In cases where drugs administered through the bloodstream might not be sufficiently effective due to this condition, HIPEC is employed as a method when other treatments are inadequate. HIPEC is not performed for cancer types that have metastasized to organs outside the abdominal cavity (such as the brain, bones, and lungs).


Peritonectomy is a surgical procedure performed to remove the peritoneum. It involves cleaning the abdominal cavity as much as possible from tumors by excising the peritoneum covered with the tumor and affected organs or organ. This procedure is referred to as "cytoreductive surgery + peritonectomy.


FREQUENTLY ASKED QUESTIONS ABOUT PERITONEAL CANCER

What happens if peritoneal cancer is not treated?


The symptoms resulting from the disease caused by peritoneal cancer, such as vomiting, nausea, changes in urination and bowel habits, will adversely affect a person's quality of life. Unfortunately, there is a significant risk of death in a short period if left untreated.


Can peritoneal cancer be completely cured?


Peritoneal cancer is often indicative of advanced cancer, making its treatment very difficult, even impossible. However, it is possible to alleviate the symptoms, including abdominal fluid accumulation that causes the patient's discomfort.

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