Peritoneal Cancer

Your peritoneum is a thin membrane lining your abdomen (belly) and pelvis. Tissue called epithelium forms this membrane. It covers many of the organs inside your abdomen. It also covers your bladder, intestines, rectum and uterus.

When cancer grows in these epithelial cells, you might develop:

• Primary peritoneal cancer: This cancer happens when epithelial cells in the peritoneum grow in ways they shouldn’t.
• Peritoneal mesothelioma: This cancer is more common among people who work with or have had exposure to asbestos.
• Secondary peritoneal cancer: Secondary peritoneal cancer begins somewhere else in your body and spreads to your peritoneum. It’s a metastatic cancer.

Often, primary peritoneal cancer can be confused with ovarian cancer because ovarian cancer can spread to your peritoneum. These two cancers can have some of the same symptoms, like abdominal bloating and pain, unexplained weight loss, constipation and abnormal vaginal bleeding. Primary peritoneal cancer can develop even if your ovaries have been removed. In most cases of peritoneal cancer, the ovaries are minimally involved. The treatment of peritoneal cancer is similar to that of ovarian cancer.

What to expect during your first visit

A rare cancer diagnosis often carries added weight and worries that your providers aren’t familiar with your uncommon condition. When you come to Cleveland Clinic, your condition’s anything but uncommon.

Our team is experienced in treating rare cancers. And we’ll never mention how uncommon peritoneal cancer is. To us, it isn’t. And we’re here to help care for you in the most personalized and attentive way possible.

That’s why, when you come in for your first appointment, we’ll ask you to tell us your story — in your own words. It’s important for us to understand how your cancer is affecting your life. You’ll want to be prepared to share:

• What symptoms you’re having.
• When you first noticed your symptoms.
• How your symptoms are affecting your life.
• Your personal and family medical history.

Your provider will also do a physical exam, including a pelvic exam of your reproductive organs. They may also order more tests to help diagnose peritoneal cancer.

Blood tests

The CA-125 blood test lets us check your blood for levels of proteins called cancer antigen 125. These proteins are often higher (elevated) when you have peritoneal cancer.

Imaging tests

Our experts use technology to see detailed views of your abdomen and pelvis. You may have:

• Abdominal ultrasound.
• CT scan (computed tomography scan).
• MRI (magnetic resonance imaging).
• Pelvic ultrasound.

Fluid sample testing (paracentesis) or biopsy

Sometimes, peritoneal cancer causes fluid to build up in your abdomen (ascites). If this happens, we’ll use a needle to remove some of the fluid and test it. We can also remove fluid in this same way to help with pain and discomfort. A biopsy can also be done by a radiologist to confirm the diagnosis and help us decide on the best treatment.

Laparoscopy

Our trained surgeons may do laparoscopy to check out the organs in your abdomen and pelvis firsthand. During this, they may do a biopsy of peritoneal tissues. Pathologists at the lab will look at these samples under a microscope to see if cancer is there. They can also stage peritoneal cancer to help us decide on the best treatment for you.

Second Opinions for Peritoneal Cancer

Learning you may have cancer can be overwhelming. There are so many things to think about. So much to digest. You likely want the best possible care — and to feel confident you’re working with a team of healthcare providers you trust completely. That’s why we encourage second opinions.

Our highly skilled, experienced and compassionate cancer specialists will spend time with you to help you better understand your diagnosis and what treatment options might best meet your needs. And because we know that cancer doesn’t wait, we always try to meet with you as soon as possible. Getting a second opinion can make you feel in control of your care and give you peace of mind, knowing you’re in the most capable hands.

Meet Our Peritoneal Cancer Team

When you come to Cleveland Clinic, you’ll have a team of expert healthcare providers from different specialties. We build this team based on your unique diagnosis and needs. They work together to make sure you’re getting the best care possible. Your care team could include:

• Gynecologic oncologists.
• Gynecologic surgeons.
• Radiologists.
• Anesthesiologists.
• Genetic counselors.
• Nurse practitioners.
• Physician assistants.
• Care coordinators (specialists who make sure that you’re aware of all your treatment options and advocate on your behalf).
• Social workers.

Our providers use the latest peritoneal cancer treatments. Your care plan depends on the type of peritoneal cancer you have, its stage, and your age and health. Your healthcare team will go over all of the best options with you, and we may use a combination of treatments.

Minimally invasive surgery

Surgery is the most common treatment for peritoneal cancer. Our surgeons often try to use laparoscopic surgery and robotic surgery whenever possible, but open abdominal surgery (laparotomy) is more common.

Depending on the location and stage of the cancer, we may do:

• Cytoreduction: Removes cancer from your abdomen. We may also remove part of your peritoneum and other abdominal organs if the cancer has spread.
• Omentectomy: Removes a fatty layer called the omentum that covers some organs in your abdominal cavity.
• Hysterectomy: Removes your uterus, if it’s been affected.
• Bilateral salpingo-oophorectomy: Removes both of your fallopian tubes and ovaries.

Systemic therapy

Sometimes, you may need medications that work throughout your body (systemic therapy). These drugs destroy cancer cells and stop tumors from growing. You may have these medications after surgery or without surgery, either alone or in combination:

• Chemotherapy.
• Targeted therapy.

Hyperthermic intraperitoneal chemotherapy (HIPEC)

Our experts may treat you with hyperthermic intraperitoneal chemotherapy (HIPEC). We flush your abdominal cavity with heated chemotherapy drugs right after surgery while you’re still under anesthesia. HIPEC treatment helps make sure no cancer cells remain after surgery.

Taking the Next Step

No cancer diagnosis is easy to accept. But when you come to Cleveland Clinic for peritoneal cancer diagnosis and treatment, you’ll get expert and compassionate care every step of the way. We’re here to help you understand what’s going on, what to expect and how to move forward. We listen to you, answer your questions and provide the best possible treatment for your unique diagnosis and specific needs.