Treatments
Peritoneal Disease
What is Peritoneal Disease
When bowel cancer spreads to the peritoneum, which is the thin layer of tissue lining the inside of the abdomen and covering stomach, liver or bowel, it is known as a peritoneal metastasis. Bowel cancer tumours can form on the peritoneum or the surface of the organs that it covers.
When bowel cancer has spread to the peritoneum, then it is considered advanced, stage IV cancer.
Cancer that develops from the peritoneum itself, known as primary peritoneal cancer, is very rare.
Symptoms
Symptoms of Peritoneal Disease
The symptoms of peritoneal metastasis include the following
Ascites – this is a build-up of fluid in the abdomen, causing swelling and bloating, and is very common for patients with peritoneal metastases
Abdominal pain
Nausea and vomiting
Obstructions – peritoneal metastases can cause blockages of the bowel
Constipation
Weight loss
Who might be at risk?
Patients that are suffering from gastrointestinal cancers are at risk of developing peritoneal metastases.
Common Methods of Treatments
Treatment for peritoneal metastasis could include chemotherapy and surgery.
Chemotherapy can be used to shrink the cancer and can be used in conjunction with biological therapies. A biomarker test may be performed to see whether you will benefit from one of these targeted therapies.
Peritoneal surgery is performed to remove visible tumours from the peritoneum, which is known as cytoreductive surgery. You may also need parts of some organs removed if they are affected.
Cytoreductive surgery may be combined with Hyperthermic lntraperitoneal Chemotherapy (HIPEC), a process whereby a heated chemotherapy solution is applied in the peritoneal cavity.
About 30% of colorectal cancers which have metastases (spread to distant sites) spread to the peritoneum, the lining of the abdomen. We give the volume of disease a score, which can be determined by scans or by laparoscopy (a daycase surgical procedure). Those with lower scores and few sites of disease which are operable are found to do better, if they are administered a single dose of chemotherapy into their abdomen at the time of surgery. Moreover, the tissue penetration is improved by circulating this fluid at a temperature of 42 C. This can be done at presentation or for recurrence of peritoneal disease.
The heated circulated chemotherapy is termed HIPEC (Hyperthemic IntraPEritoneal Chemotherapy). This part of the process is usually performed for 90 minutes. These are open surgeries and take a long time to complete.
There are very few units in the UK who are specialised to perform this procedure. Dr Minicozzzi is peritoneal consultant with a large experience gained in Italy and at the Christie Hospital in Manchester.
A potential new treatment is called PIPAC which stands for pressurised intraperitoneal aerosolised chemotherapy and is currently in clinical trials. It is chemotherapy that is delivered directly into the abdomen during a short general anaesthetic and aims to shrink tumours in the peritoneum.
