Peritoneal cancer is usually caused by the spread of another cancer. Affecting the membrane that covers the organs of the abdomen (belly), its treatment is delicate. The actress Mylène Demongeot led a long fight against this cancer before dying on December 1, 2022.
[Mise à jour le 1er décembre 2022 à 16h26] Peritoneal cancer struck the actress Mylene Demongeotwho died aged 87 on December 1, 2022, according to the words of his friend the writer Henry-Jean Servat to our colleagues from Free lunch. The TV host Jean-Luc Delarue also died of it in 2012 at the age of 48. The peritoneum is the membrane covering the walls of the abdomen (tummy) and its organs (colon, stomach, liver, pancreas…). It consists of two sheets, one lining the abdominal wall, the other covering the organs, defining in its middle a virtual cavity, normally empty. the peritoneal cancer is often secondary to another cancer. L’life expectancy of peritoneal cancer has been improved with the discovery of new treatment techniques such as CHIP (intraperitoneal hyperthermic chemotherapy) imagined in Japan and practiced today in France.
Definition: what is peritoneal cancer?
Peritoneal cancer characterizes the presence of foci of cancer cells on the peritoneum that is, the membrane that covers the walls of the abdomen and its oranges. It is also called “peritoneal carcinomatosis“. He is usually caused by the spread of another cancer (for example from the pancreas, stomach, colon or even the ovary) but can also come from the peritoneum itself (primary cancer) in the case of a mesothelioma. It can also reach the pleura, a membrane located around the lungs, or the pericardium located around the heart (less than 200 new people per year in France). In all cases, it requires both surgery and chemotherapy sessions as well as the removal of certain organs (gallbladder, spleen, etc.) or part of the digestive tract.
What are the symptoms of peritoneal cancer?
Peritoneal cancer can lead to the formation of ascites (the abdominal cavity fills with too much fluid) which can lead to the patient:
- rapid weight gain
- an increase in the size of the abdomen abdomen.
- If the quantity of ascites is very abundant, this appetite suppressant of the patient.
- He may also experience shortness of breath.
From other symptoms of peritoneal cancer: abdominal cramps, vomiting, transit disorders (absence of stools).
What are the stages of peritoneal cancer?
Like all tumors, cancer of the peritoneum is classified according to 4 stages which take into account the size, the advance of the tumor and its dissemination to other organs. Stage 1 corresponds to a small local tumor without dissemination while stage 4 represents a metastasized tumor.
What are the causes of peritoneal cancer?
Peritoneal cancer is most often secondary to another cancer : cancer of the colon, rectum, ovary, stomach, pancreas or bladder. Sometimes cancers of organs outside the abdomen, such as the breast or lung cancer for example, can cause peritoneal metastases. In rarer cases it can also be primitive, ie it develops in the peritoneum. In this case, the cause can be attributed to asbestosa highly carcinogenic substance.
What tests are used to diagnose peritoneal cancer?
The diagnosis of peritoneal cancer is suspected on imaging examination as a abdominal scan. This radiological assessment can be supplemented by a MRI (Magnetic Resonance Imaging) and/or a PET scan (Positron Emission Tomography) depending on the origin of the peritoneal carcinomatosis. To find out if it is a primary or secondary tumour, a analysis of peritoneal fluid can help. If there is peritoneal carcinomatosis, the primary cancer in question should be sought. If it is mesothelioma, the assessment of extension, that is to say a set of examinations to search for metastases, secondary locations of the cancer, will be carried out. In some cases, in order to better understand the spread of the disease and the organs affected, a laparoscopy explorer is proposed to directly visualize the disease using a camera inserted into the abdomen and to perform biopsies. It also makes it possible to better appreciate the extension of the peritoneal carcinomatosis than the other examinations and therefore to rule on the possibilities of curative surgery.
What are the treatments for peritoneal cancer?
Several treatments can be considered, but the most common iscombination of surgery and chemotherapy. The first removes as many cancer cells as possible, including removing part of the digestive tract or other organs, such as the gallbladder or spleen, if necessary. Chemotherapy by direct injection of products into the peritoneum is frequently used. Furthermore, the technique of CHIP (intraperitoneal chemohyperthermia) or HIPEC (international name of the technique) for Hyperthermic IntraPERitoneal Chemotherapy which means the flushing the cavity of the abdomen with preheated chemotherapy can be offered in addition to surgery.
What is HIPEC in peritoneal cancer?
“CHIP” is the abbreviation of: Intra-Peritoneal Chemo-Hyperthermia. It’s a technique imagined in Japan used in association with surgery, to treat cancerous cells localized on the peritoneum. As explained by Gustave Roussy Centerthe technique consists first of all in remove all visible peritoneal disease (if this is not possible, HIPEC cannot be performed) then at treat non-visible disease with a bath containing chemotherapy, heated to 43°C. Chemotherapy given in the form of a bath can be given in very high concentrations, unlike intravenous chemotherapy, which makes it more efficient. “However, this locally administered chemotherapy only penetrates 1-2mm deep into the tissue, requiring the surgeon to have removed all disease larger than 1mm beforehand” specifies the center. Depending on the extent of disease in the peritoneum, surgery may be more or less long (varying from 5 to 12 hours) and require the partial or complete resection of several organs (stomach, small intestine, colon, spleen, uterus, ovaries, etc.). During this surgery, the gallbladder and appendix are usually removed. The creation of a temporary stoma (stool diversion).
What is the survival prognosis with peritoneal cancer?
In the absence of any treatment, the natural evolution of peritoneal cancer is inevitable. For peritoneal mesothelioma, with palliative treatment (systemic chemotherapy), the median survival is less than 1 to 2 years. However after cytoreductive surgery and HIPECthe median survival can reach more than 50 months with a 5-year survival rate of more than 50%.
Sources
Peritoneum surgery & CHIP, Gustave Roussy, 2016.
The Peritoneum Clinic, Brussels, Chirec.
The association AMARAPE is the reference association for patients with rare tumors of the peritoneum. It brings together patients and relatives of patients, doctors and caregivers.
Thanks to Dr Claire Lewandowski for her medical validation.