Peritoneal metastasis is when cancer spreads to the peritoneum, the thin lining that covers the inside of the abdomen and the organs within it. It most often comes from cancers of the ovary, colon, rectum, stomach, appendix or pancreas. It was once considered untreatable, but for selected patients, cytoreductive surgery (CRS) with HIPEC can offer long-term control.
What Is the Peritoneum?
It is a smooth, thin membrane that lines the abdominal wall and covers organs like the stomach, intestines and liver. It produces a small amount of fluid that allows organs to move smoothly.
Which Cancers Spread to the Peritoneum?
- Ovarian cancer
- Colorectal cancer
- Appendix cancer, including pseudomyxoma peritonei
- Stomach cancer
- Pancreatic cancer
- Primary peritoneal cancer
- Peritoneal mesothelioma
Common Symptoms
- Bloating or abdominal swelling
- Fluid in the abdomen (ascites)
- Abdominal pain or discomfort
- Feeling full quickly
- Nausea or vomiting
- Change in bowel habits
- Unexplained weight loss
- Signs of bowel blockage in advanced cases
How Is It Diagnosed?
- CT scan: often the first test
- MRI or PET-CT: for more detail
- Tumour markers: such as CEA or CA-125
- Fluid analysis: if ascites is present
- Diagnostic laparoscopy: to look directly at the extent of spread and take biopsies
What Is the PCI Score?
The Peritoneal Cancer Index scores how much cancer is present in different parts of the abdomen. It helps decide whether CRS and HIPEC are suitable.
How Is It Treated?
Systemic chemotherapy
Given through the vein to control cancer throughout the body.
Cytoreductive surgery (CRS)
Surgery to remove all visible tumour from the abdomen.
HIPEC
Heated chemotherapy washed through the abdomen after CRS to target remaining microscopic cancer cells.
PIPAC
A newer technique delivering aerosolised chemotherapy in selected patients.
Palliative care
To manage symptoms such as fluid build-up or bowel blockage.
Who May Benefit From CRS and HIPEC?
Patients with limited, removable peritoneal disease, good general health and no widespread spread to other organs.
Key Takeaways
- Peritoneal metastasis is spread to the abdominal lining.
- It often comes from ovarian, colorectal or appendix cancer.
- Bloating and ascites are common symptoms.
- Laparoscopy and PCI help guide treatment.
- CRS and HIPEC may help selected patients.
Final Thoughts
A diagnosis of peritoneal spread is serious, but it no longer always means there are no options. Specialist evaluation can open the door to treatment. For peritoneal surface oncology assessment, you can consult Dr. Varadharajan, a surgical oncologist in Chennai.
