Peritoneal carcinomatosis is characterized by the spread of cancer cells to the peritoneum, a membrane lining the abdominal cavity and the viscera it contains. Formerly of very poor prognosis, it benefits from major therapeutic advances which make it possible in certain patients to treat it and sometimes to cure it. Therapeutic procedures nevertheless remain complex, with a high risk of postoperative complications.

Definition

Peritoneal carcinomatosis is defined by the invasion by cancer cells of all or part of the peritoneum, this thin membrane that covers the wall of the abdominal (or peritoneal) cavity and the intra-adbominal organs: digestive system, spleen, female reproductive organs …

Causes

The swarming of malignant tumors in the abdomen is most often a sign of metastatic spread following a primary cancer of the stomach, colon, rectum or pancreas, or gynecological cancer. We then speak of secondary peritoneal carcinosis. 

There are also much rarer primary peritoneal carcinomas (peritoneal pseudomyxoma, peritoneal mesothelioma, primary peritoneal carcinoma, disseminated peritoneal leiomyomatosis and desmoplastic small cell tumors).

Diagnostic

Diagnosis is mainly based on imaging. Unfortunately, due to the spread of tumor foci, up to 40% of lesions may go unnoticed.

A first radiological assessment established thanks to the scanner, which makes it possible to assess the extent of the disease and to check whether distant organs such as the liver and lungs are affected. Additional imaging examinations by MRI (Magnetic Resonance Imaging) and / or PET Scan (positron emission tomography) may be necessary.

Most often, a high endoscopy (gastroscopy to observe the esophagus and stomach) or low endoscopy (colonoscopy), sometimes coupled with biopsies, is performed to look for the primary tumor.

Exploratory laparoscopy makes it possible to directly visualize the tumor nodules using a camera inserted in the abdomen.

The people concerned

In France, more than 6 people are affected each year from peritoneal carcinoma secondary to another cancer. Primary peritoneal carcinoma, on the other hand, is a rare disease, with only 000-150 new cases each year.

Risk factors

The progression of colon or rectal cancer to peritoneal carcinoma is the most common. This development is also relatively usual following cancers of the ovary, stomach, pancreas or breast.

Dissemination often occurs directly as a result of surgical trauma to the peritoneum, not through blood or lymph.

People with peritoneal carcinoma present with nonspecific and discreet symptoms at the onset of the disease, which vary depending on the location and size of the tumor foci. At an advanced stage, the signs become more evident.

Ascite

Ascites is often one of the first signs of carcinoma. It is an effusion of fluid in the abdominal cavity, which causes the abdomen to distend and increase in size and may cause a feeling of discomfort or diffuse abdominal pain.

Troubles digestifs

Patients may present with nausea and vomiting, transit disorders, constipation, intestinal obstruction, etc.

Alteration of general condition

We often observe a loss of weight and appetite, and a state of significant fatigue.

The prognosis for peritoneal carcinomatosis has long been very poor, with complete surgical removal of tumor lesions rarely possible. The therapeutic approach was most often limited to palliative chemotherapy, with low efficacy and significant side effects.

The treatment options have expanded over the past twenty years. They depend on the origin of the peritoneal carcinoma, its extent and the possibilities of completely removing the tumor nodules, but also on the patient’s state of health.

The CHIP

CHIP (hyperthermic intraperitoneal chemotherapy) is the standard treatment today. France was a pioneer in the development of this innovative but complex to implement process. The principle is to proceed with the surgical removal of all visible cancerous nodules, then to treat the residual invisible disease with a chemotherapy bath heated to 42-43 ° C. Expert centers perform CHIPs in two ways, with an open stomach, with the skin pulled up, or with a closed stomach

The chemotherapy bath allows higher doses of therapeutic agents to be administered than intravenously, and the heat potentiates its effects. However, chemotherapy only penetrates 1 to 2 millimeters deep; the surgery must therefore be extremely careful – in total, the procedure can last 8 hours or more. 

This innovation has made a leap forward in the 5-year survival rate for peritoneal carcinomas and offers hope for a cure for many patients. On the other hand, it is not easily tolerated and causes a high rate of postoperative complications. 

The CIPPI 

CIPPI (post-operative intraperitoneal chemotherapy is sometimes still practiced when CHIP is not possible. Following tumor reduction surgery, anti-cancer drugs are administered inside the peritoneal cavity by catheter, five days right now.

The PIPAC

Vaporized PIPAC (intraperitoneal chemotherapy) is a very promising treatment that has been developed in recent years. The anticancer agents are vaporized in the form of an aerosol and dispersed homogeneously in the peritoneal cavity by laparoscopy (minimally invasive technique). The rate of tissue penetration is higher than with CHIP and surgical trauma is less.

Supportive treatments

The treatments for peritoneal carcinomatosis are particularly heavy, with frequent complications and often significant side effects of chemotherapy. Different strategies can help patients cope better.

Psychological support often plays an essential role in getting through this ordeal.

Alternative medicine (homeopathy, acupuncture), sophrology or even various relaxation techniques can help alleviate anxiety, improve the patient’s general condition and reduce certain side effects of chemotherapy (fatigue, lack of appetite, nausea and diarrhea…). 

Surgical lesions of the peritoneum today constitute a major route of dissemination of secondary peritoneal carcinomatosis in the abdominal cavity. Avoiding unnecessary surgical procedures is therefore a crucial issue.

Moreover, the risk factors for cancer are now well known. Diet and lifestyle play an important role in preventing digestive cancers. Increase your consumption of plants, avoid consuming too much animal fats and alcohol, fight against smoking, overweight and physical inactivity help prevent these cancers.