Peritoneal Cancer

Signs and Symptoms

Peritoneal cancer is a rare cancer that develops in the peritoneum, a thin, delicate sheet that lines the inside wall of the abdomen and covers the uterus and extends over the bladder and rectum. The peritoneum is made of epithelial cells. By producing a lubricating fluid, the peritoneum helps the organs to move smoothly inside the abdomen. Peritoneal cancer looks and behaves like ovarian cancer, but the ovaries are minimally involved. Women who develop ovarian cancer after having had their ovaries previously removed likely have peritoneal cancer.

The surface of the ovaries also is made from epithelial cells. Therefore, peritoneal cancer and the most common type of ovarian cancer, called epithelial cancer, produce some of the same symptoms and are often treated in the same way. In addition, women who are at an increased risk of developing ovarian cancer, particularly due to the BRCA1 and BRCA2 genetic mutations, also are at increased risk for peritoneum cancer.

Symptoms

In its earliest stages, symptoms for peritoneum cancer can be very vague and difficult to spot. Like ovarian cancer, the condition often does not produce any symptoms until late in its development. When symptoms of peritoneum cancer do develop, they are similar to those of ovarian cancer. Symptoms may include:

• General abdominal discomfort and pain, such as gas, indigestion, pressure, swelling, bloating or cramps
• Nausea, diarrhea, constipation and frequent urination
• Loss of appetite
• Feeling full even after a light meal
• Weight gain or loss with no known reason
• Abnormal bleeding from the vagina

Diagnosis

In making a diagnosis of peritoneum cancer, your doctor will begin by asking about any symptoms you may be experiencing, as well as reviewing your medical history and conducting a thorough physical exam. The following tests also may be performed:

• Pelvic Exam -- This test involves feeling the uterus, vagina, ovaries, fallopian tubes, bladder and rectum to find any abnormality in their shape or size.

• Ultrasound -- This refers to the use of high-frequency sound waves that are aimed at the ovaries. The pattern of the echoes they produce creates a picture called a sonogram. Healthy tissues, fluid-filled cysts and tumors look different on this picture.

• CA-125 Assay -- This is a blood test used to measure the level of CA-125, a tumor marker that is often found in higher-than-normal amounts in the blood of women with ovarian cancer or peritoneal cancer.

• Computed Tomography (CT) Scan -- This is a series of detailed pictures of areas inside the body created by a computer linked to an X-ray machine.

• Lower GI Series or Barium Enema -- This is a series of X-rays of the colon and rectum. The pictures are taken after the patient is given an enema with a white, chalky solution containing barium, which outlines the colon and rectum on the X-ray, making tumors or other abnormal areas easier to see.

• Biopsy -- This test involves removing tissue from the suspected area for examination under a microscope. A pathologist studies the tissue to make a diagnosis. To obtain the tissue, the surgeon performs a laparotomy, an operation to open the abdomen. If cancer is suspected, the surgeon may perform an oophorectomy, where the entire ovary is removed. Occasionally a needle biopsy is performed, but this is not generally performed on ovarian tumors if surgery is planned.

Treatment

Treatment for peritoneum cancer will depend on a number of factors, including:

• The stage of your cancer, or how advanced it is
• How extensively your cancer has metastasized, or spread to other parts of the body
• Your general health

You and your doctor will work together to develop the most effective treatment plan that best meets your needs.

Treatment for peritoneum cancer may include combinations of the following approaches:

• Surgery -- Surgery may be used to diagnose and treat peritoneum cancer if the place where the cancer first started to grow is unclear, or if you have a pelvic mass. This procedure is called exploratory surgery, during which the tumor is removed from the lining of the abdomen where the cancer has started to grow.

• Chemotherapy -- Chemotherapy uses anti-cancer drugs, which are usually injected into a vein. The drugs used for peritoneum cancer are similar to those anti-cancer drugs used for treating ovarian cancer. Depending on the type of chemotherapy drugs used, this treatment can be given weekly or every two to three weeks. In most cases, patients receive the treatment on an outpatient basis.

• Supportive care -- Unfortunately, in some cases, peritoneum cancer is not diagnosed until it has advanced. Supportive care, also known as palliative care, is designed for patients whose disease has advanced to the point where they are too ill to cope with intensive chemotherapy. Supportive care aims to relieve symptoms of peritoneum cancer, such as pain, weight loss and fluid in the abdomen, which can be drained during a procedure called, abdominal paracentesis.