Diagnosis
Peritoneal carcinomatosis often spreads across the abdominal lining without forming distinct masses. Because of this, doctors usually need to combine imaging, fluid tests, and sometimes surgery, to confirm a diagnosis.
Tests
- Imaging tests. Imaging tests such as CT, MRI and PET scans are typically the first step in looking for suspected peritoneal carcinomatosis. These scans help identify visible tumor spread, fluid buildup or organ involvement. However, imaging is often not sensitive enough to detect smaller cancers or early peritoneal disease. Therefore, a negative scan does not rule out peritoneal carcinomatosis.
- Peritoneal washing cytology. In this test, fluid from the abdominal cavity is surgically collected during a minor procedure. It's then examined under a microscope. Healthcare professionals use peritoneal washing cytology to check for cancer cells floating in the peritoneal fluid. Even when no visible cancer is present, a positive cytology result is a strong sign that peritoneal spread has happened.
- Staging laparoscopy. Staging laparoscopy is a safe, minimally invasive surgical procedure used to look directly inside the abdominal cavity using a small camera. It allows healthcare professionals to inspect the peritoneum, find hidden tumors, and take tissue or fluid samples. This test is especially valuable for finding peritoneal metastases that are too small to be seen with imaging.
- Tumor marker tests. Tumor marker tests use a sample of blood to look for chemicals made by cancer cells.
- Circulating tumor DNA (ctDNA). This is a newer blood test that looks for small pieces of DNA from cancer cells in the blood. It can help find peritoneal cancer that doesn't show up on scans. However, the role of ctDNA in diagnosis is still uncertain.
Treatment
Treatment for peritoneal carcinomatosis often requires a combination of therapies. The exact plan depends on where the cancer started, how far it has spread and your overall health. Your healthcare team also considers your treatment goals, such as extending life, symptom relief or both.
Systemic chemotherapy
The most common treatment for peritoneal carcinomatosis is systemic chemotherapy. This is medicine given through the blood to reach the whole body. Chemotherapy uses strong medicines to kill cancer cells, help shrink tumors, and relieve symptoms such as pain or bloating. Chemotherapy also may allow for surgery later.
However, systemic chemotherapy doesn't reach the peritoneum as well as it does other parts of the body, which can limit how well it works for peritoneal carcinomatosis.
Immunotherapy
Immunotherapy is another type of systemic treatment that may be offered for certain cancers.
Cytoreductive surgery
Cytoreductive surgery (CRS) removes all visible cancer from the peritoneum and other organs in the abdomen. Also known as debulking surgery, CRS is a major operation and should only be done in centers with experience. It's best for people who are healthy enough for surgery and whose cancer can be mostly or completely removed.
Hyperthermic intraperitoneal chemotherapy
Hyperthermic intraperitoneal chemotherapy (HIPEC) is typically combined with CRS. After the cancer is removed during surgery, the abdominal cavity is bathed with heated chemotherapy to target any remaining microscopic cancer cells.
This combined approach, often referred to as CRS-HIPEC or HIPEC surgery, allows for higher medicine concentrations to reach cancer in the peritoneum. This can lessen the typical side effects people often have with systemic chemotherapy due to less absorption in the bloodstream.
Research has shown that HIPEC can prevent cancer from returning for certain people whose cancer has spread to the abdominal cavity. Therefore, HIPEC may prolong survival.
Pressurized intraperitoneal aerosolized chemotherapy
Pressurized intraperitoneal aerosolized chemotherapy (PIPAC) is a newer method to treat peritoneal carcinomatosis. During PIPAC, a special aerosolized mist of chemotherapy medicine is put directly into the belly during a minimally invasive procedure. The medicine is given as a fine aerosol under pressure, which helps it spread evenly throughout the abdomen. PIPAC is typically done when surgery isn't possible or when surgery would be too risky or not helpful.
Palliative care
When peritoneal carcinomatosis can't be cured or treated with chemotherapy or surgery, the focus may turn to comfort and quality of life. Palliative care is a special type of healthcare that focuses on relieving pain and other symptoms, such as digestive issues, malnutrition and fluid buildup, called ascites. Treatments may include fluid drainage, pain relief medicines and nutritional support.
Palliative care involves a team of healthcare professionals. The team can include doctors, nurses and other specially trained health professionals. The goal is to improve the quality of life for people with serious illnesses and their families.
Prognosis
Peritoneal carcinomatosis is a serious and often late-stage condition. Depending on how aggressive the cancer is, people with peritoneal carcinomatosis from more advanced cancers may live only 4 to 6 months on average when treated with systemic chemotherapy alone.
However, some people may live longer if they are healthy enough to have CRS-HIPEC. In some studies, CRS-HIPEC extended survival by more than three years. For people who can't have surgery, newer treatments such as PIPAC also may help them live longer.
Coping and support
It can be hard to cope with a cancer diagnosis, especially if it's a cancer recurrence or metastasis. In time, people learn to cope in their own ways. Until you find what works for you, you might try to:
- Learn enough about your cancer to make treatment decisions. Ask your healthcare team about your treatment options and their side effects. The more you know, the more you'll be able to take part in decisions about your care. Ask your healthcare team to recommend other sources of information, such as websites you can trust.
- Keep friends and family close. Keeping people you care about close to you can help you deal with cancer. Friends and family can help you take care of things if you're in the hospital. And they can offer you support when you feel like you have too much to handle.
Find someone to talk with. Find a good listener with whom you can talk about your hopes and fears. This may be a friend or family member. Talking with a counselor, medical social worker, clergy member or cancer support group also might be helpful.
Ask your healthcare team about support groups in your area or contact a cancer organization, such as the National Cancer Institute or the American Cancer Society.
Preparing for your appointment
If you have peritoneal carcinomatosis, you'll likely be sent to specialists who treat advanced disease. You might meet with:
- A doctor who uses medicines to treat cancer, called an oncologist.
- A doctor who removes cancer using surgery, called a surgeon or surgical oncologist.
Here's some information to help you get ready for your appointment.
What you can do
Ask a family member or friend to go to your appointment with you. This person can help you remember the information you're told.
Make a list of:
- Your symptoms and when they began.
- Key medical information, including other conditions you have and your family medical history.
- All medicines, vitamins and supplements you take, including doses.
- Questions to ask your healthcare team.
Some basic questions to ask include:
- How serious is my condition?
- Can you explain the lab report of my cancer to me?
- Can I have a copy of my lab report?
- Will I need more tests?
- What are the treatment options for my cancer?
- What is the chance that my cancer can be cured?
- What are the potential side effects of each treatment?
- How will each treatment affect my daily life?
- How much time can I take to decide about treatment?
- Are clinical trials available for me?
What to expect from your doctor
Be prepared to answer some basic questions about your symptoms, such as:
- What are your symptoms?
- Is there a family history of cancer, especially at a young age? And what types of cancer?
- Have you or any relatives been tested for Lynch syndrome or other hereditary cancer conditions?
- Do you have any other health conditions, such as diabetes, heart disease or kidney disease?