Introduction:
The inside of the stomach is lined by a thin layer of tissue called the peritoneum. The peritoneum is made up of epithelial cells, and it also covers the uterus, bladder, and rectum. The peritoneum also secretes a fluid that helps the smooth movement of the organs inside the stomach. The peritoneum acts as a barrier to infection and protects the organs. It has two layers. The parietal layer lines the abdominal wall and the visceral layer, covering the organs. Peritoneal cancer is a rare cancer affecting the epithelial cells of the peritoneal lining. Peritoneal cancer mainly affects women and is rare in men.
What Are the Types of Peritoneal Cancer?
There are two types of peritoneal cancer based on the location where cancer started.
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Primary Peritoneal Cancer: Primary peritoneal cancer starts and develops in the abdomen. It primarily affects women. They are similar to ovarian cancer and treated the same way as ovarian cancer.
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Secondary Peritoneal Cancer: Secondary peritoneal cancer usually starts in another organ in the abdomen and then spreads to the peritoneum. It is more prevalent than primary peritoneal cancer. They can affect both men and women.
Secondary peritoneal cancer can start in:
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Ovaries.
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Bladder.
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Colon.
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Rectum.
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Fallopian tubes.
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Appendix.
What Are the Symptoms of Peritoneal Cancer?
Most symptoms of peritoneal cancer go unnoticed, and they are diagnosed only at a later stage.
The symptoms of peritoneal cancer include:
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Abdominal discomfort and pain.
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Feeling full after consuming a small amount of food.
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Bloating and indigestion.
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Nausea or diarrhea.
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Constipation.
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Frequent urination.
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Loss of appetite.
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Unexplained weight gain or loss.
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Abnormal vaginal bleeding.
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Rectal bleeding.
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Shortness of breath.
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Back pain.
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Fatigue.
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Water accumulation in the abdomen (ascites).
End-stage peritoneal cancer shows symptoms such as:
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Complete bowel or urinary blockage.
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Stomach pain.
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Vomiting.
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Inability to eat or drink.
What Are the Risk Factors?
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Age: Old age increases the risk of peritoneal cancer.
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Genetics: Family history of ovarian or peritoneal cancer.
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Hormone Therapy: Taking hormone therapy after menopause increases the risk.
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Weight and Height: Being obese and tall increases the risk of peritoneal cancer.
How Can We Diagnose Peritoneal Cancer?
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A thorough medical history.
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Physical examination of the stomach, uterus, ovaries, vagina, rectum, and bladder.
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Ultrasound of the Abdomen: Ascites can be identified in ultrasound. But cancer tissue mass less than two centimeters is not detected.
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Cancer Antigen - 125 Blood Test: If cancer antigen -125 levels are high, chances of peritoneal or ovarian cancer are present.
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Computed Tomography (CT) Scan: It is the initial modality to detect peritoneal cancer. It can detect cancer tissue mass as small as five millimeters.
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Barium Enema: Barium is swallowed, which outlines the esophagus, stomach, colon, duodenum, and rectum that can be viewed in an X-ray.
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Biopsy: Biopsy is done by removing a tissue sample by opening the abdomen directly (laparotomy) or inserting tools through minor cuts in the stomach (laparoscopy). The sample tissue taken is examined under a microscope. They are considered the gold standard in diagnosis.
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Paracentesis: This procedure removes the fluid in the abdomen for examination under a microscope.
What Is the Staging of Peritoneal Cancer?
After diagnosing peritoneal cancer, staging is done based on size, location, and origin.
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Stages of Primary Peritoneal Cancer: The staging system used for ovarian cancer is also used for peritoneal cancer staging since they are similar. Peritoneal cancer does not produce symptoms in its early stages and is mainly diagnosed at stage 3 or stage 4.
Stage 3 is subdivided into:
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3A - Cancer has spread to lymph nodes in the area outside the peritoneum, or cancer cells that can be seen in a microscope have spread to the surface of the peritoneum, outside the pelvis.
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3B - Cancer has spread to the peritoneum outside the pelvis. Cancer in the peritoneum is two centimeters or smaller. Cancer may have spread to the lymph node area outside the peritoneum.
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3C - Cancer has spread to the peritoneum outside the pelvis, and cancer in the peritoneum is larger than two centimeters. Cancer might have spread to the lymph nodes present outside the peritoneum or to the liver or spleen surface.
In stage 4, cancer has spread to other body parts and is divided into two:
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4A - Cancer cells are found in the fluid that builds up around the lungs.
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4B - Cancer has spread to organs and tissues outside the abdomen, such as the liver, lungs, or lymph nodes in the groin.
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Stages of Secondary Peritoneal Cancer: Secondary peritoneal cancer is staged according to the location of primary cancer. When primary cancer spreads to another part of the body, it is usually considered stage 4.
How Can We Treat Peritoneal Cancer?
The treatment is based on the following factors:
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The stage and grade of cancer.
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The location of cancer.
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Age and general health of the patient.
The treatment is usually done in multiple approaches.
Treatment methods include:
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Surgery: Removing the part of the tissues affected. Uterus, fallopian tubes, ovaries are also removed if affected.
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Chemotherapy: Use of drugs to treat cancer is called chemotherapy. Medications used are similar to those used to treat ovarian cancer. Sometimes chemotherapy is delivered into the abdomen through a catheter placed under the skin during the surgery. This is called intraperitoneal chemotherapy. It is a more complex treatment.
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Hyperthermic Intraperitoneal Chemotherapy (HIPEC): This is the administration of heated chemotherapy into the peritoneum after surgery. This technique is common for peritoneal cancer spread from the appendix, colon, or stomach.
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Radiation: They are used to treat recurrent cancer. They use high-intensity X-rays to treat cancer. They are used in combination with chemotherapy.
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Targeted Therapy: They mainly attack specific proteins or cancer cells without harming normal cells. Monoclonal antibodies act on cells that promote cancer growth.
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Palliative Care: Medications are given to relieve pain, nausea, and other symptoms. Emotional support to overcome anxiety and fear.
What Is the Prognosis?
Peritoneal cancer is an end-stage disease with a poor prognosis. Peritoneal cancer can spread rapidly through blood and lymph and recurrence are more common.
Conclusion:
Peritoneal cancer affects the lining of the stomach. It is a rare cancer. To decrease morbidity and mortality, early diagnosis and proper treatment are essential. Regular follow-ups should be done to check recurrence.
