2. Peritoneum
• Thin serous membrane
• Lining the wall of the abdominal and pelvic cavities(the parietal
peritoneum)
• Covering the existing organs(visceral peritoneum)
• Peritoneal cavity : Space between 2 layers
3.
4. Peritoneal carcinomatosis and metastasis
• Peritoneal carcinomatosis is the malignant tumor of peritoneum
Often secondary
May be primary
• Often develops when other abdominal tumors spread to the
peritoneum
• Leading to multiple new tumors on the surface of the membrane
5.
6.
7. Mechanism
• Detachment of cells from the primary tumor
• Peritoneal transport
• Mesothelial adhesion
• Invasion of the submesothelial tissue
• Systemic metastasis
15. • Tumor markers
• Endoscopy & colonoscopy
• Laparoscopy:
• To take biopsy of peritoneal implants
• To take Omental biopsy
• Sensitivity approaches 100%
16. Newer modalities for diagnosis
• Liquid biopsy:
• Molecular diagnostic studies that are performed on blood or body
fluid as opposed to cancerous tissue itself
• Utilizes circulating biomarkers in the serum of patients
• May be used to tailoring treatment plan and early intervention
• Exosomes:
• Stable patient-derived nanovesicles present in blood, urine, and
many other bodily fluids
• Promising tool for the evaluation of labile biomarkers
17.
18. Treatment
• Depending on particular case
• Usually palliative:
• Ease pain
• Paracentesis, diuretics, shunt
• Analgesia
• Nutrition
• Improvement quality of life
19. Therapeutic options
• Cytoreductive surgery
• Surgical removal of tumors on peritoneum
• in some cases, nearby abdominal organs
• Hyperthermic intraperitoneal chemotherapy
• Often used right after cytoreductive surgery
• this method bathes peritoneum
• with heated chemotherapy drugs to kill any remaining cancer cells
• Peritonectomy
• Hormonal therapy
• SERM, HER-2 receptor blocker, Aromatase inhibitor
20. • Intraperitoneal treatment modalities include
• Hyperthermic intraperitoneal chemotherapy(HIPEC),
• Pressurized intraperitoneal aerosol chemotherapy (PIPAC),
• Neoadjuvant intraperitoneal and systemic chemotherapy (NIPS)
• Early postoperative intraperitoneal chemotherapy (EPIC)
21. HIPEC
• Applied as single administration after cytoreductive surgery (CRS)
• By use of a perfusion machine
• Circulation of the heated chemotherapy solution can be performed
using
• either an open (termed Coliseum)
• or a close technique
• duration of 60–120 min
• temperature of 40–43 °C
• Indications: Curative.
• Potential other indications: Palliative, neoadjuvant and adjuvant
22. PIPAC
• Applied repeatedly by laparoscopy using a two-trochar technique.
• PIPAC is not combined with CRS.
• Administration of chemotherapy is achieved via a high-pressure
injector.
• Indications: Palliative.
• Potential other indications: Neoadjuvant, adjuvant.
23. NIPS
• Long-course combination treatment of intraperitoneal and
intravenous chemotherapy using implanted catheter access ports.
• Indications: Neoadjuvant
24. EPIC
• Administered typically after CRS and HIPEC
• by use of intraoperatively placed intraperitoneal catheters to extend
intraperitoneal drug exposure over 5 days postoperatively.
• Indications: Adjuvant
25.
26. Prognosis
• For colorectal PC, median survival is approximately five months
• Palliative systemic therapy is able to extend this to approximately 12
months
• (CRS/ HIPEC) with a curative intent is possible in some patients with
limited tumor burden
• In well-selected patients undergoing complete cytoreduction, median
survival has been reported as high as 63 month
