Peritoneal carcinomatosis

Overview

Peritoneal carcinomatosis is a serious condition that happens when cancer spreads to the lining of the abdomen, called the peritoneum. Peritoneal carcinomatosis usually comes from cancers that start in other organs, such as the colon, stomach or ovaries. Peritoneal carcinomatosis is usually a sign that the cancer is at a late stage.

Peritoneal carcinomatosis can cause belly pain and swelling, blockage in the bowels, and loss of appetite. Treatments for this condition include chemotherapy, surgery or newer methods that place heated medicine directly into the abdomen. These newer treatments can help some people feel better and live longer. Sometimes they may even lead to a cure.

Symptoms

Some people may notice symptoms of peritoneal carcinomatosis early, while others may not feel anything until the disease has gotten worse. Symptoms often become more noticeable when cancer cells grow and start affecting nearby organs, such as the intestines, bladder and stomach.

The most common symptoms include:

• Abdominal swelling or bloating. This is the most common symptom. Swelling is caused by fluid buildup, called ascites, in the belly. Someone may feel that they are gaining weight in the belly despite exercise. Women in menopause may appear as if they are pregnant.
• Abdominal pain or discomfort. This is often described as vague cramping or pressurelike pain.
• Loss of appetite. Someone may feel full quickly, even after small meals.
• Losing weight without trying. This weight loss is not related to changes in diet or activity.
• Fatigue. Someone may feel very tired, even after resting.
• Nausea and vomiting. These are often linked to bowel issues caused by tumor pressure.
• Bowel changes. These can include constipation or diarrhea and, sometimes, a blockage that prevents food or gas from passing.
• Bleeding. Peritoneal carcinomatosis may cause rectal or vaginal bleeding.

Other possible symptoms include:

• Urinary symptoms. If cancer spreads near the bladder or ureters, it may cause changes in urination or block urine flow. The ureters are thin tubes that carry urine from each kidney to the bladder.
• Shortness of breath. This is usually due to pressure from fluid buildup pushing on the lungs.

Causes

Peritoneal carcinomatosis develops when cancer cells break off from other organs. The cells then travel into the abdominal cavity and attach to the lining of the belly, called the peritoneum. The peritoneum has a large surface area with a rich blood supply. This allows cancer cells to grow quickly.

The most common cancers that can lead to peritoneal carcinomatosis include:

• Ovarian cancer.
• Colon or rectal cancer.
• Stomach cancer.
• Pancreatic cancer.
• Appendix cancer.
• Less commonly, breast, lung, neuroendocrine or skin cancer or gastrointestinal stromal tumors.

Cancer that starts in the peritoneum is called primary peritoneal cancer. This is much rarer than peritoneal carcinomatosis that has spread from other organs, which is considered a secondary or metastatic cancer. The most common primary peritoneal cancer is peritoneal mesothelioma.

Risk factors

Most of the time, peritoneal carcinomatosis happens when cancer spreads to the peritoneum from another part of the body. Some traits of the cancer or the person can make the cancer more likely to spread to the peritoneum.

• Advanced or larger cancers. Cancers that grow through the outermost layers of the organs or spread to lymph nodes are more likely to reach the peritoneum.
• Certain types of cancer cells. Some cancer cells, including mucinous and signet ring cancer cells, are strongly linked to peritoneal carcinomatosis. These types of cancers can be fast growing and aggressive and are more likely to spread throughout the abdomen rather than stay in one spot. That raises the risk that they will cause peritoneal carcinomatosis.
• Lymph node involvement. When cancer has already spread to nearby lymph nodes, the risk of peritoneal carcinomatosis is higher.
• Surgery to remove primary cancer. Having surgery to remove primary cancer in nearby organs increases the risk of cancer cells spreading during the procedure. If the cancerous tissue is accidentally cut or leaks during surgery, cancer cells can spill into the abdominal cavity. These cells can implant on the peritoneum and grow into new cancers.
• Cancer location. Cancers on the right side of the colon are more likely to spread to the peritoneum than are cancers on the left side of the colon.

Complications

Peritoneal carcinomatosis can lead to several serious complications as the cancer spreads and affects organs within the abdominal cavity:

• Fluid buildup in the belly. Cancer cells in the peritoneum often cause fluid to build up in the belly, a condition called ascites. This leads to bloating, discomfort, shortness of breath and, sometimes, infection. Fluid may need to be drained often, sometimes through catheters that you or your caregiver must manage at home.
• Bowel blockage. As cancer spreads across the peritoneum, it can press on or wrap around the intestines. This can lead to a bowel blockage, called obstruction. This can cause severe pain and vomiting and make it difficult to pass stool or eat. Obstructions may require emergency surgeries.
• Urinary blockage. In peritoneal carcinomatosis, cancer can press on or grow around the thin tubes called ureters that carry urine from each kidney to the bladder. This can block the flow of urine.
• Trouble absorbing nutrients. When the intestines aren't working well, the body can't take in enough nutrients from food. Over time, this can make a person weak and raise the risk of conditions such as infections or poor nutrition.