Internal Medicine

Peritoneum metastases

Synonyms

Peritoneum settlements
peritoneal filae
Peritoneal metastases
Daughter tumors in the peritoneum
Settlements in the peritoneum
Peritoneal carcinosis
Carcinosis peritonei
Carcinomatous peritonitis

introduction

Metastases are settlements of an original tumor (primary tumor) that have reached another location in the patient's body either directly or via the lymphatic or blood pathway. Are these metastases in or on the peritoneum (a skin that lines the abdominal cavity and envelops most of the abdominal organs - in Latin peritoneum called), these are peritoneum metastases.
These usually have their origin in tumors of abdominal organs and are an expression of a very advanced disease of the corresponding cancer. Peritoneal metastases are often numerous (multiple), flat and difficult to distinguish from the healthy surrounding tissue (diffuse). Common tumors originating from peritoneum metastases are colon cancer (colon or rectal cancer), ovarian cancer (ovarian cancer), stomach cancer (gastric cancer), and end-stage pancreatic cancer.

Read more about: Tumor in the abdomen - that is part of it!

causes

During a increasing degeneration (mutative oncogenesis) of cancer cells these eventually lose their property of being attached to the surrounding cells. So it happens that advanced cancers keep coming back single cells or small groups from the main cell group of the original tumor (primary tumor). With the blood or lymph flow, sometimes also directly (via continuitatem), they then arrive to other places, where they then settle. This process will metastasis called.

Colon cancer (colon or rectal carcinoma), ovarian cancer (ovarian carcinoma) and stomach cancer (gastric carcinoma) in particular tend to metastasize to the peritoneum.

Symptoms

Sometimes an increase in abdominal girth or a build-up of abdominal fluid (ascites) is noticeable, rarely symptoms of the gastrointestinal passage. Often, however, especially in the early stages, peritoneum metastases remain without any symptoms, so they do not reveal themselves through the manifestation of symptoms, but remain undetected for a long time.

Above all, when the peritoneum metastases have reached a certain size, they can constrict organs in the abdomen. If they push off the intestine, in extreme cases an intestinal obstruction (ileus) occurs. A narrowing of the ureters with subsequent kidney congestion is also conceivable.

A local inflammatory reaction of the body in response to the peritoneum metastases can increase the permeability of the intestine for water; as a result, water then collects in the abdominal cavity. However, ascites can also occur in the context of numerous other diseases.

diagnosis

Peritoneum metastases betray themselves not through noticeable changes in the patient's blood and are also by one detailed medical examination poorly detectable. At most one Ascites (Ascites) can create suspicion. In the medical survey (anamnese) you can ask about symptoms that could be explained by peritoneal metastases. Up to this point may be the presence of peritoneum metastases not proven because all of the symptoms they cause can be other causes as well to have.

At most one better known (or presumed) Primary tumor, who likes to sprinkle in the peritoneum, puts the Suspected diagnosis of peritoneal metastases Near. Imaging procedures such as CT and MRI often do not help; in many cases these can be peritoneal metastases not recognizable do.

If the results of a radiological examination are ambiguous or even negative, the next diagnostic step is an operation. A so-called Laparoscopy (laparoscopy), i.e. a surgical procedure in which the abdominal cavity is opened, offers the doctor the opportunity to assess the situation on site and to provide a clear answer to the question of whether there are peritoneal metastases.

Peritoneal metastasis pain

The metastases themselves can cause unspecific abdominal pain or may not be noticeable at all in the early stages. However, the metastases trigger a number of side effects in the abdomen that can lead to pain. The progressive infestation can cause a painful feeling of pressure in the abdomen and the formation of ascites (Ascites) come, which can increase the existing feeling of pressure and trigger pain.

One should not be afraid of the pain, because with adequate care by a doctor and, in the best case, by a palliative team, adequate pain therapy can be guaranteed that is tailored to the needs of the patient. Any ascites caused by the metastases can be drained through a small operation, which can be a relief for the patient.

Read more on the subject at: Puncture water in the abdomen

Peritoneal metastases in breast cancer

Mostly, peritoneal metastases occur as a result of cancer in the abdomen. However, they can Occasionally occur as a result of breast cancer. When breast cancer has metastasized, the breast cancer is generally considered to be no longer curable. Nevertheless, this is not the end of the medical measures; a doctor can continue to be there for the patient and Relieve symptoms.

About 30% of women with breast cancer develop metastases because the cancer cells can spread through the body via the blood or lymphatic systems. In order to prevent metastases or to detect them at an early stage, patients suffering from cancer should have regular check-ups. In general, peritoneal metastases are not typical for breast cancer, but rather occur rarely. Bone, liver, brain and lung metastases are more common.

Peritoneal metastases in ovarian cancer

Ovarian cancer is divided into four stages. FIGO I and II describe a cancer that either only affects the ovaries or the pelvis. Unfortunately, ovarian cancer is often diagnosed late, which is why ovarian cancer has sometimes already spread to the adjacent peritoneum. The occurrence of peritoneum metastases classifies a tumor as FIGO III. Only later does the cancer metastasize beyond the neighborhood to the rest of the body and metastases can also be found in the lungs or the lymphatic system.

Surgical therapy at this advanced stage includes the removal of the ovaries, fallopian tubes, uterus, and peritoneum. If the peritoneum metastases have already spread to other abdominal organs, such as the liver or the intestines, it may also be necessary to remove them. Chemotherapy is then started to fight cancer cells in the blood. The survival time of ovarian cancer patients varies depending on the original classification. Even patients with peritoneum metastases can still have a good prognosis if the tumor and metastases can be completely removed.

Peritoneal metastases in gastric cancer

With extensive growth that breaks through the stomach walls, a stomach tumor can also spread to the adjacent peritoneum and lead to peritoneum metastases. It can then infiltrate the lymph nodes, lymph vessels and blood vessels. Frequently occurring metastatic sites in gastric cancer are the peritoneum, the liver, surrounding lymph nodes and the lungs.

In the case of peritoneal metastases, stomach cancer is no longer curable. Nevertheless, it can be useful to perform an operation to relieve severe symptoms caused by the tumor and metastases. An important part of therapy is chemotherapy, which is one Can cause cancer and metastases to regress or stagnate.

therapy

The Therapy of peritoneal metastases turns out to be extremely difficult. Usually these only occur in the Late stage cancer. Often there are then settlements (metastases or filae) of the original tumor (primary tumor) also in other places found in the body, and the settlements are usually numerous and advanced in size. If the peritoneum has metastasize, this occurs often flat. Also a Recurrence of a tumor (Relapse) in the abdominal cavity or on the peritoneum is not uncommon. Then the tumor often already has Resistances against the previously used Chemotherapy drugs developed, which makes therapy even more difficult.

The peritoneum is also one poorly perfused region in the body and chemotherapeutic agents cannot easily reach metastases there via the bloodstream.

In summary, therapy for peritoneum metastases is difficult because of these often flat and blurred, as well as via the blood route pharmacologically difficult to achieve are, and sometimes through prior therapies Resistances against the corresponding chemotherapeutic agents.

If the patient and the treating doctor then do not decide on one, despite the moderate chance of success Relieving (palliative) therapy, but for one that aims at healing (curative approach) so is usually a Complex, cross-departmental (interdisciplinary) intervention necessary.

This consists of one surgical removal of the peritoneum (Peritoneal electomy) with subsequent Irrigation of the abdominal cavity with chemotherapeutic agent. In order to increase the effectiveness of this intraoperative chemotherapy, it is routinely heated - and thus the local one Blood circulation promoted. If the rinsing is done with a liquid, then the expert speaks of a hyperthermic intraperitoneal chemoperfusion (HIPEC). Alternatively, the drug can also be supplied by a small pump be nebulized directly in the abdominal cavity, whereby the chemotherapeutic agent should get even better into the most remote corners. This procedure will Pressurized Intraperitoneal Aerosol Chermotherapy called and abbreviated to PIPAC.

forecast

Peritoneum metastases are usually expressions for that End-stage cancer or their return (Relapse), so the prognosis is generally poor. Exist in the presence of peritoneum metastases often other places as well settlements of the body that further reduce the chances of healing.
Furthermore make it difficult various circumstances a curative therapy. Some hospitals promise one when using a HIPEC 25% chance of healing. However, the individual chances of success of such a therapy depend of many factorssuch as age, general condition and existing secondary diseases.

Chances of recovery

In many cases, both the primary tumor and the peritoneum metastases are well developed. Curative approaches are rarely available that offer realistic chances of recovery. The risk that the tumor will return or new metastases will occur (relapse) is always present, even after a curative procedure. In the case of peritoneum metastases, however, there are some approaches that can alleviate the suffering of the disease and improve the patient's quality of life and sometimes even lead to healing. The individual prognosis depends on the underlying disease and stage and can only be estimated by the attending physicians.

For one, the peritoneum with the metastases surgically removed become. If neighboring abdominal organs are affected, parts of them can also be completely or partially removed.

On the other hand, a chemotherapy infused directly into the abdomen with the aim of locally fighting the metastases there. Such chemotherapy can shrink or stop the peritoneal metastases from growing and spreading. Regular chemotherapy is often not optimally effective in the case of peritoneum metastases, as the drugs are transported to the site of action via the blood and the peritoneum is not very well supplied with blood.

Another approach that is currently being tested is one Immunotherapy in the abdomen, which is supposed to fight the metastases through defense cells against the tumor.

At each stage, the symptoms caused by the peritoneum metastases (abdominal fluid, pain, feeling of pressure) should be alleviated.

End-stage peritoneum metastases

In most cases, the chances of recovery from peritoneum metastases are slim. In some cases, depending on the type and stage of the primary tumor, the presence of additional metastases elsewhere in the body and the size and severity of the peritoneum metastases themselves, a cure can be achieved through interdisciplinary therapy. However, the infestation of the peritoneum is usually the final diagnosis, especially if the metastases are found in the entire abdomen and even a surgical procedure cannot safely remove all tumor cells.

In the following you switch from one curative (healing) approach to a so-called. palliative (pain relieving) approachthrough which the discomfort is minimized and the life quality the affected person should be improved as much as possible. An important part of palliative therapy is the Pain therapy which is tailored to the needs of the patient and should be carried out by an experienced team of oncologists (cancer doctors) and pain therapists. It also relieves symptoms of the condition that are limiting for the patient as much as possible. This can include drug, but also surgical therapies. In the case of peritoneal metastases, for example, ascites can be drained in a small procedure, which can be a relief for the patient. Also one psychological careconducted by specially trained psychotherapists can help with a definitive diagnosis. The treating clinic can establish contact here.

If the care of a terminally ill patient overwhelms the relatives, there is the option of care in so-called Hospiceswho specialize in caring for terminally ill patients in the last phase of their illness.

In palliative therapy, the Will of the patient top priority.

Life expectancy with peritoneum metastases

Of course, every patient diagnosed with cancer and metastases wants to know how long they have to live. However, these are individual values that depend on how pronounced the metastases are and whether they can still be removed by surgical intervention or contained by drug therapy. In later stages, the surrounding organs (stomach, intestines, bladder) can also be affected by the peritoneum metastases. In addition, the prognosis depends on the underlying disease and other metastatic sites. The general health of the patient also plays a role. Finally, the prognosis for cancer is always influenced by how the disease responds to the therapy.

The prognosis can only be estimated by the attending physicians. Even these, even if they take into account all the decisive factors, can only give one probability of survival. Ultimately, nobody can predict with certainty whether and how long an individual patient will survive with a certain disease.