Have you ever heard of this name 'primary peritoneal cancer'? Probably not. Because it's a relatively rare type of cancer. But it's very important to know about it, especially for women. Today, we'll talk about it simply, in a way that you can understand.
What is Primary Peritoneal Cancer?
Simply put, primary peritoneal cancer is cancer that starts in the lining of your abdomen, the thin membrane that lines the inside of your abdominal cavity. This membrane is called the peritoneum . Think of it like the lining of a balloon.
This peritoneum also covers several important organs inside your abdomen. For example:
- Bladder
- Intestines
- Rectum
- Uterus (female)
Did you know that this peritoneum is made up of a special type of cell called epithelial cells . These cells protect the various surfaces of our body. Also, this peritoneum secretes a special fluid. This fluid is what allows the organs inside the abdomen to move freely without bumping into each other.
So, primary peritoneal cancer develops when cells in the peritoneum start to grow abnormally and uncontrollably.
Now let's look at the types of peritoneal cancer. Doctors divide it into two types, depending on where the cancer first starts:
1. Primary peritoneal cancer: In this type of cancer, the cancer starts in the cells that make up the peritoneum. We are mainly talking about this type today.
2. Secondary peritoneal cancer: This is when cancer starts somewhere else in the body (for example, the ovaries, stomach, intestines) and spreads to the peritoneum. This means that it did not start in the peritoneum.
How common is this primary peritoneal cancer?
In fact, primary peritoneal cancer is a very rare type of cancer. Think about it, the disease is diagnosed in less than 7 out of a million people per year. However, these statistics do not tell the whole picture. According to some researchers, about 15% of women diagnosed with advanced ovarian cancer may actually have peritoneal cancer. Because the symptoms of the two are so similar.
Who is at higher risk of developing this?
Women are more likely to develop primary peritoneal cancer than men. The risk factors for this are very similar to those for ovarian cancer. Let's take a look at what they are:
- Age: This disease is most often diagnosed in people aged 60 or older.
- Endometriosis: If you have endometriosis (cells similar to those that line the inside of the uterus grow outside the uterus), your risk may be increased.
- Genetic influences (heredity): If a close family member (mother, sister, daughter) has had peritoneal cancer, fallopian tube cancer, or ovarian cancer, you are also at higher risk. Women with BRCA1 or BRCA2 gene mutations are also at higher risk. People with the genes for Lynch syndrome (a hereditary condition that increases the risk of several types of cancer) are also at higher risk.
- Height: People who are taller than average appear to have a slightly higher risk of developing this cancer.
- Hormone replacement therapy: Women who take hormone therapy after menopause may be at increased risk.
- Obesity: People with high body fat are also at higher risk.
- Reproductive history: This risk may be slightly increased in those who have had difficulty having children (infertility) and/or have never had children.
What is the difference between peritoneal cancer and ovarian cancer?
This is where many people get confused. Peritoneal cancer starts in a different place than ovarian cancer. Ovarian cancer usually starts in the ovaries, or in the cells at the ends of the fallopian tubes. However, peritoneal cancer, as I mentioned earlier, starts in the cells of the peritoneum, the membrane that lines the inside of the abdomen and covers the organs in the abdomen.
These two cancers can easily be confused with each other. This is because the peritoneum and the lining of the ovaries are both made up of the same type of cells (epithelial cells). Also, because both cancers spread along the lining of the abdomen, it is sometimes difficult to pinpoint exactly where the cancer first started.
Typically, people diagnosed with peritoneal cancer are older than those diagnosed with ovarian cancer. It is also said that the prognosis for peritoneal cancer may be slightly worse than for ovarian cancer.
Why does this primary peritoneal cancer develop?
In fact, researchers still don't know exactly why some people develop primary peritoneal cancer. However, as mentioned earlier, it has been found that people born with certain gene mutations are at higher risk of developing the disease.
What are the symptoms of this?
Like ovarian cancer, this disease rarely shows symptoms in its early stages . Even if there are symptoms, they are often vague and may resemble those of other common illnesses. Most people only experience symptoms when the cancer is more advanced, meaning it has spread.
However, if someone develops symptoms in the early stages, they may be like this:
- Pain in the stomach and/or lower abdomen.
- Unusual vaginal bleeding or discharge.
- Feeling full, a feeling of heaviness in the stomach or lower abdomen.
- Bowel changes (constipation and/or increased flatulence) or rectal bleeding.
- Needing to urinate frequently.
- Digestive problems, loss of appetite, or feeling full after eating only a small amount of food.
- Unintentional weight gain or loss.
As peritoneal cancer progresses, other symptoms may appear. These include:
- Fatigue.
- Fluid buildup in the abdomen (this is called `ascites` ).
- Nausea or vomiting.
- Difficulty breathing (dyspnea).
- Swelling of the legs.
What are the possible side effects (complications) of this?
People with advanced peritoneal cancer may develop complications such as:
- Severe abdominal pain.
- Inability to eat or drink.
- Severe nausea or vomiting.
- Small bowel obstruction, large bowel obstruction, or urinary tract obstruction.
How do you accurately diagnose this disease?
When you see a doctor, they will first ask you about your symptoms and do a physical exam. If your symptoms suggest peritoneal cancer, they may order tests such as:
- Blood tests: These blood tests look for a chemical called CA-125, which is produced by some cancer cells. People with peritoneal cancer may have elevated levels of this substance. They may also look for an increase in a protein called HE4 (which can also be produced by peritoneal cancer cells).
- Imaging tests: Tests such as ultrasound, MRI, or CT scan can look for cancerous growths. However, these tests can sometimes be difficult to detect in cases of peritoneal cancer.
- Laparoscopy: To confirm the diagnosis, the doctor may perform a laparoscopy. This involves making several small incisions in the abdomen and inserting a camera-equipped instrument. During this procedure, a small sample of abnormal tissue (called a biopsy) is taken, which is then examined under a microscope by a pathologist (a doctor who specializes in examining tissue) to determine if cancer is present.
- Paracentesis: If your abdomen is full of fluid (called ascites), your doctor may take a sample of the fluid and test it. This is often done during a laparoscopy.
- Pelvic exam: Your vagina, cervix, uterus, fallopian tubes, ovaries, and rectum are examined for any unusual lumps or areas.
Let's also learn about special tests
If you have any of these conditions, your doctor may refer you to a genetic counselor to talk about some of the genetic conditions that are associated with an increased risk of developing peritoneal cancer:
- If a close family member (mother, sister, daughter) has had peritoneal cancer, fallopian tube cancer, or ovarian cancer.
- If someone in the family has a `BRCA1` or `BRCA2` gene mutation.
- If someone in the family has Lynch Syndrome.
What is the stage of this cancer?
Because symptoms often do not appear in the early stages of primary peritoneal cancer, the cancer is usually at stage 3 or 4 when it is diagnosed.
- Stage 3: The cancer has spread outside the pelvic cavity or to the lymph nodes in the back of the abdomen.
- Stage 4: The cancer has spread to organs outside the abdomen (e.g., lungs, liver, spleen) or to the membrane that covers the lungs and chest.
How is this treated and managed?
The treatment of primary peritoneal cancer depends on several factors:
- The size and location of the cancerous tumor.
- Stage of cancer.
- Your age and overall health.
Most often, doctors will perform surgery as the first treatment. You may have a procedure called cytoreductive surgery . The goal of this is to remove as many cancer cells as possible. Research has shown that the results are better when this surgery is performed by a gynecologic oncologist (a doctor who specializes in treating diseases and cancers of the female reproductive system).
The surgeon may also remove:
- Fallopian tubes and ovaries (this is called an `oophorectomy` ).
- The uterus (this is called a `hysterectomy` ).
- The fatty tissue around your intestines, called the omentum (this is called an `omentectomy` ).
- Other abnormal tissues.
To stop cancer cells from spreading to other parts of the body, your treatment plan may also include:
- Chemotherapy: Traditional chemotherapy for peritoneal cancer is given either intravenously or directly into the abdominal cavity (intraperitoneal). In some cases, doctors use heated chemotherapy drugs (called hyperthermic intraperitoneal chemotherapy (HIPEC) ). This HIPEC treatment is given immediately after cytoreductive surgery, while you are still under anesthesia in the operating room, and is injected into the abdominal cavity. This HIPEC method of giving chemotherapy can be more effective for some cancers.
- Targeted therapy: The doctor can use specific drugs that target only cancer cells, without harming normal cells.
- Hormonal therapy: In advanced cases, doctors sometimes combine hormonal therapy with chemotherapy. This treatment works by blocking your body's natural hormones from reaching cancer cells, preventing them from growing.
- Radiation therapy: Radiation therapy is rarely used as the first treatment for peritoneal cancer. If the cancer has come back after initial treatment and is confined to a small area, radiation therapy may be given.
How can I reduce my risk of developing this?
If you have done these things, your risk of developing primary peritoneal cancer may be slightly reduced:
- If the children have been breastfed.
- If you have given birth to children.
- If you have taken birth control pills.
- If you have had your fallopian tubes and/or ovaries surgically removed.
- If the fallopian tubes have been tied (tubal ligation).
Some people with a family history of ovarian cancer or those with a BRCA gene mutation who are at increased risk of developing peritoneal cancer choose to have their ovaries and fallopian tubes removed. It is important to remember that while this surgery reduces the risk of developing peritoneal cancer, it does not eliminate it completely .
What is the future for someone with this disease? (Prognosis)
Because peritoneal cancer is usually diagnosed at a later stage of the disease, the prognosis is poor. The cancer can recur after treatment. However, early detection can help improve outcomes.
About half of people with peritoneal, fallopian tube, or ovarian cancer live five years or more after diagnosis. While younger people are more likely to live longer, the prognosis for older people may be somewhat worse.
Survival rates may increase in cases like these:
- If the cancer hasn't spread to your lymph nodes.
- If you have received `HIPEC` treatment.
- If the surgeon has removed as much of the cancer as possible.
Several clinical trials are already underway to find new ways to treat peritoneal cancer. These new treatments include targeted therapies and immunotherapy . Immunotherapy works by stimulating your own immune system to recognize and attack cancer cells in your body.
How should I take care of myself?
To help manage symptoms of advanced peritoneal cancer, your doctor may suggest that you see a palliative medicine provider (a field of medicine that focuses on relieving and addressing symptoms of a serious medical condition). Your care may include:
- Reducing nausea and vomiting.
- A nutritional consultation to get recommendations regarding appetite and diet.
- Pain management.
- Paracentesis to remove fluid from your abdomen (ascites).
How can I cope well with a situation like this?
Joining a support group with others who are going through the same treatment as you can help you feel less alone. Support groups can also help your family understand what you are going through.
The most important message to take home
Primary peritoneal cancer is a rare type of cancer that develops in the lining of the abdomen. Symptoms often appear after the cancer has grown, so it is often diagnosed at a later stage. However, advanced treatments such as HIPEC, targeted therapy, and surgery can improve outcomes. Clinical trials are also underway to find other treatment options that can increase survival rates.
The most important thing is that if you continue to have the symptoms mentioned above (especially unusual changes in the abdomen, pain, heaviness), you should definitely seek medical advice. The earlier it is detected, the more likely it is that treatment will be successful.
` Peritoneal cancer, Primary peritoneal cancer, Peritoneal Cancer, Abdominal cancer, Women's cancer, Cancer symptoms, Cancer treatment
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