A cancer that primarily affects the abdominal cavity but can spread to other areas, including the ovaries, uterus, and bowels.
What is peritoneal cancer?
Peritoneal cancer is a rare cancer that develops in the peritoneum, which is a thin layer of tissue lining the inside of the abdomen and covering most of the abdominal organs. This cancer can spread to other nearby organs.
Peritoneal cancer is rare. It is related to epithelia ovarian cancer, which is the most common type of ovarian cancer. Peritoneal cancer is diagnosed at a smaller rate than ovarian cancer and often only affects women over the age of 65. There are two main types of peritoneal cancer, including:
- Primary peritoneal cancer: This type starts in the peritoneum itself. It is very similar to epithelial ovarian cancer, and, in fact, it's often treated in the same way. The cells look very similar under a microscope.
- Secondary peritoneal cancer: This is more common and occurs when cancer from another part of the body spreads to the peritoneum. Common sources include ovarian cancer, colon cancer, stomach cancer, and appendix cancer.
Generally, the five-year survival rates for primary peritoneal cancer are similar to those for epithelial ovarian cancer, and can range from around 20% to 70%, depending on the stage at diagnosis and treatment response. Secondary peritoneal cancer survival rates depend on the primary cancer's origin and stage and are generally lower than those for primary peritoneal cancer.
AHN Molecular, Metastatic, and Rare Cancer Center of Excellence
Our Molecular, Metastatic, and Rare Cancers Center of Excellence was designed to address the unique challenges posed by complex cancer types. This includes rare cancers, such as peritoneal and pleural metastases, and hereditary cancer syndromes. We use cutting-edge genomic sequencing and molecular profiling, to identify specific genetic mutations, alterations, and biomarkers that drive these metastatic processes. Our treatment options are focused on your specific cancer and needs.
Why choose AHN for your peritoneal cancer care?
Our center stands at the forefront of innovation, offering a combination of expertise and resources that few institutions can match. Here are some key differentiators:
- Precision oncology: We employ next-generation sequencing and molecular profiling to analyze the genetic and molecular characteristics of each tumor. This enables us to customize treatment strategies that target the specific mutations driving the cancer, maximizing efficacy while minimizing side effects.
- Comprehensive multidisciplinary care: Our team includes oncologists, molecular pathologists, geneticists, radiologists, surgeons, and specialized nurses who collaborate to create and implement individualized care plans. Each patient’s case is reviewed in tumor boards, ensuring a holistic and tailored approach.
- Access to innovative clinical trials: We provide patients with access to a robust portfolio of clinical trials, including those investigating novel therapies such as CAR T-cells, bispecific antibodies, and tumor-infiltrating lymphocytes (TILs). Our close partnerships with pharmaceutical companies and research institutions allow us to bring promising new treatments to our patients before they are widely available.
- Focus on rare and metastatic cancers: Our expertise extends to cancers that are often underrepresented in clinical studies, such as sarcomas, neuroendocrine tumors, and metastatic cancers of unknown primary origin. This focus ensures that patients with rare and complex conditions receive the same level of specialized care as those with more common malignancies.
- Patient-centered care: From advanced pain management to psychological support, our center is committed to treating the whole patient. Dedicated patient navigators guide individuals and their families through every stage of the journey, providing education, emotional support, and assistance with logistics.
Peritoneal cancer symptoms and signs
Symptoms of peritoneal cancer can be vague and often mimic those of other abdominal conditions, which can make early diagnosis challenging. Common signs and symptoms include:
- Abdominal pain: Persistent or worsening pain in the abdomen.
- Abdominal swelling or distension: A build-up of fluid in the abdomen (ascites) can cause swelling and a feeling of fullness.
- Bloating: Feeling bloated or having a distended abdomen.
- Nausea and vomiting: Due to the cancer affecting the digestive system.
- Changes in bowel habits: Constipation or diarrhea can be an indication of cancer affecting the peritoneum.
- Loss of appetite: Feeling full quickly or not feeling hungry.
- Unexplained weight loss: Losing weight without trying.
- Fatigue: Feeling unusually tired.
- Shortness of breath: If fluid build-up (ascites) presses on the diaphragm.
It is important to know that these health conditions do not necessarily mean you will develop or have peritoneal cancer. Talk with your doctor about any changes to your health or new issues you may be having. Early detection can help find issues before they become more severe.
Causes and risk factors
It is important to know that these symptoms, signs, and health conditions do not necessarily mean you will develop or have peritoneal cancer. Talk with your doctor about any changes to your health or new issues you may be having. Early detection can help find issues before they become more severe. The cause of peritoneal cancer isn’t fully understood, but having an understanding of some potential links and risk factors can help. One of the most significant causes is another cancer, often one in the abdomen, spreading to the peritoneum. The risks of developing the cancer include:
- Genetic factors: Some women with BRCA1 or BRCA2 gene mutations have a higher risk.
- Family history: Having a family history of ovarian, breast, or peritoneal cancer may increase the risk.
Peritoneal cancer screening and diagnosis
Unfortunately, there is no standard screening test for peritoneal cancer in women who are at average risk. Regular communication with your doctor and having your annual exams can be a good place to start in detecting any illness or health condition in the early stage. The diagnosis of peritoneal cancer typically involves a combination of the following:
- Physical exam: A doctor will examine the abdomen for any signs of swelling or masses.
- Imaging tests including:
- CT scan: A CT scan of the abdomen and pelvis can help to visualize the peritoneum and identify any tumors or fluid buildup.
- MRI: An MRI may be used to further evaluate suspicious areas seen on a CT scan.
- PET scan: A PET scan can help to detect cancer cells throughout the body.
- Paracentesis: A procedure to remove fluid from the abdomen (ascites) for analysis. The fluid is examined for cancer cells.
- Biopsy: A tissue sample is taken from the peritoneum and examined under a microscope to confirm the diagnosis and determine the type of cancer. This can be done through laparoscopy or laparotomy.
- Blood tests: These tests, such as CA-125, may be elevated in some cases of peritoneal cancer, but it is not a reliable screening tool.
- Laparoscopy: A minimally invasive surgical procedure that allows doctors to directly visualize the peritoneum and obtain tissue samples. This technique not only reduces recovery time compared to traditional open surgery, but also minimizes complications, allowing patients to return to their normal activities more swiftly.
Types and stages of peritoneal cancer
We treat several types of this rare cancer including:
- Primary peritoneal cancer (PPC): This cancer originates in the peritoneum itself. It's often considered very similar to epithelial ovarian cancer, and in many cases, it's treated in the same way. The most common type of PPC is:
- Serous peritoneal carcinoma: This is the most common subtype and is histologically similar to serous ovarian cancer.
- Secondary peritoneal cancer (peritoneal carcinomatosis): This occurs when cancer spreads to the peritoneum from another site, such as the ovaries, colon, stomach, or pancreas. It's essentially metastatic cancer in the peritoneum.
- Peritoneal mesothelioma: A rare cancer arising from the mesothelial cells of the peritoneum, often linked to asbestos exposure.
Staging of peritoneal cancer is similar to epithelial ovarian cancer. Staging helps your care team understand the extent of the cancer and the best treatment options available. The staging of peritoneal cancer includes:
- Stage 1: The cancer is confined to the peritoneal cavity.
- Stage 1A: Cancer is only inside one of the peritoneal organs (e.g., ovary or fallopian tube.)
- Stage 1B: Cancer is in both of the peritoneal organs (e.g., both ovaries or both fallopian tubes).
- Stage 1C: Cancer is in one or both peritoneal organs, and is on the surface of the organ, OR the cancer capsule broke open OR cancer cells are in the ascites (abdominal fluid).
- Stage 2: The cancer has spread within the pelvis.
- Stage 2A: Cancer has spread to the uterus or fallopian tubes.
- Stage 2B: Cancer has spread to nearby pelvic organs, such as the bladder or rectum.
- Stage 3: The cancer has spread beyond the pelvis to the upper abdomen and/or to the lymph nodes.
- Stage 3A: Cancer has spread to the lymph nodes in the back of the abdomen.
- Stage 3B: Cancer has spread to the peritoneum (lining of the abdomen) and is larger than 2 cm, AND/OR it has spread to lymph nodes.
- Stage 3C: Cancer has spread to the peritoneum (lining of the abdomen) and is larger than 2 cm, AND/OR it has spread to lymph nodes and is larger than 1 cm.
- Stage 4: The cancer has spread outside the abdomen.
- Stage 4A: Cancer cells are in fluid around the lungs (pleural effusion).
- Stage 4B: Cancer has spread inside the spleen or liver, or to distant organs such as the lungs or brain.
Peritoneal cancer treatment
Treatment for peritoneal cancer typically involves a combination of surgery and chemotherapy. The specific treatment plan will depend on the stage and type of cancer, as well as the patient's overall health. Because peritoneal cancer is relatively rare, treatment should be managed by a multidisciplinary team of specialists with experience in treating this type of cancer.
Surgery
AHN has the surgical expertise and minimally advanced treatment options to allow for tailored care options to treat your specific cancer diagnosis. We create custom treatment plans based on your needs, and your surgical team — along with your entire multidisciplinary team — will be available to explain this process every step of the way. Types of surgery for peritoneal cancer include:
- Cytoreductive surgery: This involves removing as much of the visible tumor as possible.
- Hyperthermic Intraperitoneal Chemotherapy (HIPEC): After cytoreductive surgery, heated chemotherapy is delivered directly into the abdominal cavity to kill any remaining cancer cells. This is called HIPEC, and AHN uses this advanced treatment plan to target the cancer cells in a way traditional chemotherapy does not.
Systemic chemotherapy
Systemic chemotherapy involves using drugs that travel through the bloodstream to reach cancer cells throughout the body. For peritoneal cancer, chemotherapy is often the primary treatment, especially for advanced stages. It works by interfering with the cancer cells' ability to grow and divide. Chemotherapy is usually given intravenously (through a vein) in cycles. A cycle consists of a treatment period followed by a rest period to allow the body to recover. Common side effects include nausea, vomiting, hair loss, fatigue, loss of appetite, increased risk of infection, and mouth sores. These side effects vary depending on the specific drugs used, and medications can help manage them. Regular blood tests are needed to monitor blood cell counts and kidney and liver function. Dose adjustments may be necessary based on how the patient responds to the treatment and the severity of side effects.
Targeted therapy
Targeted therapy uses drugs that target specific molecules (such as proteins or genes) involved in cancer cell growth and survival. By blocking these molecules, targeted therapies can disrupt cancer cell growth and spread. Targeted therapies are often taken orally (as pills) or given via an IV. Side effects depend on the specific targeted therapy being used. Common side effects may include skin rashes, diarrhea, high blood pressure, liver problems, and fatigue. Before starting targeted therapy, doctors usually perform biomarker testing on the patient's tumor cells to identify specific target. Regular monitoring is necessary to assess treatment effectiveness and manage side effects.
Immunotherapy
AHN’s immunotherapy helps the body's immune system recognize and attack cancer cells. It is administered via an IV and the combination of the drugs and the body’s own defense system fight the cancer cells. Immunotherapy can cause a range of side effects, as it can affect the immune system's activity throughout the body. Common side effects include fatigue, skin reactions, diarrhea, and hormone imbalances. In some cases, the immune system can attack healthy organs, leading to more serious side effects. Your AHN team will carefully monitor your response and adjust anything as needed.
Palliative care
Palliative care focuses on providing relief from the symptoms and stress of a serious illness like peritoneal cancer. It aims to improve the quality of life for both the patient and their family because it is focused on both the emotional and physical health of the patient. You can lean on AHN’s palliative care support resources to help you with pain management, symptom control, emotional and psychological support, help with decision-making, and coordination of care.
Peritoneal cancer FAQs
Questions about peritoneal cancer are understandable. Your AHN care team is an amazing resource to get you answers to your specific questions. In the meantime, we’ve included some answers to our patients’ most frequently asked questions. You can use these to guide your conversations with your care team.
What causes peritoneal cancer?
The cause of primary peritoneal cancer is often unknown, but genetic factors (like BRCA mutations) and a family history of ovarian, breast, or peritoneal cancer can increase the risk. The cause of secondary peritoneal cancer is caused by cancer spreading from another site (like the ovaries, appendix, colon, or stomach) to the peritoneum.
Are peritoneal nodules always cancerous?
No, peritoneal nodules are not always cancerous. They can be caused by various non-cancerous conditions, such as infections, inflammation, or benign tumors. However, they can also be a sign of cancer, especially if cancer has spread from another site.
What are the signs of peritoneal cancer?
Signs and symptoms can be vague but often include:
- Abdominal pain or swelling
- Bloating
- Nausea or vomiting
- Changes in bowel habits (constipation or diarrhea)
- Loss of appetite
- Unexplained weight loss
- Fatigue
- Shortness of breath (due to fluid build-up)
What is the survival rate for peritoneal cancer?
Survival rates vary widely depending on the type and stage of the cancer, as well as the patient's overall health. In general:
- Early-stage primary peritoneal cancer can have five-year survival rates ranging from 70% to 90%.
- Advanced-stage primary peritoneal cancer and secondary peritoneal cancer tend to have lower survival rates, ranging from 20% to 50%.
How aggressive is peritoneal cancer?
The aggressiveness of peritoneal cancer varies depending on the type and other factors:
- Primary peritoneal cancer can be aggressive, especially if it is not detected early.
- Secondary peritoneal cancer's aggressiveness depends on the primary cancer's characteristics and how far it has spread.
Can peritoneum cancer be cured?
A cure is possible, especially for primary peritoneal cancer diagnosed at an early stage. Treatment with surgery and chemotherapy can be effective. For advanced stages or secondary peritoneal cancer, treatment can help control the disease and improve quality of life, even if a cure is not possible.
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