What is the incidence of peritoneal carcinomatosis

In our surgical unit we are dedicated to the treatment of advanced abdomino-pelvic tumors, especially those that affect the inner lining of the abdomen, also known as peritoneum. These metastatic cancer affectations are known as peritoneal carcinomatosis.

Peritoneal carcinomatosis is a specific form of cancer metastasis that occurs when tumor cells detach from their initial tumor and reproduce through the peritoneum. The most common types of cancer that cause peritoneal carcinomatosis are:

  • Colon.
  • Rectum.
  • Appendix.
  • Stomach.
  • Ovary.
  • Peritoneal mesothelioma.
  • Peritoneal pseudomyxoma.
  • Rare tumors.
  • Etc.

Peritoneal carcinomatosis has a complex and mostly late diagnosis; the most effective treatment is multidisciplinary and in most cases requires a combination of chemotherapy and surgery. The surgical procedure for the treatment of peritoneal metastases is called cytoreductive surgery, or Sugarbaker procedure, and is performed in conjunction with the application of chemotherapy at elevated temperatures directly into the abdomen, technically known as HIPEC (Heated IntraPeritoneal Chemotherapy).

What is the incidence of peritoneal carcinomatosis?

The incidence differs according to the type of cancer that causes it. About 15% of patients with colon cancer will develop peritoneal metastases, between 30 and 50% in gastric cancer. On the other hand, appendiceal cancer also has a high risk of peritoneal carcinomatosis and is present in more than 50% of patients, however the risk is much higher in patients with ovarian cancer; in the latter case 2/3 of patients will have metastatic spread to the peritoneum.

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What are the symptoms?

Peritoneal carcinomatosis does not usually cause specific symptoms during the early stages. For this reason, it is important that patients with advanced tumors and/or suspected peritoneal metastases are referred early to specialized units. In those cases in which the peritoneal involvement of the cancer is more advanced, it can produce:

  • Abdominal pain.
  • Increase in abdominal perimeter.
  • Accumulation of fluid in the abdomen (ascites).
  • Intestinal obstruction.

How is it diagnosed?

As mentioned above, peritoneal carcinomatosis is difficult to diagnose, as the tumor cells tend to form small deposits that are located on the surface of the peritoneum and multiple organs. As these deposits are small, they may not be visible with current imaging tests until they become more voluminous. The most common imaging tests used to diagnose peritoneal carcinomatosis include:

  • CT scan.
  • Magnetic resonance imaging.
  • Positron emission tomography (PET).
  • In selected cases it is necessary to perform an exploratory laparoscopy.

Knowing the extent of the disease helps professionals to recommend the optimal treatment for each patient and to decide whether it is possible to perform CRS + HIPEC.

What does the Sugarbaker technique consist of?

The Subarbaker procedure, cytoreductive surgery + HIPEC, is a specialized surgery used to treat peritoneal carcinomatosis and other advanced tumors. It is a complex procedure performed by highly specialized teams. During the procedure surgeons will remove all affected parts of the peritoneum and/or other organs involved by the disease, if necessary. As peritoneal carcinomatosis can affect several organs at once, this type of surgery can be very extensive and should only be performed in referral centers. Once all visible tumor deposits have been surgically removed, hyperthermic chemotherapy is applied directly into the abdominal cavity to increase the efficacy of the drug at the loco-regional level and to eliminate all microscopic (invisible) tumor residue present in the abdominal cavity.

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What is HIPEC?

Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) is the application of chemotherapy at a temperature of 41-42°C, directly into the abdominal cavity, just after the completion of surgical procedures. The circulation of the chemotherapy is carried out through a specialized medical device, which allows a circuit between the machine and the patient, ensuring the circulation of the hyperthermic liquid with chemotherapy and the control of the parameters during the whole procedure. The heat makes the chemotherapy more effective by facilitating penetration into the tissues and the direct application to the abdomen makes it possible to achieve higher concentrations of the drug on the abdominal surfaces, minimizing the amount of drug circulating in the rest of the body, as well as its adverse effects.

How is the patient’s recovery after the operation? What is the patient’s quality of life after the mass?

The hospital stay after this procedure is usually approximately 8-12 days, although much depends on the aggressiveness of the surgery performed. Patients are advised to be active and walk daily throughout their hospital stay. In addition, there is strict monitoring by a team nutritionist. Recovery continues at home until 6-10 weeks, when normal life can be resumed. All published studies show that patients recover a normal or better quality of life after the procedure, although much depends on the residual intestinal reserve.

Can this technique be applied to all patients with peritoneal carcinomatosis?

Not all patients with peritoneal carcinomatosis are candidates for CRS and HIPEC. The decision has to be assessed on a case-by-case basis, in the context of a multidisciplinary team of experts, including surgeons, medical oncologists, radiologists, pathologists and clinical nurses. In the event that such treatment cannot be indicated, the various therapeutic options will be evaluated in order to always offer the best treatment available at the time and adapt it to each patient.