What Is Peritoneal Cancer

Overview

Peritoneal cancer is the invasion of the serous membrane lining the peritoneal cavity (which is the membrane that lines the abdominal cavity and covers the organs inside it) by malignant cells or cancerous cells . The peritoneum  membrane also provides a conduit for blood, lymph, and conduction. ¹

Peritoneal cancer is a rare type of cancer that can be difficult to diagnose and treat. In this essay, we will discuss the types, stages, causes, signs, symptoms, management, diagnosis, and risk factors of peritoneal cancer. We will also answer frequently asked questions about this disease.

Types of peritoneal cancer

Peritoneal cancer is often classified into two types, primary and secondary peritoneal cancer and this depends on where cancer started.

• Primary peritoneal carcinoma: This is a type of cancer that starts in the peritoneum membrane and is often classed as stage three or four of peritoneal cancer and there are no early stages either^1,2
• Secondary peritoneal carcinoma: This is a type of cancer that develops in other abdominal organs such as the appendix, intestines, ovaries, and stomach. Secondary peritoneal can sometimes  metastasize (Spread) to the peritoneal membrane as well.¹ This is very common as peritoneal metastasis is present in 75% of ovarian cancer patients²
• Mesothelioma: This is a type of cancer that starts in the mesothelial cells, which are the cells that make up the peritoneum. Mesothelioma is an aggressive type of cancer and is most commonly caused by exposure to asbestos in 33-50% of cases¹

Stages of peritoneal cancer

Peritoneal cancer staging is divided into four stages: I, II, III, and IV, based on the extent of the cancer spread. The most common staging system used is the FIGO (International Federation of Gynecology and Obstetrics).⁴

• In stage I, cancer is limited to the peritoneum of the pelvis
• In stage II, cancer has spread beyond the pelvis but is still within the abdomen¹
• Stage III cancer has spread to the lymph nodes outside of the abdomen or to the peritoneal surface outside the pelvis, with sub-stages IIIA, IIIB, and IIIC depending on the extent of cancer spread¹
• Stage IV is characterized by cancer that has metastasized to other organs in the body, with sub-stages IVA and IVB based on the site of metastasis. IVA involves malignant pleural effusions, or cancer spread to the liver or spleen. IVB refers to cancer spreading  to organs and tissues outside of the peritoneal cavity, such as the lungs or brain¹

Whereas in secondary peritoneal cancer, the staging depends on the primary site of the cancer.

Cause of peritoneal cancer

The exact causes of peritoneal cancer are unknown, but several risk factors  may increase a person's chances of developing this disease. In the UK, it is estimated that 10 out of 100 women with ovarian, and fallopian cancer have peritoneal cancer.³ 

These risk factors include:

• Age: Peritoneal cancer is more common in older adults
• Gender: Women are more likely than men to develop peritoneal cancer
• Family history: People who have a family history of peritoneal cancer or ovarian cancer may be at increased risk
• Gene Mutations: those who carry BRCA1 or BRCA2 gene mutations are in increased  risk of developing peritoneal cancer
• Asbestos exposure : Asbestos exposure  can increase a person's risk of developing mesothelioma, which can affect the peritoneum¹
• Previous cancer treatment: People who have had radiation therapy or chemotherapy for other types of cancer may be at increased risk of developing peritoneal cancer¹

Signs and symptoms of peritoneal cancer

The signs and symptoms of peritoneal cancer can be vague and may be mistaken for other conditions. These symptoms may include:

• Abdominal pain or swelling
• Changes in bowel habits
• Loss of appetite or feeling full quickly
• Nausea or vomiting
• Fatigue
• Unexplained weight loss

Management and treatment for peritoneal cancer

The treatment for peritoneal cancer depends on the type and stage of  cancer, as well as the person's overall health. Treatment options may include:

• Surgery: Surgery may be used to remove the cancerous tissue and any affected organs. In some cases, aprocedurecalled debulking maybeperformed, which involves removing as much of the cancer as possible
• Chemotherapy: Chemotherapy may be used to kill cancer cells that may have spread beyond the peritoneum. It may be given before or after surgery. Radiotherapy can also  be offered as an option to help shrink the tumour or kill any remaining cancerous cells after surgery
• Targeted therapy: Targeted therapy drugs may be used to specifically target cancer cells and limit damage to healthy cells
•  Palliative care: Palliative care focuses on relieving symptoms and improving the quality of life for people with advanced peritoneal cancer

Diagnosis of peritoneal cancer

The diagnosis of peritoneal cancer typically involves several tests, including:

• Physical exam: A doctor may perform a physical exam to check for any lumps or swelling in the abdomen
• Imaging tests: Imaging tests, such as CT scans or MRI scans, may be used to look for signs of cancer in the abdomen¹
• Biopsy: A biopsy involves removing a small piece of tissue from the peritoneum to be examined under a microscope to look for cancer cells
• Paracentesis: is a procedure performed to obtain a sample of ascitic fluid for diagnosis and it is commonly used in peritoneal cancer diagnosis¹

Risk factors

In addition to the risk factors mentioned above, other factors may increase a person's risk of developing peritoneal cancer, including:

• Obesity
• Smoking
• Alcohol consumption
• Family history or Gene Mutation
• Chronic inflammation in the abdomen
• Hormone replacement therapy

FAQs

How can I prevent peritoneal cancer?

There is no sure way to prevent peritoneal cancer, but maintaining a healthy lifestyle, avoiding smoking and excessive alcohol consumption, and getting regular check-ups may help reduce the risk.

How common is peritoneal cancer?

As previously highlighted, peritoneal cancer is a rare type of cancer but accounts for around 10% of all cases of ovarian cancer.³

When should I see a doctor?

You should see a doctor if you experience any persistent abdominal pain, bloating, or changes in bowel habits.. It is also important to talk to your doctor if you have a family history of peritoneal or ovarian cancer.

Summary

Peritoneal cancer is a rare type of cancer affecting the peritoneum, the membrane that lines the abdominal cavity. It can be difficult to diagnose and treat, and the exact cause is unknown. Risk factors include age, gender, family history, BRCA mutations, exposure to asbestos, and previous cancer treatment. Symptoms can include abdominal pain, changes in bowel habits, and unexplained weight loss. Treatment options may include surgery, chemotherapy, radiation therapy, targeted therapy, and palliative care. Regular check-ups and maintaining a healthy lifestyle may help reduce the risk of developing peritoneal cancer.