Primary peritoneal cancer (PPC) is a cancer that develops in the peritoneum - a thin layer of tissue that lines the abdomen. Peritoneal carcinomatosis is cancer that spread to the peritoneum from another part of the body.
Peritoneal cancer is difficult to diagnose. Other cancers share similar characteristics, complicating the diagnostic process. A combination of radiological imaging, blood tests, and in some cases biopsy or surgery is essential for ruling out other more common cancers. Given the complexity of peritoneal cancer, imaging tests should be interpreted by academic-level subspecialty radiologists in order to ensure accuracy.
Primary Peritoneal Cancer The peritoneum is made of epithelial cells. It lines the entire abdominal cavity and pelvic cavity, covering the digestive tract, liver, and reproductive organs. When any of these cells transform into cancerous cells, it results in primary peritoneal cancer - meaning cancer that originated inside the peritoneum.
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Peritoneal Carcinomatosis Peritoneal carcinomatosis, also called peritoneal metastasis, is a cancer that develops in the peritoneum after spreading from cancer in another part of the body. Technically, cancer from almost any type of tumor has the potential to spread and develop into peritoneal carcinomatosis. However, in most cases, it originates from gastrointestinal or gynecologic cancers.
Peritoneal carcinomatosis occurs frequently in patients with colon cancer, gastric cancer, and appendiceal. It is more common than primary peritoneal cancer. Most often, by the time cancer enters the peritoneum - regardless of where it came from - it is considered advanced (stage IV). Proper diagnosis is crucial for patient treatment and management.
Peritoneal cancer looks and behaves similarly to epithelial ovarian cancer. This is because the cells of the peritoneal lining develop from the same type of cell that lines the surface of the ovary and fallopian tubes. It should be noted, however, that you can still get peritoneal cancer even if you have your ovaries removed. In addition, despite similar behavior between the two cancers, the ovaries are usually only minimally affected with peritoneal cancer.
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Peritoneal cancer can be very difficult to diagnose. Because early-stage peritoneal cancer typically causes no symptoms, it is usually not discovered until its advanced stages (stage III or IV). Unfortunately, this often means that the cancer has spread to other parts of the abdomen, making it much more difficult to treat. While ultrasound, CT, and MRI can all be used to detect abnormalities in the liver - to accurately confirm peritoneal cancer diagnosis, laparoscopy or exploratory surgery are often performed.
Given its complexity, peritoneal cancer diagnosis relies heavily on ruling out other similar cancers that it could easily be mistaken for. This requires image interpretation from expert subspecialist radiologists. If your doctor suspects peritoneal cancer, a second opinion is recommended before treatment of surgery.
Ultrasound is generally good for discovering abnormalities in the abdomen. It can be especially helpful in ascites detection - which can act as an indicator for further testing. While a good starting point in the diagnostic journey - it is not sufficient enough for diagnosing and evaluating the stage of peritoneal cancer.
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PET has a slightly higher sensitivity. In all radiographic imaging, however, it is extremely difficult to catch early stage peritoneal cancer. Subspecialist radiology experts can help ensure appropriate testing and treatment planning for patients.
Despite its similarity to ovarian cancer, the symptoms associated with peritoneal tumors are more commonly gastrointestinal than gynecologic in nature. However, for some, a peritoneal tumor may remain asymptomatic. Generally, those who develop ascites (accumulation of fluid in the abdomen) from the cancer are more likely to experience symptoms. Unexplained changes in weight is also common in patients with peritoneal cancer.
Treatment of peritoneal cancer varies depending on the origin and stage of the cancer. Whenever possible, surgery is used to remove as much of the cancer as possible. Chemotherapy and radiation may also be used to shrink the cancer.
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A treatment called hyperthermic intraperitoneal chemotherapy, or HIPEC, has been shown to has been shown to be an effective treatment option for patients whose tumors can be completely or nearly completely removed by surgery. HIPEC can help manage symptoms and has been shown to improve survival rates.
The platform enables people all over the world to get an expert second opinion in as little as 24 - 72 hours.
An easy 3-step process - instantly upload your scans, select an expert subspecialty radiologist (or have assign your case to the appropriate subspecialist), and submit your request. Upon uploading your scans, you’ll also have the opportunity to ask any questions you might have about your case. Not sure what a subspecialist is? Learn more with our in-depth article on the importance of getting a second opinion from a subspecialty radiologist.
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Dr. Richard Semelka, leading expert in abdominal imaging, has been practicing radiology for over 28 years. He’s written over 16 text-books, 370 peer-reviewed papers, and has over 21, 000 research citations in Abdominal Imaging.
In this article... How is Peritoneal Cancer Detected Types of Peritoneal Cancer: The Difference Between Peritoneal Cancer and Ovarian Cancer How is Peritoneal Cancer Detected Which Imaging Modality Is the Best for Detecting Peritoneal Cancer Peritoneal Cancer Symptoms Peritoneal Cancer Treatment
Related articles Dr. Richard Semelka, Former Vice Chairman of Radiology at UNC, Reveals the Latest in Abdominal MR Liver Lesions: Types, Causes, Diagnosis & More Hemangioma Liver LesionsPrimary peritoneal cancer (PPC) is a rare cancer. It starts in the thin layer of tissue lining the inside of the abdomen. This tissue lining is called the peritoneum.
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PPC cells are the same as the most common type of ovarian cancer cells. This is because the lining of the abdomen and the surface of the ovary come from the same tissue when we develop from embryos in the womb. So doctors treat PPC in the same way as ovarian cancer.
The peritoneum covers all of the organs within the tummy (abdomen), such as the bowel and the liver. It protects the organs and acts as a barrier to infection. It has 2 layers. One layer lines the abdominal wall and is called the parietal layer. The other layer covers the organs and is called the visceral layer.
There is a small amount of fluid between the two layers, which separates them and allows them to slide over each other. This fluid allows us to move around without causing any friction on the layers.
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There are no exact numbers for how many people get it in the UK. American research suggests that around 10 out of 100 (around 10%) of all women with ovarian, fallopian and peritoneal serous cancers have PPC.
The causes of PPC are unknown. Most cancers are caused by a number of different factors working together. Research suggests that a very small number of PPCs may be linked to the inherited faulty genes BRCA 1 and BRCA 2. These are the same genes that increase the risk of ovarian cancer and breast cancer.
Symptoms for primary peritoneal cancer can be very unclear and difficult to spot. Many of the symptoms are more likely to be caused by other medical conditions.
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Most people start by seeing their GP. They might want to examine your abdomen. They will press gently on the outside of your abdomen to feel for any lumps, or tender areas.
Your doctor might also want to examine you internally. This is to see if your abdomen, including your womb and ovaries, feels normal. Your doctor will ask you to lie on your back on the couch with your feet drawn up and your knees apart.
They will then put one or two gloved fingers into your vagina. At the same time they press down on your abdomen with the other hand. If any part of the abdomen is enlarged, or if a lump of any kind is there, your doctor might be able to feel it.
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Primary peritoneal cancers often produce a protein called CA125 that shows up in a blood test. Doctors call this a tumour marker.
A raised level of CA125 can be a sign of either PPC, ovarian cancer or fallopian tube cancer. But it can be raised for other reasons, such as:
You might need to have an ultrasound scan to help make a diagnosis. An ultrasound uses sound waves to build up a picture of a part of the body. You might have an abdominal ultrasound or a transvaginal ultrasound.
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Your doctor may also want you to have a CT scan or MRI scan to check whether the cancer has spread within your abdomen.
The staging system for PPC is the same as for ovarian cancer, but there is no early stage. PPC is always either stage 3 or stage 4. This is an advanced cancer.
The aim of treatment for advanced cancer is usually to shrink the cancer and control it for as long as possible. You might have the following treatments.
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The aim of surgery is to remove as much of the cancer from the abdomen as possible before chemotherapy. This is called debulking surgery.
Chemotherapy tends to work better when there are only small tumours inside the abdomen. The surgery usually includes removing your womb, ovaries, fallopian tubes and the layer of fatty tissue called the omentum.
The surgeon will also remove any other cancer that they can see at the time of surgery. This could include
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