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Peritoneal Carcinoma: Causes, Symptoms and Treatment

Peritoneal carcinoma is a malignant tumor of the peritoneum, the tissue lining the abdominal cavity. It may arise primarily or spread from other cancers and requires specialized treatment.

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Things worth knowing about "Peritoneal carcinoma"

Peritoneal carcinoma is a malignant tumor of the peritoneum, the tissue lining the abdominal cavity. It may arise primarily or spread from other cancers and requires specialized treatment.

What is Peritoneal Carcinoma?

Peritoneal carcinoma is a malignant disease of the peritoneum – the thin tissue layer that lines the abdominal cavity and covers the internal organs. There are two main forms: primary peritoneal carcinoma, which originates directly from the peritoneum, and peritoneal carcinomatosis, in which cancer cells from other tumors (e.g., ovarian, colorectal, or gastric cancer) spread to the peritoneum.

Primary peritoneal carcinoma is histologically very similar to ovarian carcinoma and is often treated using comparable methods. It occurs more frequently in women but can affect individuals of any sex.

Causes and Risk Factors

The exact causes of primary peritoneal carcinoma are not yet fully understood. The following factors are known to increase the risk:

Genetic mutations: Mutations in the BRCA1 and BRCA2 genes are associated with a significantly elevated risk.
Family history: A family history of ovarian or breast cancer increases the risk.
Age: The disease predominantly occurs in postmenopausal women.
Prior cancer diagnoses: Patients with ovarian, colorectal, gastric, or pancreatic cancer have an increased risk of developing peritoneal carcinomatosis.

Symptoms

Peritoneal carcinoma often causes no or only non-specific symptoms in the early stages, making diagnosis challenging. Common symptoms include:

Bloated or enlarged abdomen, often due to ascites (fluid accumulation in the abdominal cavity)
Abdominal pain or pressure
Unintentional weight loss
Nausea, vomiting, or changes in bowel function
Loss of appetite and early satiety
General weakness and fatigue

Diagnosis

Because symptoms are non-specific, several diagnostic methods are used:

Imaging: Ultrasound, CT (computed tomography), and MRI (magnetic resonance imaging) help visualize tumor formations and fluid accumulations.
Blood tests: The tumor marker CA-125 is elevated in many peritoneal carcinomas, although it is not specific to this condition alone.
Biopsy: A definitive diagnosis is established by obtaining and examining a tissue sample, typically through laparoscopy.
Paracentesis: Fluid from the abdominal cavity can be aspirated and analyzed for cancer cells.

Treatment

Treatment of peritoneal carcinoma depends on the stage, the general health of the patient, and the tumor type. The main treatment options include:

Surgery (Cytoreductive Surgery)

The goal of surgery is to remove as much visible tumor tissue from the abdominal cavity as possible (cytoreduction). This complex procedure is often combined with a specialized form of chemotherapy.

Chemotherapy

Following surgery, or as a primary treatment in inoperable cases, systemic chemotherapy is commonly used, often with agents such as carboplatin and paclitaxel.

HIPEC (Hyperthermic Intraperitoneal Chemotherapy)

HIPEC involves delivering a heated chemotherapy solution directly into the abdominal cavity after cytoreductive surgery. This approach increases the local effectiveness of chemotherapy and is offered at specialized centers.

Targeted Therapies and Immunotherapy

For patients with specific genetic alterations (e.g., BRCA mutations), targeted agents such as PARP inhibitors may be used. Immunotherapeutic approaches are being investigated in clinical trials.

Prognosis

The prognosis of peritoneal carcinoma depends strongly on the stage at diagnosis, the extent of tumor spread, and response to therapy. Modern combination approaches (surgery and HIPEC) have improved survival rates in recent years. Early diagnosis and treatment at a specialized center are key determinants of outcome.

References

Leitlinienprogramm Onkologie der AWMF: S3 Guideline on Diagnosis, Therapy and Follow-Up of Malignant Ovarian Tumors, Version 5.1 (2022). AWMF Register No. 032/035OL.
Sugarbaker, P.H.: Peritoneal Surface Oncology – A Subspecialty of General Surgery. World Journal of Surgical Oncology, 2021.
National Cancer Institute (NCI): Primary Peritoneal Cancer Treatment (PDQ). Available at: https://www.cancer.gov (2023).

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