Peritoneal Cancer Progression: Manifestations, Remedies, and Prospects
Peritoneal cancer is a rare form of cancer that develops in the epithelial cells lining the peritoneum, a protective membrane that envelops the organs in the abdomen. This article provides an overview of the stages, treatment options, and prognosis for primary and secondary peritoneal cancer.
Staging Peritoneal Cancer
The staging of peritoneal cancer varies depending on the specific type. For primary peritoneal cancer, which originates in the peritoneal cavity and has not spread from another area of the body, staging follows the FIGO/AJCC ovarian cancer system, ranging from stage I to IV based on tumor spread, lymph node involvement, and distant metastasis. In contrast, peritoneal mesothelioma, a type of peritoneal cancer caused by asbestos exposure, does not have an official staging system; instead, doctors use the Peritoneal Cancer Index (PCI) to score disease extent.
Primary Peritoneal Cancer Staging
- Stage I: Cancer is limited to the peritoneum without spread.
- Stage II: Spread within the pelvis.
- Stage III: Spread to the abdominal cavity beyond the pelvis or lymph nodes.
- Stage IV: Distant metastasis to organs or fluid outside the abdomen, such as the lungs.
Peritoneal Mesothelioma Staging
- Stage 1: PCI score 1–10
- Stage 2: PCI 11–20
- Stage 3: PCI 21–30
- Stage 4: PCI 31–39
A higher PCI indicates more extensive disease and a worse prognosis.
Treatment Options by Stage
The treatment for primary and secondary peritoneal cancer involves a combination of surgery, targeted therapy, and chemotherapy.
Primary Peritoneal Cancer Treatment
- Stages I-II: Surgery for staging and tumor removal (debulking), including hysterectomy, oophorectomy, and removal of visible tumors; followed by chemotherapy (typically carboplatin and paclitaxel).
- Stage III: Aggressive cytoreductive surgery removing the uterus, ovaries, fallopian tubes, omentum, and as much tumor as possible (goal is optimal debulking, leaving no tumor >1 cm), plus chemotherapy (intravenous ± intraperitoneal).
- Stage IV: Similar approach with surgery and chemotherapy, but prognosis is poorer due to metastasis.
Peritoneal Mesothelioma Treatment
- The main curative treatment is cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC), which surgically removes visible tumors followed by heated chemotherapy directly to the abdomen to kill remaining cells.
- When surgery is not an option or for advanced cases, chemotherapy alone or palliative care may be used to ease symptoms.
Prognosis and Survival Rates
The median survival of primary peritoneal cancer is 11-17 months, while the median survival of secondary peritoneal cancer varies depending on the stage. The location of the primary tumor within the peritoneum may also affect survival rates: colorectal region (6.9 months), gastric area (6.5 months), pancreatic area (2.9 months).
For advanced stages, such as stage 4 peritoneal cancer, treatment options may include targeted drugs like olaparib, rucaparib, and niraparib to help prevent the cancer from returning. In some cases, doctors may opt to monitor high-grade tumors and delay further treatment or administer chemotherapy. Palliative care may also be discussed for those with peritoneal cancer to improve comfort without fighting the cancer.
In conclusion, understanding the stages, treatment options, and prognosis of peritoneal cancer is essential for early detection, effective treatment, and improved outcomes. Consulting with a healthcare professional is crucial for personalised treatment plans and support throughout the journey.
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