Do you sometimes feel stomach discomfort, bloating, or stomach pain? These symptoms are actually very common, and sometimes they can be caused by something we eat or drink, or even a minor infection. However, sometimes there may be something more serious behind them that needs attention. That is what peritoneal carcinomatosis is. The name may sound a bit complicated, but let's talk about it simply and understand it.
What is Peritoneal Carcinomatosis?
Simply put, this means that cancer that has started elsewhere in our body has spread to a membrane called the peritoneum . Now you may be wondering what this peritoneum is. It is a thin membrane that lines the inside of our belly, that is, the abdominal cavity and the pelvic cavity. Several internal organs, such as our intestines, liver, and stomach, are covered by this membrane.
So, when cancer develops in another organ, for example, an ovary or a colon, and those cancer cells come to the peritoneum and form new tumors there, we call it peritoneal carcinomatosis . This is different from primary peritoneal cancer, which starts in the peritoneum itself, because in this case the cancer starts somewhere else.
These types of cancers are also called late-stage cancer or metastatic cancer . True, these are a little more serious than early-stage cancers. But don't worry. With new treatments available, it is possible to control the spread of this disease and help the patient live longer.
What types of cancer usually cause this condition?
Virtually any cancer can spread to the peritoneum, but the following types of cancer are most likely to cause this condition:
- Ovarian cancer (this is the most common)
- Colon cancer
- Stomach cancer
- Pancreatic cancer
- Appendix cancer
- Rectal cancer
What are the symptoms of Peritoneal Carcinomatosis?
Most of the time, this condition does not cause any symptoms until it affects a large area of the peritoneum. That is, symptoms only begin to appear after the disease has spread a little. When this happens, the most common symptom is fluid accumulation in the abdomen (ascites) . This is when the abdomen begins to swell abnormally.
There may be several other symptoms related to this:
- Frequent fatigue
- Swollen abdomen ( due to fluid retention)
- Abdominal pain
- Abdominal mass
- Low back pain
- Nausea and vomiting
- Constipation
- Unexplained weight loss or weight gain
Now, look, most of these symptoms are also common in other common diseases. For example, stomach pain can also occur in gastritis. So, just because you have these symptoms, don't panic and think you have this serious condition. However, if you continue to have these symptoms, it is wise to definitely see a doctor and get checked out. Because only a doctor can tell for sure whether this is cancer or not.
What causes this?
Peritoneal carcinomatosis occurs, as mentioned earlier, when cancer from one part of the body spreads to the peritoneum. Most often, this cancer starts inside the abdomen, in an organ that is close to the peritoneum. For example, the ovaries or the colon.
However, in about ten percent (10%) of cases, this cancer starts in an organ outside the abdominal cavity. In that case, the cancer cells travel through the bloodstream or lymphatic system to reach the peritoneum. Think of it like small pieces of dirt moving through a waterway, these cells also travel through body fluids.
How is this disease diagnosed? (Diagnosis)
Doctors use several tests to diagnose this condition. Some of them are:
- Imaging tests: These include CT scans , MRI scans , and PET scans . These types of scans can give a clear picture of how far the cancer has spread to the peritoneum and where it is located.
- Blood tests: Your blood is checked for special proteins called tumor markers . Some cancer cells release these into the blood. Elevated levels of these can be a sign of the disease.
- Paracentesis: If you have fluid in your abdomen (ascites), your doctor may take a small sample of the fluid and have it tested in a lab. This can help determine what type of cancer has spread, or what the primary cancer is.
- Biopsy: This involves taking a very small piece of the tumor and examining it under a microscope to see if there are any cancer cells. This is the only test that can definitively tell if it is cancer or not.
What is the Peritoneal Carcinomatosis Index (PCI)?
This PCI is an important tool in the diagnostic process that helps doctors plan treatment. Using this index, doctors give you a score based on where and how large the cancer cells are in your stomach and small intestine.
This information can help the doctor understand and get an idea of whether or not surgery can completely remove these tumors.
What are the treatments for this? (Treatment)
The current mainstay and standard treatment for peritoneal carcinomatosis is a treatment called Hyperthermic Intraperitoneal Chemotherapy (HIPEC) combined with cytoreductive surgery (CRS) .
Although this may seem like a complicated two-word phrase, it simply goes like this:
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* CRS (Cytoreductive Surgery): The goal of this surgery is to remove all visible cancerous tumors in the peritoneal membrane.
* HIPEC (Hyperthermic Intraperitoneal Chemotherapy): This method is used to destroy any remaining cancer cells that are too small to be seen by the naked eye after CRS surgery. In this, heated chemotherapy drugs are injected directly into the abdominal cavity, left in place for a short time, and then removed. Because the drugs are heated and delivered directly to the cancer, it is more effective than traditional chemotherapy.
These CRS and HIPEC treatments are given in addition to the treatment given to the organ where the cancer first originated.
Sometimes, not everyone can undergo CRS surgery. That is, the patient's condition may not be suitable for surgery. Even for such people, palliative care can help control symptoms and reduce pain. Palliative care is a treatment that helps the patient to be as comfortable as possible, regardless of the stage of the cancer.
Are there any complications of the treatment?
The latest research shows that both CRS and HIPEC are safe and effective treatments when patients are carefully screened and appropriately selected. The results are particularly good when the surgery is performed at an experienced center that routinely performs this treatment.
However, as with any major surgery, there are some complications that can occur. Although very rare, these can be life-threatening if not treated promptly. These include:
- Heavy bleeding
- Perforation of an organ
- Anastomotic leak after surgery
- Infection
- Abscess
- Sepsis ( a serious condition caused by germs entering the bloodstream)
Your doctor will explain all of this to you in advance. The important thing is that you understand how the benefits of treatment outweigh the risks.
What is the prognosis of peritoneal carcinomatosis?
The poor prognosis associated with peritoneal carcinomatosis has now been greatly improved with the advent of CRS and HIPEC treatments. Although there is no cure for the condition, these treatments help patients live longer .
Of those who have had surgery to completely remove all traces of the cancer (CRS), 45% are alive after five years. That is, forty-five percent of those who have had successful CRS survive for five years. However, if surgery cannot completely remove the cancer, the five-year survival rate is less than 10%.
There are several other factors that affect your outlook:
- The type of primary cancer
- How abnormal the cancer cells look
- How severe your symptoms are
- Your PCI score
Your doctor can explain more about these factors that affect your condition.
How do I take care of myself? (Self-care)
Living with metastatic cancer, a condition like peritoneal carcinomatosis, can be challenging. The physical symptoms can make it difficult to get through the day. And the uncertainty about how your body will respond to treatment can be emotionally overwhelming.
This is why it is essential to get all the support you can get.
This may include receiving palliative care to help manage symptoms. It is also a good idea to seek counseling to help you deal with the complex emotions that come with a diagnosis. It is especially helpful to join a support group where you can connect with others who are living with advanced cancer conditions like you. This can help you feel less alone and you can learn from others' experiences.
Ask your doctor about resources that can make living with peritoneal carcinomatosis a little easier.
When should I see the doctor?
You will need to see your doctor regularly to see how well your treatment is working. In the meantime, if you develop new symptoms or if your symptoms get worse, let your doctor know right away. He or she can recommend additional treatments or changes to your treatment plan that may help.
What questions should I ask my doctor?
When you meet your doctor, it's a good idea to ask questions like these:
- What tests do I need to do?
- What kind of treatment do you recommend for me?
- What side effects can I expect from the treatments?
- What results can I expect after treatment?
- What resources are available to help me cope with symptoms and side effects?
Finally, things to remember (Take-Home Message)
In the past, when a person was diagnosed with Peritoneal Carcinomatosis, it was thought that they had a very short life expectancy. However, the situation is different now. Thanks to advanced treatments available today, the survival time of people with this condition has been significantly extended.
However, your experience will depend on your specific diagnosis. Your doctor can explain to you whether you are a good candidate for treatments like CRS and HIPEC. He or she can also connect you with resources to ensure you get the support you need to cope with this condition.
Never give up hope. Getting the right information, getting timely treatment, and getting the mental and physical support you need are very important in this fight.
` Peritoneal Carcinomatosis, Peritoneal Carcinomatosis, Cancer, Peritoneum, Ascites, CRS, HIPEC, Cancer Symptoms, Cancer Treatment
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