HIPEC: Advanced Solution in the Treatment of Peritoneal Carcinomatosis

HIPEC procedure – minimally invasive surgery

View the full interview with Chief of Works Dr. Bartoș – a qualified medical doctor, focusing on the HIPEC (hyperthermic intraperitoneal chemotherapy) procedure for peritoneal cancer. You can view the full interview by clicking on the youtube link or if you want to read more information visit the hipec.ro website

Peritoneal Carcinomatosis: Causes, Symptoms, Diagnosis and Treatment

Peritoneal carcinomatosis is a rare and devastating condition that affects the peritoneum, the thin membrane that surrounds the abdominal organs. This type of cancer generally develops when other abdominal tumours spread to the peritoneum, causing more new tumours to appear on the surface of this vital membrane. In this article, we explore in detail the causes, symptoms, diagnosis and treatment options for peritoneal carcinomatosis.

Causes of Peritoneal Carcinomatosis

Peritoneal carcinomatosis most often develops as a consequence of other advanced abdominal cancers. These cancers include:

Peritoneal pseudomyxoma (cancer of the appendix): This can spread to the peritoneum, initially considered a rare condition, but with significant impact on the peritoneum.

Colon and rectal cancer: These cancers can invade the peritoneum, causing peritoneal carcinomatosis, the most common type of peritoneal cancer in men.

Pancreatic cancer: Any of the three types of pancreatic cancer (adenocarcinoma, endocrine tumors and exocrine cell tumors) can lead to peritoneal carcinomatosis.

Gastric cancer: Advanced stomach cancer can spread to the peritoneum, causing this rare but dangerous condition.

Ovarian cancer: Ovarian cancer is the leading cause of death among women suffering from malignant tumours of the reproductive organs. One of the major causes of this high mortality is that ovarian cancer has a pronounced tendency to spread to the peritoneal cavity before it is identified by diagnosis. This development is very common and, as a result, ovarian cancer is the most common source of peritoneal cancer in women.
Regrettably, most ovarian cancer patients end up consulting their doctor when the disease is already advanced and has spread to other organs. At the time of diagnosis, these patients may show symptoms such as fluid accumulation in the abdomen (ascites), difficulty in eating adequate food, weight loss, abdominal pain and/or the presence of tumour formations in the abdomen that can be detected on physical examination. Ovarian cancer can occur at any age, but its risk increases with advancing age, especially after the onset of menopause. It should also be noted that there are rare cases of primary peritoneal carcinomatosis, which starts in the peritoneum itself. These cases are more common among women and are often associated with an increased risk of developing ovarian cancer.

Risk Factors for Peritoneal Carcinomatosis

Apart from the presence of other abdominal cancers, there are other risk factors that may contribute to the development of peritoneal carcinomatosis. These include:

Age: The risk of developing peritoneal carcinomatosis increases with advancing age as the body becomes more susceptible to developing cancer.

Family history of ovarian or peritoneal cancer: If you have family members who have had ovarian cancer or peritoneal carcinomatosis, your risk may be higher.

BRCA gene mutations: BRCA1 and BRCA2 gene mutations are associated with an increased risk of ovarian cancer and, by implication, peritoneal carcinomatosis.

Hormone replacement therapy: Long-term use of hormone replacement therapy may increase the risk of ovarian cancer and, by extension, peritoneal carcinomatosis.

Obesity: Excess body weight can contribute to the development of cancer and increase the likelihood of peritoneal carcinomatosis.

Endometriosis: This gynaecological condition can increase the risk of ovarian cancer and, by extension, peritoneal carcinomatosis.

Symptoms of Peritoneal Carcinomatosis

Symptoms of peritoneal carcinomatosis may vary depending on the stage of the condition. In the early stages, they may be absent or very vague, making diagnosis difficult. However, in the later stages, cancer can cause the following symptoms:

Diarrhoea, constipation or nausea: Digestive dysfunction may occur as the tumor invades the peritoneal area.

Abdominal pain: Persistent abdominal pain can be a sign of peritoneal carcinomatosis, especially when the tumour is pressing on internal organs.

Bloating: Irritated peritoneum can lead to bloating and abdominal discomfort.

Weight loss or gain: Unintentional changes in body weight may occur as the condition progresses.

Frequent urination: The discomfort created by the pressure exerted by the peritoneal tumour can lead to frequent urination.

Lack of appetite or feeling full during meals: Eating disorders can be a sign of peritoneal carcinomatosis.

It is important to point out that many other conditions can cause similar symptoms, which is why accurate diagnosis of peritoneal carcinomatosis requires evaluation by a medical specialist.

How is Peritoneal Carcinomatosis Diagnosed?

If a doctor suspects you have peritoneal carcinomatosis, tests and investigations will be carried out to confirm the diagnosis. These may include:

Blood tests: Certain tumour markers may be present in the blood in peritoneal carcinomatosis.

Medical imaging: Computed tomography (CT) and magnetic resonance imaging (MRI) can provide detailed images of the peritoneum and abdominal organs.

Biopsy: Taking a sample of peritoneal tissue by biopsy can confirm the presence of cancer cells.

Sometimes peritoneal carcinomatosis can be diagnosed during surgery for another type of cancer when the surgeon notices tumours on the peritoneum.

Treatment Options for Peritoneal Carcinomatosis

Treatment of peritoneal carcinomatosis is a challenge because this type of cancer is often at an advanced stage when diagnosed. In most cases, chemotherapy has no significant effect on peritoneal tumours. Doctors therefore focus on palliative care to improve patients’ quality of life and control symptoms. Palliative care is an important option for those facing peritoneal carcinomatosis.

Depending on the individual case, the following treatment options may be considered:

Cytoreductive surgery: this involves the removal of tumours from the peritoneum as well as the affected abdominal organs in extreme cases.

Hyperthermic intraperitoneal chemotherapy (HIPEC): After surgery, chemotherapy drugs are administered directly into the abdominal cavity, heated to 41 to 42 degrees Celsius, to increase the effectiveness of chemotherapy and destroy remaining microscopic cancer cells.

Peritonectomy: In some cases, the peritoneum may be surgically removed to control the spread of cancer.

For an optimal approach to treatment, it is essential to talk to your multidisciplinary abdominal cancer team and consider all available options.

In conclusion, peritoneal carcinomatosis is a complex and serious condition that requires specialised evaluation and treatment. It is important to be aware of the risk factors and symptoms associated with this condition in order to seek prompt and appropriate medical care. With the right approach and appropriate treatment, quality of life can be improved and symptoms associated with peritoneal carcinomatosis can be managed.