Posted on May 24, 2019
Primary peritoneal cancer (PPC) is a cancer that develops in the peritoneum - a thin layer of tissue that lines the abdomen. Peritoneal carcinomatosis is cancer that spread to the peritoneum from another part of the body.
It is estimated that at least 10% of patients with colon cancer will develop peritoneal cancer during their disease.
Approximately 30% of patients with gastric cancer will develop peritoneal cancer.
Peritoneal cancer is difficult to diagnose. Other cancers share similar characteristics, complicating the diagnostic process. A combination of radiological imaging, blood tests, and in some cases biopsy or surgery is essential for ruling out other more common cancers. Given the complexity of peritoneal cancer, imaging tests should be interpreted by academic-level subspecialty radiologists in order to ensure accuracy.
Primary Peritoneal Cancer The peritoneum is made of epithelial cells. It lines the entire abdominal cavity and pelvic cavity, covering the digestive tract, liver, and reproductive organs. When any of these cells transform into cancerous cells, it results in primary peritoneal cancer - meaning cancer that originated inside the peritoneum.
Peritoneal Carcinomatosis Peritoneal carcinomatosis, also called peritoneal metastasis, is a cancer that develops in the peritoneum after spreading from cancer in another part of the body. Technically, cancer from almost any type of tumor has the potential to spread and develop into peritoneal carcinomatosis. However, in most cases, it originates from gastrointestinal or gynecologic cancers.
Peritoneal carcinomatosis occurs frequently in patients with colon cancer, gastric cancer, and appendiceal. It is more common than primary peritoneal cancer. Most often, by the time cancer enters the peritoneum - regardless of where it came from - it is considered advanced (stage IV). Proper diagnosis is crucial for patient treatment and management.
Peritoneal cancer looks and behaves similarly to epithelial ovarian cancer. This is because the cells of the peritoneal lining develop from the same type of cell that lines the surface of the ovary and fallopian tubes. It should be noted, however, that you can still get peritoneal cancer even if you have your ovaries removed. In addition, despite similar behavior between the two cancers, the ovaries are usually only minimally affected with peritoneal cancer.
Peritoneal cancer can be very difficult to diagnose. Because early-stage peritoneal cancer typically causes no symptoms, it is usually not discovered until its advanced stages (stage III or IV). Unfortunately, this often means that the cancer has spread to other parts of the abdomen, making it much more difficult to treat. While ultrasound, CT, and MRI can all be used to detect abnormalities in the liver - to accurately confirm peritoneal cancer diagnosis, laparoscopy or exploratory surgery are often performed.
Given its complexity, peritoneal cancer diagnosis relies heavily on ruling out other similar cancers that it could easily be mistaken for. This requires image interpretation from expert subspecialist radiologists. If your doctor suspects peritoneal cancer, a second opinion is recommended before treatment of surgery.
Ultrasound is generally good for discovering abnormalities in the abdomen. It can be especially helpful in ascites detection - which can act as an indicator for further testing. While a good starting point in the diagnostic journey - it is not sufficient enough for diagnosing and evaluating the stage of peritoneal cancer.
CT and MRI have increased accuracy in peritoneal cancer detection. They may be used to evaluate the stage of cancer growth.
PET has a slightly higher sensitivity. In all radiographic imaging, however, it is extremely difficult to catch early stage peritoneal cancer. Subspecialist radiology experts can help ensure appropriate testing and treatment planning for patients.
Surgery remains critically important for both diagnosis and therapy of peritoneal cancer. Biopsy may also be performed to confirm diagnosis.
Despite its similarity to ovarian cancer, the symptoms associated with peritoneal tumors are more commonly gastrointestinal than gynecologic in nature. However, for some, a peritoneal tumor may remain asymptomatic. Generally, those who develop ascites (accumulation of fluid in the abdomen) from the cancer are more likely to experience symptoms. Unexplained changes in weight is also common in patients with peritoneal cancer.
In peritoneal cancer, symptoms may include:
Treatment of peritoneal cancer varies depending on the origin and stage of the cancer. Whenever possible, surgery is used to remove as much of the cancer as possible. Chemotherapy and radiation may also be used to shrink the cancer.
A treatment called hyperthermic intraperitoneal chemotherapy, or HIPEC, has been shown to has been shown to be an effective treatment option for patients whose tumors can be completely or nearly completely removed by surgery. HIPEC can help manage symptoms and has been shown to improve survival rates.
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Dr. Richard Semelka, leading expert in abdominal imaging, has been practicing radiology for over 28 years. He’s written over 16 text-books, 370 peer-reviewed papers, and has over 21,000 research citations in Abdominal Imaging.
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