Not long ago, treating patients with peritoneal cancer was thought of as a useless maneuver. At that time, these patients typically lived only a few weeks to months after diagnosis depending on the severity of the disease, the patient's condition and the origin of peritoneal metastases.
Over the past two decades, this has changed and many hospitals around the world now offer treatment for select patients with peritoneal cancer. The treatment is challenging and requires expert medical professionals in this peritoneal condition.
The optimal treatment for an individual depends on many factors, including the age, general condition, origin and severity of the carcinomatosis. Ideally, patients with peritoneal cancer are evaluated by a multidisciplinary team composed of an oncologist, an oncologist, a radiologist and a pathologist with knowledge about this pathology.
Even today, treatment may not be completely possible for some patients. For example, treatment may not be possible in very advanced cases in which the patient's condition does not allow him to receive it.
Fortunately, some form of treatment is possible in many patients. Generally speaking, there are two strategies to treat these patients:
Treatment with palliative intent
This treatment focuses on prolonging survival and resolving the symptoms of peritoneal cancer as much as possible, but does not intend to cure the patient. Such treatment may include different aspects ranging from pain relief and ascites removal to treatment with systemic chemotherapy and surgery to resolve intestinal obstruction.
Treatment with palliative intent
This treatment seeks to cure the patient. This approach is typically a multidisciplinary effort combining systemic chemotherapy, extensive surgery to remove all peritoneal tumor cells and intraperitoneal hyperthermic chemotherapy (HIPEC) to destroy microscopic tumor cells.
Again, patients with peritoneal cancer should seek help from a multidisciplinary team with specific knowledge about their disease whenever possible to complete their optimal treatment.
- PHYSICAL EXAM - Sometimes nodules peritoneal tumors or ascites can be detected during physical examination of the abdomen, but this typically occurs only in advanced cases.
- DETECTION OF TUMOR MARKERS - These are blood studies that may indicate the presence of a malignant tumor in the body, but these studies are not very specific for most cancers, especially cancer peritoneal The most commonly used tumor markers are Embryonic Carcino Antigen (ACE) for colon cancer, CA 19-9 for pancreatic cancer and CA-125 for ovarian cancer.
- ULTRASOUND - This test uses sound waves to create a detailed image of the abdominal cavity on a computer monitor. This study is good for ascites detection, but it is usually not sensitive enough to detect peritoneal cancer or the primary tumor.
- COMPUTERIZED TOMOGRAPHY (CAT) - This detailed radiological examination may reveal the presence of peritoneal cancer or ascites in some cases. Unfortunately, a CT scan is not very good for detecting nodules of peritoneal cancer, especially not in the early stages of the disease. In general, tumor nodules should be at least 1cm, which is larger than the size of typical tumor nodules in peritoneal cancer, to be detected by CT
- PET-SCAN - This is a study that combines CT with nuclear radiology (positron emission tomography), and is especially useful for detecting metastases outside the peritoneal cavity. Similar to what happens with CT, peritoneal cancer is typically not visualized by PET.
- BIOPSY - If peritoneal cancer is suspected, a biopsy can be obtained. In a biopsy, a small piece of tissue is removed from the body for microscopic research. The biopsy can be taken after the patient has received local anesthesia through the skin or during a laparoscopy when the patient is under general anesthesia. A biopsy can confirm the presence of cancer cells in the peritoneal cavity. If the primary tumor is located in the gastrointestinal tract, an endoscopy may be necessary to take a biopsy.
- LAPAROSCOPY - When peritoneal cancer is suspected, a laparoscopy may be performed. This procedure is especially useful for collecting biopsies of tumor nodules and determining the extent of peritoneal cancer. Usually, the extent of the cancer is determined by calculating the peritoneal carcinomatosis index (PCI).
- PATHOLOGY - Small parts of the tumor can be removed and examined under a microscope. Cancer can be confirmed and tumor aggressiveness can be predicted based on these observations. Using specific techniques, the origin of the tumor can be determined, which is especially useful in cases where the location of the primary tumor is still unknown.
- ENDOSCOPY - When the primary tumor is potentially located in the gastrointestinal tract, an endoscope can be inserted through the mouth to investigate the esophagus, stomach and duodenum ("esophagogastroduodenoscopy") or through the anus to investigate the large intestine ("colonoscopy"). The deepest layer of the gastrointestinal tract is visualized with the endoscope. Most gastrointestinal tumors originate from the deepest layer and can be detected by endoscopy. In addition to the visualization of the tumor, biopsies of the tumor can be obtained with the endoscope, which can help confirm the presence of cancer and direct subsequent treatment.