Peritoneal carcinomatosis represents the metastatic phase of a tumor in the abdominal cavity (i.e. colon, ovary, stomach or peritoneum). In this phase, the expansion of malignant tumor nodules occurs. According to SEOM data, “in colon cancer, up to 35% of relapses affect the peritoneum”. On the other hand, 70% of stage III ovarian cancer diagnoses already present with peritoneal carcinomatosis, and in the case of gastric cancers, they account for 20%.
Complex cancer surgery in expert hands
In view of the growing need for a surgical approach for these patients, the J. Torrent Institute Surgical Oncology has set up the first Peritoneal Carcinomatosis Reference Unit in Barcelona. The Unit is made up of a multidisciplinary team of international renown, in which surgeons, oncologists, radiologists, physicians, pathologists and specialists in gynecology and the digestive system collaborate.
The Unit is directed by Dr. Juan José Torrent, gynecologic oncologic surgeon, and Dr. François Quénet, digestive oncologic surgeon, who affirm that peritoneal carcinomatosis is a disease that confers on the patient a worse prognosis and quality of life than other metastatic locations. For this reason, continues Dr. Torrent, “it is necessary for these patients to be aware of the importance of surgical treatment. It is a very complex surgery that requires a great deal of experience and, of course, very specialized training”.
According to data from the Spanish Society of Medical Oncology (SEOM), the real incidence figures of peritoneal carcinomatosis are unknown, since the dissemination of a primary tumor is difficult to diagnose in its initial stages. For this reason, peritoneal carcinomatosis is considered a metastatic phase of a primary tumor. The tumors of primary origin with the highest incidence of peritoneal carcinomatosis are colon, ovarian, appendiceal, gastric and peritoneal cancer. It is expected that 20-35% of patients with colon cancer will develop peritoneal carcinomatosis, while in ovarian cancer, the incidence is 80%, and in stomach cancer up to 20% initially and 30% in recurrences.
Intraperitoneal chemotherapy, the treatment to improve survival.
Cytoreduction surgery together with the application of intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) is the best therapeutic combination. It consists of removing the tumor and the intra-abdominal tumor implants by surgery, followed by the application of a dose of chemotherapy at high temperature (42º C) and localized within the abdominal cavity. Forty percent of the patients who undergo this treatment survive 5 years and 85% improve their quality of life and average survival.
The intraperitoneal chemotherapy technique in the form of an aerosol is Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC), which reduces the volume of the tumor, giving the option of performing cytoreductive surgery afterwards or acting as palliative therapy. The PIPAC technique consists of introducing intraperitoneal chemotherapy by means of an aerosol, so that the drugs are spread inside the abdominal cavity in a homogeneous and localized manner.
Dr. Torrent Correa is the pioneer in Spain in the PIPAC technique, and according to him “the great contribution of PIPAC chemotherapy is that, in spite of being considered an experimental technique, it offers an alternative for patients refractory to previous chemotherapies”. In these cases it is considered a palliative treatment that offers good results in terms of quality of life. There is a group of patients who have been undergoing several sessions of PIPAC and are living a normal life. As it is not possible to operate with curative intent, with this treatment they maintain a good quality of life”, concludes Dr. Torrent.