Peritoneal Carcinomatosis

What is peritoneal carcinomatosis?

Peritoneal carcinomatosis is cancer that’s spread to your peritoneum. Your peritoneum is a membrane that lines your abdominal and pelvic cavities. It coats several organs housed inside these cavities. With peritoneal carcinomatosis, cancer that’s started in a different organ travels to this membrane and forms tumors there. It’s different from cancer that starts in your peritoneum (primary peritoneal cancer).

Any type of cancer can spread to your peritoneum. But the primary (originating) cancers most likely to lead to peritoneal carcinomatosis are:

• Ovarian cancer (most common)
• Colon cancer
• Stomach cancer
• Pancreatic cancer
• Appendix cancer
• Rectal cancer

Cancers that have spread, like peritoneal carcinomatosis, are also called late-stage or metastatic cancers. They’re usually more serious than early-stage cancers. But treatments can help slow disease progression and help you live longer.

What are the symptoms of peritoneal carcinomatosis?

Peritoneal carcinomatosis doesn’t usually cause symptoms until it affects a large portion of your peritoneum. At this point, the condition may cause fluid build-up in your abdomen called ascites.

Related symptoms include:

• Fatigue
• Swollen abdomen
• Abdominal pain
• Abdominal mass
• Low back pain
• Nausea and vomiting
• Constipation
• Unexplained weight loss or weight gain

These symptoms are common across lots of conditions. And many of them aren’t as serious as peritoneal carcinomatosis. But only a healthcare provider can rule out cancer in your peritoneum.

What causes peritoneal carcinomatosis?

Peritoneal carcinomatosis forms when cancer in one part of your body travels to your peritoneum. Usually, the cancer begins in a nearby organ in your abdomen, like your ovaries or colon.

In about 10% of people with peritoneal carcinomatosis, cancer starts in organs outside of the abdominal cavity. When this happens, cancer cells use the bloodstream or lymphatic system to reach your peritoneum.

How is peritoneal carcinomatosis diagnosed?

Tests that diagnose peritoneal carcinomatosis include:

• Imaging tests. Procedures may include a CT scan, MRI, PET scan or a combination of these. They show how much the cancer has spread throughout your peritoneum.
• Blood tests. Your provider may need to check your blood for tumor markers (substances that tumors release). High levels of certain proteins may be a sign of peritoneal carcinomatosis.
• Paracentesis. Your provider may remove a sample of the fluid in your abdomen if you have ascites. They can test the sample in a lab for signs of the primary cancer (the cancer that’s spread).
• Biopsy. Your provider may remove a sample of the tumor and test it in a lab for cancer cells.

What is the peritoneal carcinomatosis index (PCI)?

The PCI is one resource your healthcare provider may use during the diagnostic process to plan treatment. Using this index, providers map the location of the tumor in your abdomen and your small intestine. They assign a score based on the tumor’s size.

This information helps your provider know how likely it is that surgery can get rid of the tumor.

How is peritoneal carcinomatosis treated?

The standard treatment for peritoneal carcinomatosis is cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). The goal of cytoreductive surgery is to remove all visible tumors in your peritoneum. HIPEC destroys any remaining microscopic cancer cells. This treatment circulates heated chemotherapy drugs throughout your abdominal cavity. The heat and direct application make it stronger than traditional chemotherapy.

People receive cytoreductive surgery and HIPEC in addition to treatments for primary cancer.

If you’re not a candidate for surgery, you may still need palliative care. This treatment can help you manage symptoms better, no matter your cancer stage or prognosis (likely outcome of treatment).

What are the complications of treatment?

Research shows that CRS and HIPEC are both safe and effective when people are screened carefully to ensure they’re good candidates for treatment. Results are best when surgery happens at a center that delivers this treatment regularly. But as with any surgery, complications can happen. In rare instances, they can be fatal without emergency care. They include:

• Heavy bleeding
• Perforation
• Anastomotic leak
• Infection
• Abscess
• Sepsis

Your healthcare provider will discuss potential complications with you beforehand. It’s important to understand how the benefits of treatment outweigh the risks.

What is the prognosis of peritoneal carcinomatosis?

CRS and HIPEC treatment have improved the prognosis associated with peritoneal carcinomatosis. Although there’s no cure, this treatment can help you live longer.

The five-year survival rate for people who receive CRS that removes all signs of the tumor is 45%. This means that 45% of people who receive CRS successfully are alive five years later. But the five-year survival rate is less than 10% when surgery can’t remove all the cancer. Other factors that play a role in your prognosis include:

• The type of primary cancer
• How abnormal the cancer cells look
• How severe your symptoms are
• Your PCI score

Your healthcare provider can explain the factors that impact your likely outcome.

How do I take care of myself?

Living with any metastatic cancer (cancer that has spread) — including peritoneal carcinomatosis — is hard. It causes physical symptoms that can make for challenging days ahead. The uncertainty of not knowing how your body will respond to treatment can take an emotional toll, too.

This is why it’s essential to seek every available resource. This may include getting palliative care to help with symptom management. It may include getting counseling to process the complex emotions surrounding your diagnosis. It’s an especially good idea to join a support group that allows you to connect with others also living with metastatic cancer.

Ask your healthcare provider to recommend resources that can make living with peritoneal carcinomatosis more manageable.

When should I see my healthcare provider?

You’ll need regular visits with your healthcare provider to check how treatment is working. In the meantime, contact your provider if you’re experiencing new or worsening symptoms. They may recommend additional treatments or changes to your care plan that can help.

What questions should I ask my healthcare provider?

Questions to ask include:

• What tests will I need?
• What treatments would you recommend?
• What treatment side effects should I expect?
• What outcomes should I expect after treatment?
• What resources are available that can help me cope with symptoms and side effects?