Peritoneal carcinomatosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
Synonyms and keywords: Peritoneal metastases
Overview
Peritoneal carcinomatosis (also known as peritoneal metastases) is defined as a malignant tumoral seeding of the peritoneum. Peritoneal carcinomatoses are the most common peritoneal malignancy, these commonly arise from ovarian cancer, colon cancer, gastric cancer, and pancreatic cancer. Calcified peritoneal carcinomatosis may occur in serous ovarian adenocarcinoma, colon cancer, and gastric cancer.
Historical Perspective
- Peritoneal carcinomatosis was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
- In [year], [gene] mutations were first identified in the pathogenesis of peritoneal carcinomatosis.
- In [year], the first [discovery] was developed by [scientist] to treat/diagnose peritoneal carcinomatosis.
Classification
- Peritoneal carcinomatosis may be classified according peritoneal carcinomatosis index into 2 groups:
- Localized peritoneal carcinomatosis
- Dissiminated peritoneal carcinomatosis
Pathophysiology
- The pathogenesis of peritoneal carcinomatosis is characterized by the malignant seeding of a tumor in the peritoneal cavity.
- The mutation on BRCA1/BRCA2 has been associated with the development of peritoneal carcinomatosis.
- On gross pathology, characteristic findings of peritoneal carcinomatosis, include:
- Multilocular thin-walled cysts containing serous fluid
- Occasionally unilocular
- May be up to 15 cm.
- Adherent to the surface
- On microscopic histopathological analysis, characteristic findings of peritoneal carcinomatosis, include:
- Thin-walled, irregular-shaped cysts
- Mesothelial lining
- Squamous metaplasia
- Eosinophilic fluid
Causes
- Common causes of peritoneal carcinomatosis, include:
- Colon cancer
- Gastric cancer
- Pancreatic cancer
- Peritoneal carcinomatosis may also be caused by a mutation in the BCRA1 or BCRA2 genes.
Differentiating Peritoneal Carcinomatosis from Other Diseases
- Peritoneal carcinomatosis must be differentiated from other diseases that cause abdominal pain, ascites, and weight loss, such as:
Epidemiology and Demographics
- The prevalence of peritoneal carcinomatosis is approximately 0.03 per 100,000 individuals worldwide.[1]
Age
- Peritoneal carcinomatosis is more commonly observed among patients aged 50 - 70 years.
- Peritoneal carcinomatosis is more commonly observed among adults.[2]
Gender
- Females are more commonly affected with peritoneal carcinomatosis than males.[2]
Race
- There is no racial predilection for peritoneal carcinomatosis.
Risk Factors
- Common risk factors in the development of peritoneal carcinomatosis are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
Natural History, Complications and Prognosis
- The majority of patients with peritoneal carcinomatosis may be initially asymptomatic.
- Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
- If left untreated, [#%] of patients with peritoneal carcinomatosis may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
- Common complications of peritoneal carcinomatosis include [complication 1], [complication 2], and [complication 3].
- Prognosis is generally poor, and the 5 year survival rate of patients with peritoneal carcinomatosis is approximately
Diagnosis
Diagnostic Criteria
- The diagnosis of peritoneal carcinomatosis is made when at least the following diagnostic criteria are met:
- Imaging findings compatible with peritoneal carcinomatosis (see below)
- Elevated protein concentration (more than 4.0 g/dL)
- Abnormal serum-ascites albumin gradient ( less than 1.1 g/dL )
- High cell count (lymphocyte predominance)
Symptoms
- Peritoneal carcinomatosis is usually asymptomatic.
- Symptoms of peritoneal carcinomatosis may include the following:
Physical Examination
- Patients with peritoneal carcinomatosis usually appear pale and lethargic.
- Physical examination may be remarkable for:
Inspection
- Enlarged abdomen
- Abdominal distension
Palpation
- Bulging of the flanks or shifting dullness
- Fluid thrill or fluid wave
- Other physical examination findings may include:
Laboratory Findings
- Laboratory findings consistent with the diagnosis of peritoneal carcinomatosis, include:
- Elevated carcinoembryonic antigen (unspecific)
- Elevated cancer antigen 125
Imaging Findings
- Enhanced CT scan is the imaging modality of choice for peritoneal carcinomatosis.
- On CT, peritoneal carcinomatosis is characterized by the following findings:
- Smooth or nodular peritoneal thickening and enhancement.
- Implants on the liver and the splenic surfaces are frequently seen and result in scalloping of the surface by the masses.
- Sites of tumor implantation are the intersegmental fissure, superior recess of the lesser sac, subphrenic space, and Morison pouch.
- Usually there is large ascites, which is often loculated.
- The images below demonstrate a case of peritoneal carcinomatosis.
Other Diagnostic Studies
- Peritoneal carcinomatosis may also be diagnosed using abdominal paracentesis.
- Findings on paracentesis may include:
- Opalescent appearance
- Elevated protein concentration (more than 4.0 g/dL)
- Abnormal serum-ascites albumin gradient ( less than 1.1 g/dL )
Treatment
Medical Therapy
- The mainstay of therapy for peritoneal carcinomatosis, include:
Surgery
- Surgery is the mainstay of therapy for peritoneal carcinomatosis.
- [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of peritoneal carcinomatosis.
- [Surgical procedure] can only be performed for patients with [disease stage] peritoneal carcinomatosis.
Prevention
- There are no primary preventive measures available for peritoneal carcinomatosis.
- Once diagnosed and successfully treated, patients with peritoneal carcinomatosis are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
References
- ↑ Segelman J, Granath F, Holm T, Machado M, Mahteme H, Martling A (2012). "Incidence, prevalence and risk factors for peritoneal carcinomatosis from colorectal cancer". Br J Surg. 99 (5): 699–705. doi:10.1002/bjs.8679. PMID 22287157.
- ↑ 2.0 2.1 Kusamura S, Baratti D, Zaffaroni N, Villa R, Laterza B, Balestra MR, Deraco M (2010). "Pathophysiology and biology of peritoneal carcinomatosis". World J Gastrointest Oncol. 2 (1): 12–8. doi:10.4251/wjgo.v2.i1.12. PMC 2999153. PMID 21160812.