Peritoneal cancer means the presence of cancer cells on the peritoneum which is the lining of the abdominal cavity and the organs that it contains like the liver spleen and the intestines.
Any cancer can spread to the peritoneum and is called peritoneal cancer.
Commonly, cancers of the ovary, colorectum (large intestine), stomach and appendix spread to the peritoneum. There are some other rare cancers like pseudomyxoma peritonei and mesothelioma which commonly affect the peritoneum.
Peritoneal cancer is stage 4 cancer
Peritoneal cancer is usually treated with systemic chemotherapy. An aggressive surgical treatment called cytoreductive surgery (CRS) and HIPEC- hyperthermic intraperitoneal chemotherapy is used to treat patients with peritoneal cancer resulting in a prolonged survival and even cure in some patients
HIPEC stands for Hyperthermic Intraperitoneal Chemotherapy. In this procedure, a solution containing a chemotherapeautic agent in circulated in the abdominal/ peritoneal cavity and a high temperature for 30-90 mins.
HIPEC is done during surgery. During surgery, first all the tumor is removed which is called Cytoreductive Surgery (CRS) and then the hot solution containing the anti cancer drug (chemotherapy drug) is circulated in the abdominal cavity. By this process 1-2mm sized tumors can be destroyed. Microscopic tumor is also destroyed.
HIPEC is a single procedure done during surgery. Only 1 session is done at a time. Some patients can undergo a second HIPEC is the cancer comes back.
Cytoreductive surgery comprises of removal of tumor from the peritoneal /abdominal cavity. The aim of this surgery is to remove all the visible tumor. To achieve this the peritoneum that has tumor is stripped off the abdominal wall and from the organ surfaces. Sometimes a part of the small or large intestine, gall bladder, liver, spleen, stomach or pancreas may also have to be removed to completely remove the tumor. This is a very important part of the surgery which is done before HIPEC is performed. Complete tumor removal depends on the expertise of the surgeon and also the extent of tumor itself.
There is a logic behind such treatment. Peritoneal cancer that remains in the peritoneal cavity is best treated by directly targetting the peritoneal cavity- surgery to remove the tumor and chemotherapy that is given directly in the peritoneal cavity called intraperitoneal chemotherapy
Cytoreductive surgery and HIPEC is very complicated surgery and the risk of complications is a little high as compared to other cancer surgeries. After a HIPEC, complications occur in about 15- 20% of patients.
The cancers that spread to the peritoneum are ovarian cancer, colon and rectal cancer, stomach cancer, appendix cancer and some very rare cancers like pseudomyxoma peritonei and peritoneal mesothelioma. These are some of the most common peritoneal cancers that can be treated with surgery.
HIPEC is one type of intraperitoneal chemotherapy, another type is PIPAC.
For some patients that are not eligible for this treatment, there is another type of treatment called PIPAC that is pressurized intraperitoneal aerosol chemotherapy. PIPAC is very new therapy that is performed laparoscopically and takes only two hours. It is given in multiple sittings at 6-8 weeks’ interval. The main advantage is that is can be given to patients along with intravenous (conventional) chemotherapy. PIPAC is very well tolerated and patients can get discharged within 1-2 days of surgery.