Understanding Peritoneal Carcinomatosis

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If you’ve been diagnosed with an abdominal cancer, you may have also come across the terms “peritoneal carcinomatosis” or "peritoneal surface malignancy." These refer to the spread of cancer in the abdominal and pelvic cavities.

Diagram showing organs in the abdominal and pelvic cavities, including the liver, stomach, gallbladder, pancreas, colon, small bowel, appendix, rectum, peritoneum, fallopian tube, ovary, and uterus, illustrating areas affected by abdominal cancers and peritoneal surface malignancies.

Peritoneal Carcinomatosis

Peritoneal carcinomatosis, also referred to as peritoneal metastases, is the diffuse spread of cancer in the abdominal cavity that may or may not involve solid organs such as the liver, spleen, and lymph nodes. It is caused by peritoneal surface malignancies, which can originate from a wide variety or tumors, including the appendix, colon, rectum, stomach, ovaries, and small bowel, as well as from primary peritoneal tumors, sarcomas, and mesothelioma (a rare form of cancer that develops from the protective lining that covers many of the body's internal organs, the mesothelium). Other abdominal and extra-abdominal cancers, such as pancreatic, gallbladder, or breast, can also lead to this condition; however, they tend to have a poorer prognosis.

In the past, these cancers were considered incurable tumors; however, we have learned that they respond well to aggressive therapy consisting of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC).

To determine if you have peritoneal carcinomatosis, doctors typically start with advanced imaging such as CT, MRI, or PET scan to look for tumor nodules or fluid buildup (ascites) in the abdominal cavity.

The diagnosis is usually confirmed through diagnostic laparoscopy, a minimally invasive surgery where a camera is inserted through a small incision to visually inspect the peritoneum and take a biopsy for pathology. In cases with fluid accumulation, a needle may be used to perform paracentesis, draining the fluid to check it for malignant cells under a microscope.

Frequently Asked Questions

What are the symptoms of peritoneal carcinomatosis?

Abdominal pain
Abdominal swelling or bloating
Change in bowel habits, such as recurrent diarrhea or constipation
Lumps of tissue in the abdomen
Unexplained weight loss

What is the best treatment for peritoneal carcinomatosis?

Peritoneal carcinomatosis is best treated with aggressive cytoreductive surgery utilized in conjunction with hyperthermic intraperitoneal chemotherapy (HIPEC). Only a small number of surgeons across the country and the world perform this procedure. Depending on your tumor type, systemic ("IV") chemotherapy and/or radiation may also be recommended in combination with cytoreductive surgery and HIPEC.

A poor understanding of the disease by physicians, including surgical and medical oncologists and other healthcare providers, has led to late referrals for the appropriate treatment. While not all patients are candidates for the procedure, it is important that you are evaluated by a surgical oncologist who specializes in HIPEC procedures and peritoneal surface malignancies.

Learn More

Appendix
Cancer

Colorectal Cancer

Endometrial Cancer

Gastric
Cancer

Ovarian
Cancers

Peritoneal Mesothelioma

Uterine
Sarcoma

For the following cancers, extensive spreading throughout the abdomen is less common. In some cases, they may be treated similarly to other abdominal malignancies, such as with CRS/HIPEC.

Breast
Cancer

Simplified diagram showing the liver with the gallbladder highlighted in red below it and a red bile duct connecting both, illustrating gallbladder and bile duct cancer.

Gallbladder and Bile Duct Cancer

Neuroendocrine Tumors

Pancreatic Cancer

Simplified diagram illustrating the prostate gland and nearby structures with the prostate highlighted in red, representing prostate cancer.

Prostate
Cancer

Small Bowel Cancer

Early detection and early referral save lives.

Early detection can lead to better health outcomes, reduced treatment costs, and improved quality of life for patients. This proactive approach allows for timely intervention, which can prevent disease progression and save lives. This is why we do the work we do.

Getting Multiple Opinions

Rare and advanced cancers present unique challenges due to their limited research and treatment options. By seeking multiple medical opinions from doctors specialized in advanced abdominal cancers, patients can benefit from a comprehensive evaluation, explore alternative treatment options, gain confidence in their decisions, and ultimately improve their chances of successful outcomes.