This disease, therefore, develops following the formation of other tumors that can affect different organs, but which are generally located in the abdominal cavity.
Unfortunately, peritoneal carcinosis is a rather aggressive form of cancer and the treatments undertaken to combat it are not always able to eliminate it completely. Despite this, medical research has achieved remarkable results in recent decades, allowing the "life expectancy" of patients suffering from this disease to be increased.
of other cancers.Peritoneal carcinosis is considered extremely aggressive, so much so that until a few years ago it left no way out for patients diagnosed with it. This is because the malignant cells spread inside the cavity circumscribed by the peritoneum can affect other organs that are still healthy, further worsening the patient's condition and making it extremely difficult to eliminate the neoplasm, both through surgery and through chemotherapy and radiotherapy.
Note: The terms tumor cells, malignant cells and neoplastic cells are used interchangeably in this article.
peritoneal: it is a rare tumor that originates on the same peritoneum;Peritoneal carcinoma, therefore, can be caused not only by tumors located in other organs and located both in the abdominal and extra-abdominal level, but also by tumors that directly affect the peritoneum. However, it should be noted that this "occurrence is quite rare, although not impossible.
. ;Furthermore, the aforementioned symptoms are often accompanied by swelling of the abdomen which tends to worsen as the disease progresses due to the increase in the size of the tumor masses and due to the accumulation of fluids.
Of course, the patient may also manifest other symptoms closely related to the type of cancer that gave rise to the peritoneal carcinosis (colorectal cancer, pancreatic cancer, stomach cancer, ovarian cancer, etc.).
(better known as TAC) which can be followed by a more in-depth investigation by performing a positron emission tomography (PET) scan. In the event that CT and PET are not sufficient to make a certain diagnosis of peritoneal carcinosis, it is also possible to resort to laparoscopy. It is a technique that must be performed under general anesthesia, but which allows the collection of histological samples (biopsy) in order to dissolve any doubts about the nature of the disease afflicting the patient. able to intervene even in these particularly delicate situations.
Therefore, the main treatments that are undertaken to combat and eliminate peritoneal carcinosis will be analyzed below.
Cytoreductive surgery
Cytoreductive surgery - also known by the acronym CRS, from the English Cyto-Reductive Surgery - is the first-line treatment against peritoneal carcinosis. Its purpose is to remove all visible peritoneal nodules by using special high voltage electrosurgical units. To be precise, in this case it would be good to talk about cytoreductive surgery with peritonectomy.
When peritoneal carcinosis involves a certain abdominal area to a large extent, it may be necessary to intervene by also removing portions of other abdominal organs, such as intestine, stomach, ovaries, etc.
At the end of the operation, to eliminate the malignant cells not visible to the naked eye, the patient with peritoneal carcinosis can undergo hyperthermic intraperitoneal chemotherapy.
Hyperthermic Intraperitoneal Chemotherapy
Hyperthermic intraperitoneal chemotherapy (HIPEC, Hyperthermic Intraperitoneal Chemotherapy) is a relatively recent treatment that has proved very useful in the treatment of peritoneal carcinosis.
This therapeutic strategy is essentially based on the administration of anticancer chemotherapy drugs directly into the peritoneal cavity. The administration, however, is carried out in conditions of hyperthermia (about 42 ° C), ie with higher temperatures than normal body temperature. This is because it has been shown that heat is able to increase the ability of antineoplastic drugs to penetrate inside the tumor tissues.
Furthermore, it has also been shown that - thanks to the presence of a sort of plasma-peritoneal barrier consisting of the subsomesothelial tissue and the basement membrane of the blood capillaries - the high molecular weight and very hydrophilic anticancer drugs administered locally are not able to enter the bloodstream. Thanks to this phenomenon, therefore, the antineoplastics administered intraperitoneally hardly manage to reach other parts of the body, consequently, the side effects are reduced and, at the same time, it is possible to administer higher drug concentrations.
Among the active ingredients with anticancer action that can be used in this type of chemotherapy, we mention cisplatin, oxaliplatin, mitomycin C and doxorubicin. Generally, the choice of the active ingredient to be used depends on the type of tumor that interests the patient. and its severity.
Please Note
The cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy is a treatment that is carried out only in specialized centers, since it requires a high level of knowledge both of the techniques and tools used, and of the peritoneal carcinosis itself.
Effectiveness of Combined Treatment
The combined treatment of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy appears to be the best for peritoneal carcinosis resulting from mesothelioma or pseudomyxoma. As regards peritoneal carcinosis secondary to other cancers, on the other hand, the combined treatment can prove useful and effective in selected cases in which the cancer cells that undergo metastases derive from colorectal or ovarian cancers.
Finally, as regards peritoneal carcinosis induced by other cancers (such as stomach and pancreatic cancer), the prognosis, unfortunately, turns out to be rather unfavorable even after the above combined treatment.
In any case, each case of peritoneal carcinosis is unique and the most suitable treatment will be established by the oncologist on a strictly individual basis.
Intraperitoneal Pressurized Air Flow Chemotherapy
Intraperitoneal chemotherapy with pressurized air flow (abbreviated with the acronym PIPAC, from the English Pressurized Intraperitoneal Aerosol Chemotherapy) is a relatively recent technique developed for the treatment of patients with peritoneal carcinosis on which it is not possible to intervene with the surgical approach (cytoreductive surgery).
This innovative technique provides for the laparoscopic administration of anticancer drugs by aerosol. Thanks to the use of the laparoscopic technique, in addition to the administration of medicines, it is also possible to perform biopsies and / or aspirate any liquid accumulated inside the peritoneal cavity.
Goals and Benefits
Intraperitoneal pressurized air flow chemotherapy is performed in patients with non-surgically treatable peritoneal carcinosis in order to:
- Reduce, or at least limit, the expansion and spread of peritoneal carcinosis itself;
- Prepare the patient for any cytoreductive surgery;
- Prevent the new accumulation of fluids inside the peritoneal cavity.
Among the main advantages of this technique, the scarce invasiveness (with laparoscopy, in fact, it is sufficient to make small incisions at the level of the abdomen), the possibility of administering anticancer drugs directly in the vicinity of the malignant cells and the lower number of effects stand out. collateral compared to the administration of a systemic anticancer chemotherapy.
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