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Peritoneal Cancers were historically considered as end stage of various malignancies. Historically patient was referred to palliative care and was considered to have a life expectancy of only 6 months. However with improvements in surgical techniques and evolution of new technologies like HIPEC and PIPAC, the survival has increased upto almost 5 years depending on the extent and type of cancers.
There are 2 types of peritoneal carcinomatosis : Primary peritoneal cancers and metastases from other abdominal and extra abdominal organs.
Primary peritoneal cancers include the primary peritoneal adenocarcinoma, which behaves like ovarian cancer and Peritoneal Mesothelioma.
Peritoneal metastases may be the only site of metastases or may be associated with other metastases like liver and lung metastases. The common cancers which metastasise to the peritoneum and abdominal cavity include the ones affecting appendix, ovary, colon, stomach, pancreas, gall bladder, uterus and rarely extra-abdominal organs like breast and lung.
An entity called pseudomyxoma peritonei which may range from almost benign (DPAM: diffuse peritoneal adenomucinosis) to low grade and high grade appendiceal carcinoma can present only intra-abdominally as a jelly like collection of Mucin. Traditional chemotherapy is not effective in these cases.
There has been a paradigm shift in the way peritoneal cancers are treated. Two points are important to be noted at this juncture.
Firstly, 'not all peritoneal carcinomatosis are created equal'. They differ in their behaviour across different tumour types as well as within the same tumour type. The prognosis associated with peritoneal dissemination of an indolent mucinous neoplasm of the appendix is typically measured in years, whereas the prognosis for peritoneal carcinomatosis from gastric cancer may be measured in weeks. Similarly, the expected prognosis of a patient with T4 signet ring cell cancer of the colon with diffuse miliary seeding of the peritoneum is much less than that of a patient with T4, lymph node-negative, low-grade colon cancer with a limited number of discrete, resectable tumor nodules within the peritoneum.
Secondly, cancer or metastases localised only to the peritoneum, without spread to lungs, liver or any other extra-abdominal location is considered as local disease. As such directed therapies can achieve complete removal of disease and chances of a cure.
The therapies which have brought about this change can be grouped as follows