In patients with advanced stage colon cancer (colon and rectum cancer), the spread of cancer cells to the abdominal cavity and the abdominal membrane (peritoneal) covering the organs in the abdominal cavity is called Peritoneal Carcinomatosis (PC).
In general, cancer can reach the outer surface of the intestinal wall, ie the cancer cells can spread to the abdomen. Often due to gravity and the effect of diaphragms, there involvement of the lower abdomen or diaphragm.
The rate of disease involvement (peritoneal cancer index) can be determined according to the involvement of cancerous cells in the abdomen. According to this degree of spread, treatment plan is made.
Peritoneal Carcinomatosis F.A.Q
- Peritoneal Mesothelioma: tumor which develops in the peritoneum
- Pseudomixoma Peritonei: tumor caused by mucocele, often located in the appendix
- Primary Tumors developed in other organs:
The number varies depending on the origin of the malignancy:
- Peritoneal Mesothelioma: 2/3 patients per year every 1 million people
- Pseudomixoma Peritonei: 1/2 patients per year every 1 million people
- Peritoneal Carcinomatosis originated by tumors of other organs: hundreds of thousands every year.
It is estimated that at least 15% of colon tumor patients, 60% of ovarian cancer patients and 50% of gastric tumor patients may develop Peritoneal Carcinomatosis.
During its initial phase, Peritoneal Carcinomatosis can be completely asymptomatic, and in many cases it is detected only during the surgical resection of the primary tumor.
These may be the symptoms:
- abdominal bloating
- loss of appetite and weight
- nausea and constipation
- abdominal pain
- shortness of breath due to the accumulation of big quantities of fluids in the abdominal cavity (ascitis)
A specific test does not exist; a combination of exams is often required, among which:
- Hematochemical standard tests and tumor markers
- CT scan (Computerized tomography)
- PET (Positron emission tomography)
Treatment for Peritoneal Carcinomatosis
It is a complex surgical intervention in two combined phases to be executed in sequence:
1. CRS – Cyto-reductive surgery: it is aimed to remove all visible tumors in the abdomen.
The intra-abdominal organs affected by the tumor can be safely resected and removed to ensure that no trace of malignancy is left
2. HIPEC – Intra-Peritoneal Hyperthermic Chemoterapy: its goal is to kill the residual microscopic deposits and tumor cells, otherwise invisible to the naked eye, which may be left behind in the abdomen after surgery.
It consists in the administration of an hyperthermic solution of highly concentrated chemotherapics directly in the peritoneal cavity. It is a real bathing of the peritoneal cavity made by circulating for 60/90 minutes the chemotherapics heated at 42-43°, utilizing a dedicated equipment.
The mean survival time for untreated patients is 2-6 months from diagnosis, depending on the tumor origin.
The treatment is performed with the aim of healing the patient; nonetheless it must be underlined that Peritoneal Carcinomatosis is a highly aggressive cancer which in some cases can recur after the intervention.
Even though not all patients can be treated, in general the survival time can be expressed in years instead than months.
The prognosis can be influenced by many factors such as:
- origin and extension of the malignancy upon diagnosis
- possibility to kill all visible tumor cells during surgery
- patient conditions
No, not all patients are eligible for CRS+HIPEC treatment: it depends on factors like age, general conditions, origin of the carcinomatosis, and disease gravity upon diagnosis.
This treatment is currently considered the standard approach in many Countries, for selected patients diagnosed with Mesothelioma, Pseudomixoma and Peritoneal Carcinomatosis originated by colon-rectum cancer.
Some hospitals also perform this treatment for other indications such as peritoneal Carcinomatosis from gastric or ovarian cancer.
The intervention is performed in general anaesthesia and generally lasts from 3 to 9 hours, but in some cases it can take even longer times.
Despite the complexity of this procedure, this intervention is now considered safe.
The death rate from treatment complications is lower than 3%, more favourable than other high-risk surgeries.
Since this procedure is very complex and invasive, post-intervention side-effects are frequent.
The most frequent side-effects are lung or bladder infections, wound complications and inability to drink/eat for some days.
A less frequent side-effect is abdominal infection.
A significant hair loss is rarely observed.
From 2 to 4 weeks.
In order to further improve the intervention results, the physician can suggest an additional systemic chemotherapy. Such chemotherapy, typically started 4-6 weeks after the intervention, is administered by infusion and/or pills with the aim of preventing or delaying the cancer recurrence and the metastatic dissemination to other organs such as kidney or lungs. This type of chemotherapy is called “adjuvant chemotherapy”.
Yes, a first control is normally performed a few weeks after the intervention.
Next controls are initially performed every 3 months. This frequency gradually drops to one control per year.
Many hospitals all over the world can offer this procedure to selected patients.
This is a very challenging treatment and requires that patients are carefully evaluated by a multidisciplinary team including a medical oncologist, a surgical oncologist, a radiation oncologist and a pathologist with deep knowledge of Peritoneal Carcinomatosis.
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