Is peritoneal cancer treatable

Peritoneal Carcinosis - Medical Experts

As peritoneal carcinosis, the Infestation of the lining of the abdominal organs - the so-called Peritoneum or peritoneum - referred to as malignant (malignant) tumor cells. In peritoneal cancer, the tumor cells are mostly settlements (metastases) of another tumor of the abdominal cavity, more rarely they originate from a tumor disease of the peritoneum itself. Infestation and spread of the tumor cells can vary greatly and influence the prognosis and course of the disease. The infestation can be limited to a few nodules in very specific areas of the peritoneum (limited peritoneal carcinosis). This mostly affects abdominal areas with low motility (ability to actively move) such as the zoekal area or the Douglas space. More often, larger tumor nodules are scattered extensively throughout the peritoneum and on the surface of the adjacent organ structures (diffuse peritoneal carcinosis).

Symptoms of peritoneal cancer

At the beginning of the disease, mostly unspecific symptoms such as constipation (constipation) or abdominal pain emerge. Although these are perceived by the patient, they hardly worry him. Often home remedies are used first to counteract them. However, the increasing expansion of the tumor cells then causes displacement phenomena with subsequent phenomena Functional disorders of the adjacent abdominal organs. It comes to Ischuria (Urinary retention), restrictions in bowel activity and intestinal obstruction (subileus and ileus) as well as the formation of ascites (ascites). The impairment of the gastrointestinal tract (gastrointestinal tract) is often associated with nausea, bloating, loss of appetite and nausea.

With a computed tomography, peritoneal carcinosis can be made visible by means of contrast enhancement based on nodular to puffy condensation of the peritoneum.

The causes of peritoneal cancer

The tumor-related infestation can originate in the peritoneum itself (primary peritoneal carcinoma, peritoneal mesothelioma). Mostly, however, peritoneal cancer is an expression of an advanced and metastatic malignant tumor of another organ in the abdominal cavity.

The peritoneum lines the inside of the abdominal cavity (organs and abdominal wall). It forms a secretion that helps the intestinal loops to slide. Cells from malignant tumors of the abdominal space - so-called Primary tumors - come. This mechanism can be observed particularly in gastrointestinal cancers such as colon cancer (colorectal cancer), small intestine cancer and pancreatic cancer (malignant growth of the pancreas) as well as in ovarian cancer.

A rare tumor unit that can also lead to peritoneal cancer is the so-called Pseudomyxoma peritonei Here, the cancer develops when mucus-forming tumors perforate the appendix (so-called mucocele) and the tumor cells then migrate into the peritoneum. Although this is a benign (benign) tumor, the course is comparable to that of a slowly growing malignant tumor. In the advanced stage, the entire peritoneum is enriched with gelatinous tissue and tumor masses.

The therapeutic measures for peritoneal carcinosis

The therapeutic measures mostly consist of Treatment of the primary tumor, the removal of all tumor-bearing organ structures in the abdominal cavity as well as the affected areas of the peritoneum (cytoreduction or CRS for short) and one Rinsing the abdominal cavity with a warmed chemotherapy solution(hyperthermic intraperitoneal chemotherapy (HIPEC)).

The combined method of both is particularly advisable in the case of limited infestation by the following types of tumors:

  • primary peritoneal adenocarcinoma
  • colorectal cancer (cancer of the large and small intestines)
  • Gastric cancer
  • Ovarian cancer (primary and secondary therapy)
  • peritoneal mesothelioma
  • Pseudomyxoma peritonei
  • Small bowel cancer
  • Appendix cancer.

The goal is to make the abdomen free from tumors. As part of the Peritonectomy all affected areas of the peritoneum are used for this purpose surgically removed. During the procedure, however, a large number of tumor cells are dispersed into the peritoneal space. These can grow in the surgically caused wound surfaces and settle there (implantation of tumor cells). To prevent such an implantation, a cytostatic or chemotherapy solution (including cisplatin, mitomycin C) is introduced into the peritoneum during the operation. This as intraperitoneal chemotherapy The so-called lavage (rinsing) has a high cytotoxicity (ability of chemical substances to damage cells and tissue) and facilitates the penetration of chemotherapeutic agents into the tumor tissue.

The tumor cells are particularly sensitive and susceptible to cytostatics if these have not yet formed a visible tumor cluster. The chemotherapeutic agents can then have an optimal effect on them because there are no adhesions (adhesions) and the tumor cells are not surrounded by fibrin. At the same time, an even distribution of the chemotherapeutic agents in the peritoneal space is ensured and the release of growth hormones, which otherwise promote tumor growth, is inhibited. In addition, the effect of the cytostatics is increased by the fact that the Irrigation solution under hypothermic conditions - heated to 42 ° C - introduced into the closed abdominal cavity for 45 minutes. As a rule, the tumor cells have a poor ability to regulate heat: the local overheating therefore causes the tumor tissue to swell, while the blood flow to the surrounding healthy tissue is promoted. The result is a reduced blood flow and insufficient oxygen supply to the tumor tissue (tumor hypoxia), which makes it even more susceptible to the active ingredient solution. In addition, an acidic cell environment (acidosis) develops. When combined, these factors ultimately lead to the death of the tumor cells (tumor necrosis).

This combination therapy is not suitable for:

  • Ileus (bowel obstruction)
  • extra-abdominal metastases (metastases outside the abdomen)
  • florid (blooming) infection
In addition, a poor general condition, a subileus (not yet complete closure of the intestine) as well as metastases to the liver or behind the peritoneum cavity can rule out such a treatment. In addition to these measures, additional symptomatic treatments (including regular ascites drainage or paracentesis, diuretics to flush out water through the kidneys, treatment of nausea, if necessary intravenous nutrition with highly concentrated special solutions and other palliative therapy measures) are usually required.