Generality
Peritoneal carcinosis means the spread of tumor cells within the cavity circumscribed by the peritoneum.
This disease, therefore, develops following the formation of other tumors that can affect several organs, but which are generally located in the abdominal cavity.
Unfortunately, peritoneal carcinosis is a rather aggressive form of cancer and the treatments undertaken to combat it are not always able to eliminate it altogether. Despite this, medical research has achieved remarkable results in the last few decades, allowing the life expectancy of patients suffering from this disease to be raised.
What is that
What is Peritoneal Carcinosis?
When we talk about peritoneal carcinosis, we want to indicate the metastatic spread of neoplastic cells within the peritoneal cavity. In this case, therefore, the peritoneum and the cavity circumscribed by it can be considered as the site of metastasis of other tumor forms.
Peritoneal carcinosis is considered extremely aggressive, so much so that up until a few years ago it did not leave the patients it was diagnosed with. This is because the malignant cells spread inside the cavity circumscribed by the peritoneum can affect other healthy organs, further worsening the patient's condition and making the elimination of the neoplasm extremely difficult, both through surgery and through chemotherapy and radiotherapy.
Note : the terms tumor cells, malignant cells and neoplastic cells are used in this article as synonyms.
Causes
Peritoneal carcinosis is caused by the dissemination of tumor cells within the peritoneal cavity. Generally, tumors capable of giving rise to this disease are those that affect the organs located at the abdominal level, however - although rarely - there is the possibility that malignant cells derive from tumors located in extra-abdominal sites.
However, among the neoplastic diseases that can metastasize and give rise to peritoneal carcinosis, we find:
- Peritoneal mesothelioma: this is a rare tumor that originates on the same peritoneum;
- Pseudomixoma peritonei: a rare tumoral form often associated with tumor of the appendix;
- Colorectal cancer;
- Pancreatic cancer;
- Ovarian cancer;
- Stomach cancer;
- Breast cancer.
Peritoneal carcinoma, therefore, can be caused not only by tumors located in other organs and located both abdominal and extra-abdominal, but also by tumors that directly affect the peritoneum. However, it should be pointed out that this occurrence is quite rare, although not impossible.
Incidence
How many and which patients develop peritoneal carcinosis?
As mentioned above, patients who undergo peritoneal carcinosis are individuals who have already developed other neoplasms that, metastasizing, also invade the cavity circumscribed by the peritoneum.
In most cases, peritoneal carcinosis derives from tumors that do not affect the peritoneum itself, but other organs located at the abdominal level. In this regard, it has been estimated that 60% of ovarian cancer patients, 40% of patients with stomach cancer and at least 15% of patients affected by colon cancer can develop peritoneal carcinosis.
Symptoms
Symptoms Induced by Peritoneal Carcinosis
Unfortunately, as is the case for most neoplastic diseases, the symptoms of peritoneal carcinosis manifest themselves in a subtle and vague manner and, for this reason, they can be difficult to recognize.
However, the main symptomatology induced by this malignant pathology consists in:
- Abdominal distention and pain;
- Loss of appetite and body weight;
- Anorexia;
- Nausea;
- Constipation;
- Bowel obstruction;
- Fatigue;
- Accumulation of fluids in the peritoneal cavity (ascites) resulting in the appearance of respiratory difficulties.
Furthermore, the aforementioned symptoms are often accompanied by swelling of the abdomen which tends to increase as the disease progresses due to the increase in the size of the tumors and due to the accumulation of fluids.
Of course, the patient may also experience other symptoms closely related to the type of cancer that gave rise to peritoneal carcinosis (colorectal cancer, pancreatic cancer, stomach cancer, ovarian cancer, etc.).
Diagnosis
How is Peritoneal Carcinosis Diagnosed?
The diagnosis of peritoneal carcinosis could be made even before having diagnosed the tumor from which the neoplastic cells originate, as could be done during visits and check-ups in patients in whom the cancer from which the metastasis started was already identified and possibly treated.
Unfortunately, there are no specific tests for the diagnosis of peritoneal carcinosis, but it is often necessary to resort to more diagnostic tests and examinations.
However, in determining the presence or not of peritoneal carcinosis, computerized axial tomography (better known as TAC ) has proved to be particularly useful, which can be further investigated by performing positron emission tomography ( PET ). In the case in which TAC and PET should not be sufficient to make a certain diagnosis of peritoneal carcinosis, it is also possible to resort to laparoscopy . This is a technique that must be conducted under general anesthesia, but which allows the collection of histological samples (biopsy) in order to dissolve any doubts about the nature of the disease that afflicts the patient.
Care
Is there a cure for Peritoneal Carcinosis?
Research in the field of peritoneal cancer treatment has made giant strides in recent decades, allowing the development of therapeutic approaches and new techniques capable of increasing the life expectancy of patients suffering from this disease.
The treatment of peritoneal carcinosis generally involves performing a surgical procedure which can be achieved by local administration of an antineoplastic drug therapy . For all those patients suffering from peritoneal carcinosis that cannot be treated by surgery, instead, a new technique of administering anticancer drugs has been recently introduced, able to intervene even in these particularly delicate situations.
Therefore, the main treatments to counteract and eliminate peritoneal carcinoma will be analyzed below.
Cytoreductive Surgery
Cytoreductive surgery - also known by the acronym CRS, from the English Cyto-Reductive Surgery - is the first-line treatment against peritoneal carcinosis. Its purpose is to remove all the peritoneal nodules visible through the use of special high voltage electrosurgical units. To be precise, in this case it would be good to talk about cytoreductive surgery with peritonectomy.
When peritoneal carcinosis involves a specific abdominal area to a large extent, it may be necessary to intervene by also removing portions of other abdominal organs, such as intestine, stomach, ovaries, etc.
At the end of the operation, to eliminate malignant cells not visible to the naked eye, the patient suffering from peritoneal carcinosis may be subjected to hyperthermic intraperitoneal chemotherapy.
Hyperthermic Intraperitoneal Chemotherapy
Hyperthermic intraperitoneal chemotherapy ( HIPEC, Hyperthermic Intraperitoneal Chemotherapy ) is a relatively recent treatment that has been shown to be very useful in the treatment of peritoneal carcinosis.
This therapeutic strategy is substantially based on the administration of anticancer chemotherapy drugs directly into the peritoneal cavity. The administration, however, is carried out under hyperthermia conditions (about 42 ° C), that is with higher temperatures than the normal body temperature. This is because it has been shown that heat is able to increase the penetration capacity of antineoplastic drugs within tumor tissues.
Furthermore, it has also been shown that - thanks to the presence of a sort of plasma-peritoneal barrier consisting of the sub -sothelial tissue and the basement membrane of the blood capillaries - the high molecular weight and very hydrophilic antitumor drugs administered locally are not able to enter the blood circulation. Thanks to this phenomenon, therefore, antineoplastic drugs administered intraperitoneally are unlikely to reach other parts of the body, consequently the side effects are reduced and, at the same time, it is possible to administer higher drug concentrations.
Among the active ingredients with antitumor action that can be used in this type of chemotherapy, we mention cisplatin, oxaliplatin, mitomycin C and doxorubicin . Generally, the choice of the active ingredient to be used depends on the type of tumor that affects the patient and its severity.
Please note
The intervention of cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy is a treatment that is carried out only in specialized centers, since it requires a high knowledge of both the techniques and the tools used, and of the peritoneal carcinosis itself.
Effectiveness of Combined Treatment
The combined treatment of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy seems to be the best for peritoneal carcinosis resulting from mesothelioma or pseudomixoma. With regard to peritoneal carcinosis secondary to other cancers, on the other hand, the combined treatment can be useful and effective in selected cases in which the tumor cells that undergo metastasis derive from tumors of the colon-rectum or ovary.
Finally, as regards peritoneal carcinosis induced by other cancers (such as cancer of the stomach and pancreas), the prognosis, unfortunately, turns out to be rather unfavorable even after the combined treatment described above.
However, each case of peritoneal carcinosis is in its own right and the most indicated treatment will be established by the oncologist on a strictly individual basis.
Pressurized Air Flow Intraperitoneal Chemotherapy
Intraperitoneal chemotherapy with pressurized air flow (abbreviated PIPAC, from Pressurized Intraperitoneal Aerosol Chemotherapy ) is a relatively recent technique developed for the treatment of patients with peritoneal carcinoma on which it is not possible to intervene with the surgical approach (cytoreductive surgery).
This innovative technique involves the laparoscopic administration of anticancer drugs by aerosol . Thanks to the use of the laparoscopic technique, in addition to the administration of medicines, it is also possible to perform biopsies and / or aspirate any liquid accumulated inside the peritoneal cavity.
Objectives and Benefits
Intraperitoneal chemotherapy with pressurized air flow is performed in patients suffering from peritoneal carcinosis that cannot be surgically treated for the purpose of:
- Reducing, or at least limiting, the expansion and spread of peritoneal carcinosis itself;
- Prepare the patient for an eventual cytoreductive surgery;
- Prevent new fluid accumulation within the peritoneal cavity.
Among the main advantages of this technique, the low invasiveness (with laparoscopy, in fact, it is sufficient to make small incisions at the level of the abdomen), the possibility of administering the anticancer drugs directly near the malignant cells and the least number of effects side effects compared to the administration of systemic anticancer chemotherapy.
Prognosis
Prognosis of Peritoneal Carcinosis
Although the treatments undertaken against peritoneal carcinosis are aimed at treating neoplastic disease, it appears to be particularly aggressive and may not be permanently eliminated, just as it could recur even after performing surgery and hyperthermic intraperitoneal chemotherapy. Unfortunately, this eventuality is difficult to predict. In addition to this, the prognosis may vary from patient to patient depending on several factors, such as:
- The type of tumor from which the neoplastic cells that give rise to peritoneal carcinoma derive;
- The possibility of intervening or not using cytoreductive surgery and, when possible, the possibility of completely removing visible tumor masses;
- The patient's health conditions;
- The patient's response to therapies.
The prognosis, therefore, can also vary greatly from one patient to another and survival is not always guaranteed. However, despite this great variability, thanks to the advent of the new techniques of administration of anticancer drugs, life expectancy and the possibility of treatment of patients suffering from peritoneal carcinoma is undoubtedly increased compared to the past.
