Peritoneal cancer

Synonym: peritoneal carcinosis

introduction

Peritoneal cancer most often refers to the spreading of tumor cells from other tumors in the abdominal cavity into the peritoneum, preferably metastases from pancreatic, liver and ovarian cancer. At first, peritoneal cancer proceeds without any symptoms, but in the course there is often an accumulation of water in the abdomen and pain.

In very rare cases, the cells of the peritoneum, like all other cells in the body, can degenerate without the reasons being known.

The therapy of choice is intraperitoneal chemotherapy, in addition to removing the original tumor and parts of the peritoneum.

What is the peritoneum and what is it for?

The peritoneum is a very important part of our body that is very unknown to laypeople. As a thin skin, it encloses most of the organs in our abdominal cavity, such as the intestines, liver and stomach.

It is extremely important that these organs are covered by the peritoneum, because the peritoneum produces fluid, the abdominal fluid, which serves as a sliding layer for the organs.

This sliding layer enables the digestive organs to move very easily against one another during digestion and that no intestinal loops rub against one another.

More information can be found at Peritoneum

This coating creates a kind of delimited space in the abdomen. Increased ascites accumulates in this space, which is formed, for example, in the event of inflammation, if there are bacteria in the abdomen or, typically, in the event of liver damage.

This excess of ascites is called ascites. In extreme cases, there can even be several liters of it in the abdomen.
The peritoneum can compensate for normal amounts of fluid and so the fluid in the form of lymph fluid that has collected in the abdominal cavity is absorbed every day.
Only when the balance between production and resumption is disturbed does ascites develop.

Exactly this property as a layer covering all organs makes the peritoneum, in addition to all its good properties, also very susceptible to the spread of tumor cells of the organs embedded in it, since these can easily spread to the other organs via the continuous coating. In very rare cases the cells of the peritoneum, like all other cells, can degenerate and proliferate in an uncontrolled manner. Only in the rarest cases do the tumors originate directly from the very thin cell layer of the peritoneum, but tumors from other organs are very common on the peritoneum and are then referred to as peritoneal carcinosis.

Almost every tumor that grows in one of these organs will sooner or later reach the peritoneum, spread over it and form peritoneum metastases.

Peritoneal cancer is usually not the "first" tumor (= primary tumor), but is formed from metastases from various other (primary) tumors. Sometimes the primary tumor is not known at all and the first symptoms are only triggered by the tumor settling in the form of peritoneal cancer. If it is a question of metastases that colonize the peritoneum and lead to peritoneal cancer, then these are mostly settlements of daughter tumors from colon cancer, stomach cancer, ovarian cancer, kidney cell, liver cell cancer and gynecological (e.g. advanced uterine cancer or ovarian or fallopian tube cancer) Tumors.

For more information, see: Tumor in the abdomen - that is part of it!

Symptoms of peritoneum cancer

Most often it makes peritoneal cancer no complaints at first. The further the disease progresses, the worse the symptoms become.

The first symptoms can be the so-called General symptoms like weakness, night sweats and unspecific exhaustion. It can also be a progressive one Drop in performance come and often there will be unwanted weight loss complained about by most patients.

The disease usually progresses quickly and secondary symptoms are usually more severe.

Water in the stomach

One of the typical symptoms of involvement of the peritoneum in the context of tumor diseases is one Ascites, which is almost always present in peritoneal cancer. This means a Accumulation of water in the abdomen between the bowels and on the flanks. It comes about that the pressure conditions in the abdomen change due to the peritoneal cancer disease and both flammable liquid, as well as Fluid from the bloodstream squeezed into the free tissue. This liquid rapidly increases in volume and also presses on surrounding organs such as the intestines, stomach, lungs and heart, so that this can cause further complaints.

When the patient is lying down, ascites can be determined by creating a wave on the surface of the abdomen when the examiner taps one side of the abdomen. One can prove ascites by a Ultrasound examination.

Pain

At first, peritoneal cancer does not cause any symptoms, but since numerous nerve fibers run above and below the peritoneum, it can become more severe as the disease progresses and these nerve fibers become infected Pain come. The pain caused by peritoneal cancer usually has one dull character, are sometimes described as piercing. The pain is either localized in the abdomen or can be in the Forwarded back or in the flanks become. The pain that is triggered by peritoneal cancer is mostly permanent pain that increases in severity over time. It comes next to you Basic pain also still to so-called pain attacks, which are then stronger than the basic pain. A short time later the pain level drops again, but never becomes less than the basic pain. Patients with advanced abdominal cancer are rarely completely pain-free. The stronger a peritoneum of cancer is affected, the greater the pain and the greater the suffering. In this situation there is above all one good pain therapy with effective, strong pain relievers is important.

Late symptoms

The many small tumors on the peritoneum make the treatment very complex and require several specialist disciplines that have to work very closely together to combat the tumors. If the tumors are not combated, sooner or later there is a risk of complications such as narrowing of the intestine with intestinal obstruction or the ureter with urinary retention.

Diagnosis of peritoneal cancer

The daughter tumors are usually not single, large, solid tumors, but grow as many small tumor nests, often not even visible to the eye.
Some grow only in part of the peritoneum, others are distributed so all over the organs that the peritoneum surrounds.

Unfortunately, participation of the peritoneum is still possible today Worsening prognosis of the affected person, as it always means advanced tumor growth.

In order to assess the extent of the infestation is usually a before each treatment Computed tomogram (=CT) or a MRI of the abdomen prepared.

In addition, there is an assessment sheet with which points are determined, from the values ​​of which the extent of the illness and a statement about the prognosis can be made, the so-called PCI, the Peritoneal Carcinoma Index.

This divides the abdominal cavity and the organs into different sections for which point values ​​are then distributed. Depending on the findings and the value in the PCI, there are then recommendations for different combinations of different forms of therapy that promise success.

therapy

This is only information of a general nature! A therapy and all possible therapy options should be discussed with the responsible doctor!

Not all patients are suitable for every therapy, which is why every treatment is an individual decision which can still be supported by the methods mentioned below. An operation or the direct one chemotherapy The peritoneum is only used if the benefits of the surgery or chemotherapy outweigh the risks and consequences of the method.

There are quite a few about the water in the stomach Medication, which lower the pressure in the body and can work against increased ascites. Furthermore, the drainage of the ascites can also be done by a Puncture (Ascites puncture) reduce the pressure in the abdomen and thus improve the quality of life. As a rule, however, it comes back after draining the ascites, which occurs due to peritoneal cancer Running on of new ascites. The root cause is not fixed. It is possible that the abdomen will swell again immediately after the ascites puncture.

Changing your diet can also help. Read more about this under Diet in cancer

Intraperitoneal chemotherapy

Intraperitoneal chemotherapy means that the chemotherapy directly into the (=intra) Peritoneum (=peritoneum) and is not distributed throughout the body via the blood vessels, as is known from other tumor therapies, in order to reach the tumor in this way.

The advantage here is the protection of the rest of the body, which is inevitably affected by chemotherapy via the blood vessels and the increased concentration at the desired site of action, the peritoneum.

Chemotherapy is started during the operation and then continued in an intensive care unit for several days.
The reason for this is that although visible tumor parts in the peritoneum can be removed, individual, invisible tumor cells always remain, which can then grow again into new cancerous tumors.
The chemotherapy that follows tries to prevent this process by destroying these cells by the chemotherapeutic drugs.

What is unusual about this type of chemotherapy is that it is carried out with warm medication at approx. 42 ° C (=hyperthermic chemotherapy). On the one hand, this has the advantage that tumor cells react very sensitively to heat and, on the other hand, the additional effect that some of the chemotherapy drugs used have a better effect when they are used warmed up.

Even if this therapy appears very effective, it is by no means suitable for all patients.
In addition to criteria that make treatment impracticable to a large extent, there are also criteria that speak absolutely against the treatment.

Criteria that exclude the implementation from the outset are tumors that already have daughter tumors outside the abdominal cavity (=Distant metastases), as well as a very poor general condition of the person affected, for example due to pronounced cardiovascular diseases or the growth of tumor cells into the abdominal aorta (=aorta).

Here the risks and consequences of the treatment outweigh the benefits it could have for the patient. If there are relative contraindications, treatment should only be carried out after very careful consideration:

Such situations are, for example, very large amounts of ascites (=Ascites) or an intestinal obstruction caused by the tumor or its daughter tumors.

Here it is often questionable whether chemotherapy really benefits the patient.
Before deciding for or against a therapy, detailed discussions with each patient come first.

A patient should only make a decision when he knows all the arguments for and against the therapy and has weighed them against each other with medical support.

Radiation therapy in the abdomen is very difficult. Radiation therapy and chemotherapy attack all cells in the body that divide and multiply very quickly.
Tumor cells have this property to a particularly high degree, but so do all cells of the mucous membranes in the mouth and gastrointestinal tract, as well as hair.
The radiation and chemotherapeutic agents cannot distinguish whether cells are tumor cells or not, so they have an unfiltered effect on all these cells.

In order for radiation therapy to cause as little damage as possible to tumor-free organs, the area must be very precisely delimited. In the abdominal cavity, however, this turns out to be difficult or even impossible, since both the intestine and the peritoneum are constantly in motion due to the movements of the intestines.

So you cannot specifically target the peritoneum and then increasingly hit the very sensitive intestinal cells and irreversibly damage them.

surgery

An operation to treat peritoneal cancer is also possible in principle. But here is above all that Extent of infestation to be observed. If it is metastases from another tumor and other organs besides the peritoneum are affected, surgical treatment is usually avoided and the focus is on drug chemotherapy. Imagine metastases only on the peritoneum surgical removal of the peritoneum may be considered. This is a major surgery that must be done openly.

The organs connected to the peritoneum are often removed during the operation. The spleen, gall bladder, diaphragm or parts of the intestine cannot always be preserved in this way. The latter often means that the affected person only has an artificial anus, so that really all affected intestinal sections can be removed.

If a surgical treatment is decided, chemotherapy can also be started at the same time. Even after the operation, a long-term, accompanying chemotherapy important. It should ensure that any degenerate cells that remain in the body are successfully killed. Peritoneal surgery is performed in specialized centers performed for oncological abdominal surgery. Before deciding on this serious procedure, the age of the patient, accompanying illnesses and prognostic chances of recovery should be taken into account and considered. Is it a purely palliative treatment concept, i.e. The aim is not a cure, but the greatest possible freedom from symptoms and the best possible quality of life. As a rule, surgical treatment is dispensed with.

Prognosis / life expectancy

As a rule, it is very difficult to make a precise statement about the prognosis.

What one can usually say, however, is whether the tumor can be cured by the therapy options. There are special types of tumors, such as ovarian cancer or small intestine tumors, that in some cases can be cured.

What one must not lose sight of, however, is that the peritoneum tumors as colonies of tumors are a sign that the original tumor is already very advanced, which often makes a cure impossible.

Nevertheless, chemotherapy and radiation therapy should still be considered for such patients, because even if the affected can no longer be cured, the various forms of therapy and their possible combinations can give them valuable and livable time.