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Signs
and Symptoms
Peritoneal cancer is a rare cancer that develops in the
peritoneum, a thin, delicate sheet that lines the inside
wall of the abdomen and covers the uterus and extends
over the bladder and rectum. The peritoneum is made of
epithelial cells. By producing a lubricating fluid, the
peritoneum helps the organs to move smoothly inside the
abdomen. Peritoneal cancer looks and behaves like ovarian
cancer, but the ovaries are minimally involved. Women
who develop ovarian cancer after having had their ovaries
previously removed likely have peritoneal cancer.
The surface of the ovaries also is made from epithelial
cells. Therefore, peritoneal cancer and the most common
type of ovarian cancer, called epithelial cancer, produce
some of the same symptoms and are often treated in the
same way. In addition, women who are at an increased risk
of developing ovarian cancer, particularly due to the
BRCA1 and BRCA2 genetic mutations, also are at increased
risk for peritoneum cancer.
Symptoms
In its earliest stages, symptoms for peritoneum cancer
can be very vague and difficult to spot. Like ovarian
cancer, the condition often does not produce any symptoms
until late in its development. When symptoms of peritoneum
cancer do develop, they are similar to those of ovarian
cancer. Symptoms may include:
•
General abdominal discomfort and pain, such as gas, indigestion,
pressure, swelling, bloating or cramps
•
Nausea, diarrhea, constipation and frequent urination
•
Loss of appetite
•
Feeling full even after a light meal
•
Weight gain or loss with no known reason
•
Abnormal bleeding from the vagina
Diagnosis
In making a diagnosis of peritoneum cancer, your doctor
will begin by asking about any symptoms you may be experiencing,
as well as reviewing your medical history and conducting
a thorough physical exam. The following tests also may
be performed:
•
Pelvic Exam -- This test involves feeling
the uterus, vagina, ovaries, fallopian tubes, bladder
and rectum to find any abnormality in their shape or size.
•
Ultrasound -- This refers to the use
of high-frequency sound waves that are aimed at the ovaries.
The pattern of the echoes they produce creates a picture
called a sonogram. Healthy tissues, fluid-filled cysts
and tumors look different on this picture.
•
CA-125 Assay -- This is a blood test
used to measure the level of CA-125, a tumor marker that
is often found in higher-than-normal amounts in the blood
of women with ovarian cancer or peritoneal cancer.
•
Computed Tomography (CT) Scan -- This
is a series of detailed pictures of areas inside the body
created by a computer linked to an X-ray machine.
•
Lower GI Series or Barium Enema -- This
is a series of X-rays of the colon and rectum. The pictures
are taken after the patient is given an enema with a white,
chalky solution containing barium, which outlines the
colon and rectum on the X-ray, making tumors or other
abnormal areas easier to see.
•
Biopsy -- This test involves removing
tissue from the suspected area for examination under a
microscope. A pathologist studies the tissue to make a
diagnosis. To obtain the tissue, the surgeon performs
a laparotomy, an operation to open the abdomen. If cancer
is suspected, the surgeon may perform an oophorectomy,
where the entire ovary is removed. Occasionally a needle
biopsy is performed, but this is not generally performed
on ovarian tumors if surgery is planned.
Treatment
Treatment for peritoneum cancer will depend on a number
of factors, including:
•
The stage of your cancer, or how advanced it is
•
How extensively your cancer has metastasized, or spread
to other parts of the body
•
Your general health
You and your doctor will work together to develop the
most effective treatment plan that best meets your needs.
Treatment for peritoneum cancer may include combinations
of the following approaches:
•
Surgery -- Surgery may be used to diagnose
and treat peritoneum cancer if the place where the cancer
first started to grow is unclear, or if you have a pelvic
mass. This procedure is called exploratory surgery, during
which the tumor is removed from the lining of the abdomen
where the cancer has started to grow.
•
Chemotherapy -- Chemotherapy uses anti-cancer
drugs, which are usually injected into a vein. The drugs
used for peritoneum cancer are similar to those anti-cancer
drugs used for treating ovarian cancer. Depending on the
type of chemotherapy drugs used, this treatment can be
given weekly or every two to three weeks. In most cases,
patients receive the treatment on an outpatient basis.
•
Supportive care -- Unfortunately, in
some cases, peritoneum cancer is not diagnosed until it
has advanced. Supportive care, also known as palliative
care, is designed for patients whose disease has advanced
to the point where they are too ill to cope with intensive
chemotherapy. Supportive care aims to relieve symptoms
of peritoneum cancer, such as pain, weight loss and fluid
in the abdomen, which can be drained during a procedure
called, abdominal paracentesis.
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