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Primary Peritoneal Cancer: Symptoms, Diagnosis, Treatment, and Clinical Trials

Peritoneal Cancer

Primary peritoneal cancer, or PPC, is a rare type of cancer that attacks primarily women and is often considered to be a gynecologic cancer. It’s a very aggressive type of cancer and can spread quickly to other parts of the body. In makeup, it’s very similar to ovarian cancer, but even women who have had their ovaries removed can develop peritoneum cancer.

Primary peritoneal cancer is often referred as “the silent killer.” PPC often causes no symptoms, or either mild symptoms, when it first starts. Because the symptoms of PPC are often so vague, they are often dismissed without seeking a medical opinion. Once primary peritoneal cancer causes symptoms that can no longer be ignored, it has usually reached at least stage III. Because of this, the cancer has been assigned only two stages: III and IV.

Though primary peritoneal cancer is rare, it received considerable news coverage when a popular celebrity was diagnosed with PPC. This is the type of cancer that famous Saturday Night Live comedienne Gilda Radner had.

What is the peritoneum?

The peritoneum is the thin membrane that lines the abdominal cavity. It’s the largest space in the human body. It’s made up of epithelial cells and has a vast network of vascular and lymphatic capillaries. This lining produces a fluid that lubricates the internal organs, making them slide around easily when the body moves. If it weren't for this slippery fluid, our internal organs would "stick together" whenever they came in contact with each other.

The peritoneum is actually made up of two layers. The outer layer is attached to the abdominal wall and is called the parietal peritoneum. The inner layer encases the internal organs and is called the visceral peritoneum. The area between the two layers contains the aforementioned lubricating fluid and is referred to as the peritoneal cavity.

Who’s at risk for primary peritoneal cancer?

Doctors aren’t sure what causes peritoneal or peritoneum cancer. Risk factors include advanced age, a familial history of breast cancer, and being female. PPC usually affects women between the ages of 40 and 60. Men can have peritoneal cancer, but the occurrence is extremely rare.

Estimates for the number of people affected by PPC vary widely. In the United States, estimates for women diagnosed with peritoneum cancer each year range from about 2,000 up to 10,000. In the European Union, the figure is 0.3 people in 10,000 who are diagnosed with primary peritoneal cancer. Remember though, that PPC is difficult to diagnose in its early stages, so the true number of people with peritoneum cancer is probably much larger.

What are the symptoms of PPC?

Unfortunately, peritoneal cancer does not usually cause symptoms until the disease is in the advanced stage. Even then they’re sometimes vague or difficult to describe. When symptoms do present, they often include:

- Abdominal bloating

- Nausea

- Indigestion

- Loss of appetite

- Weight loss or gain

- Unusual vaginal bleeding

- Frequent urination

- Constipation

- Diarrhea

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- Abdominal swelling from fluid

- Abdominal cramps and pressure

- Abdominal pain, usually in the lower abdomen

How is peritoneal cancer diagnosed?

If you’re experiencing symptoms compatible with peritoneal cancer, see your doctor as soon as possible. Chances are that you're suffering from some other disorder, but it's better to be sure. He’ll ask you general health questions, as well as specific questions about your symptoms. He’ll use both a physical examination and tests as diagnostic tools.

Some of the procedures include:

Pelvic exam: The doctor will insert a lubricated gloved hand into the vagina in an effort to feel and assess the ovaries, the uterus, the bladder, the fallopian tubes, the rectum, and the vagina itself. The physician will be able to determine the size and shape of the organs and thereby note any abnormalities.

Rectal exam: Your physician might need to insert a lubricated gloved finger into your rectum to better evaluate parts of the peritoneum or organs.

Lower GI series: For this, you’ll be given an enema containing barium – a white chalky substance that shows up on x-ray. The procedure is uncomfortable but is not painful.

Blood tests: A CA125 test may be ordered. This measures the amount of a specific protein in your blood that is often elevated with ovarian or peritoneal cancer. It should be noted that other forms of cancer and even benign conditions can elevate the CA 125 level.

Computed Tomography (CT) scan: This painless procedure generally takes from 20-30 minutes. You will be given some sort of contrast. It can be in the form of a drink, an enema, or an intravenous injection. Since it contains iodine, be sure to tell your doctor if you’re allergic or if you have asthma. A momentary flushed or hot sensation is normal, but it passes soon.

Magnetic Resonance Imaging (MRI): This is a painless procedure, but it often takes an hour to complete. During that time, you’ll have to lie completely still. You’ll slide into an open ended “tunnel.” Some patients, especially those with claustrophobia, might be given a mild sedative to help them relax. There are also open MRIs, which are less claustrophobic. If you suffer from claustrophobia, ask your doctor about the possibility of an open MRI.

Ultrasound: This is a non-invasive procedure that allows the inside of the abdominal cavity to be seen and assessed for peritoneal cancer and other problems. If you’ve been pregnant in the last 30 years or so, you’ve probably had one of these. A conductive jelly is spread onto the abdomen, and an instrument is passed along the belly. The procedure is painless.

Vaginal ultrasound: With this procedure, a small sound wave device is placed in the vagina to create an image of the internal organs and the peritoneum. The device is about the size of a tampon. The procedure is painless but might be uncomfortable.

Laparoscopic biopsy: In this procedure, a surgeon will make a small incision into the perineum. A small amount of peritoneal tissue will be removed so that it can be tested for peritoneum cancer. You’ll have to be put to sleep for this, so a short hospital stay is required.

Fluid aspiration: Peritoneum cancer sometimes causes fluid to accumulate in the abdominal cavity. In this procedure, a local anesthetic is used to numb the skin, then a small amount of this fluid is drawn and tested to determine if peritoneal cancer cells are present.

What are the treatments for cancer of the peritoneum?

Because primary peritoneal cancer is almost always in either stage III or stage IV before it's discovered, advanced treatment methods are usually used. Primary treatment includes:

Surgery: You will be admitted in to the hospital and put to sleep under general anesthesia. This surgery should be done only by a gynecological oncologist. He or she will remove as much of the cancerous tissue as possible. This might include the ovaries, the uterus, and some abdominal fat called the omentum. The surgeon will also be able to detect the initial source of the peritoneum cancer.

Chemotherapy: Chemotherapy involves the administration of drugs that have cancer cell-destroying properties. Most of these drugs work by inhibiting the abnormal cells from dividing and multiplying. You will likely receive these drugs intravenously, as an outpatient. The chemotherapy drugs may be used before and after surgery. This treatment may be administered once a week, once every two weeks, or once every three weeks.

Radiotherapy (radiation therapy): This includes high-energy radiation that can be delivered in two ways. One is through a beam or radiation outside the body, and the other is placed inside the body. Both types of radiotherapy destroy cancerous cells and shrink any tumors.

Palliative care: If patients are too sick or weak to undergo chemotherapy, supportive care is given to help make them more comfortable. This might include a procedure called paracentesis - the draining away of excess abdominal fluid. Other palliative measures usually include pain management and a special diet. Anyone with this type of cancer needs a strong support group of family members, friends, and/or professional counselors.

Follow up for patients with cancer of the peritoneum

It’s imperative that you keep all your appointments with your oncologist so that he will know if the peritoneum cancer spreads. He can also evaluate any complications from the cancer and from the therapy. Be sure to tell your health care team of any new symptoms or side effects from therapies or medications.

Clinical trials for primary peritoneal cancer

Clinical trials studying the effects of new anti-cancer drugs used in the advanced treatment of primary peritoneal cancer, along with other cancer treatment options, are ongoing. Currently, there’s one being conducted at Memorial Health University Medical Center in Savannah, Georgia, studying the use of ChemoFx. One in New York, at Mt. Sinai Medical Center is testing the effectiveness of Paclitaxel or Xyotax.

If you’re interested in participating in a PPC clinical trial, talk to your physician about the risks and possible benefits of such cancer treatment options. If he thinks you might be a good candidate, you’ll need to get more information about the specific trial and be approved by the study group.

Remission of primary peritoneal cancer

If your PPC cancer goes into remission, it’s important for your doctor to keep abreast of your condition. You will be asked to return for checkups once every few months. Unfortunately, this type of cancer often recurs. Even patients who have experienced remission after primary treatment will most likely have to undergo further surgeries and additional advanced treatment with chemotherapy. Hopefully, the new clinical trials and research will soon discover a cure for primary peritoneal cancer.

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A typical MRI.

A typical MRI.


Hashp from india on November 20, 2017:

Peritoneal cancers are difficult to treat, so any naturally occuring carcinogen like asbestos should be completely banned. Its sad that India still exports tons of asbestos.

It strengthens my belief that money is the root cause of all evil.

Scot Nyman from Indonesia on December 16, 2012:

Whatever you do, consider natural cures for cancer, and don't accept one doctor's word about treatment. Chemo and radiation are not your only choices. Read any of several Hub pages here or search. Kelley Eidem has several great Hub Pages. It is working for my fiancee's stage 3 gastric cancer! The cancer specialists where she is now are shocked and amazed at her progress. It's nearly down to stage 1 now. No chemo, no radiation, just eating the right food, and taking the right vitamins. No adverse side effects to worry about either.

Cancer is not a death sentence! Cancer cells are weak and can be switched off. the answer isn't always, cut, burn or poison.

Thank you for this page. I hope many people read it.

Bless you all!

Janelle on July 19, 2011:

also Peritoneal Mesothelioma falls in this category..I am getting ready to have my whole Omentum removed plus a chemo wash next week!! it will be a 12 hour surgery.. you dont have to be old to get Mesothelioma (cancer caused by asbestos) I was dx at age 31.. not fun!

thanks for raising awareness, these cancers usually go undiagnosed till it is further spread..symptoms are common, side pains,abs pain and cramping, bloating,heaviness feeling in your stomach...honestly I felt pregnant!!

Holle Abee (author) from Georgia on May 28, 2011:

Thanks, Submission!

SubmissionWork from India on May 25, 2011:

Glad that you gather all information at one place.

I do not think that you will be able to get this huge details at one place.

Holle Abee (author) from Georgia on May 17, 2011:

Go, Bluestar! I'll be thinking about you!

Annette Donaldson from Northern Ireland on April 06, 2011:

Great hub Habee. I had a full radical hysterectomy last March, but prior to that my EA125 blood test was elevated. The problem I have now is that I got the all clear from the biopsies taken during surgery and have never had the courage to ask for another EA125 check. Reading this great hub, maybe I should pluck up the courage and go and ask. Thank you for sharing.

Holle Abee (author) from Georgia on February 04, 2011:

Jay, glad to hear you're doing well, and thanks for the info!

jayraye on January 31, 2011:

Very complete information! I was diagnosed with PPC at the age of 22, and will be celebrating 11 years as a survivor this spring.

The only additional information I would suggest is the addition of information regarding PET scans- or Positron Emission Tomography. It is also a nuclear based procedure that is capable of detecting active cancer cells by way of the metabolic signals released. Couple that with a CT, and the picture is complete.

I have a PET scan in store for the near future...even after 11 years, it still haunts.

Holle Abee (author) from Georgia on December 10, 2010:

You're welcome, LL!

L.L. Woodard from Oklahoma City on December 09, 2010:

Very complete information about a little known health topic. Thanks for the hub.

Holle Abee (author) from Georgia on October 04, 2010:

Glad you found the hub interesting!

Funom Theophilus Makama from Europe on October 03, 2010:

This is amazing. I just published a hub of Pneumonia, when this hub was shared on my page and of course it caught my attention. Its really informative and I very much appreciate reading it. You have given me an added material to ponder upon and do more research on it. Thanks once again.

Holle Abee (author) from Georgia on July 31, 2010:

Thanks, Ed! We never need to take life for granted.

Holle Abee (author) from Georgia on June 09, 2010:

Casey, that's wonderful news!

casey4599 on June 06, 2010:

mu husband has peritoneal cancer and something is working - I think it is the Cesium/DMSO protocol that we are doing that I found on

he thinks it's the chemo- DCF

Holle Abee (author) from Georgia on May 03, 2010:

Sorry about your friend, Peggy. I'll check out Kelley!

Peggy Woods from Houston, Texas on May 01, 2010:

Hi habee,

We had a friend who ultimately died because of this condition.

For you...have you discovered the hubpage writer, Kelley Eidem, who writes about curing cancer?

Holle Abee (author) from Georgia on March 30, 2010:

Andrea, I've been reading about that. I have a pre-cancerous condition called MGUS. I wish there was a way to treat it!

AndreaGerak from Stockholm/Budapest on March 30, 2010:

Sounds scary indeed! However, no cancer is scary, if you know the cause of it, hence how to heal it - and that is something the official medicine won't tell you...

Holle Abee (author) from Georgia on January 06, 2010:

Hi, HH. Thanks for reading!

Ethel, this one is especially deadly. I'm praying some of the new clinical trials will find a cure - or at least something that slows the progression.

Ethel Smith from Kingston-Upon-Hull on January 06, 2010:

So many scary cancers. Still we need to be aware. Thanks for the info

Holle Abee (author) from Georgia on January 05, 2010:

Hi, free. Yes, it is a scary disease - even for cancer.

Hello, hello, from London, UK on January 05, 2010:

Thank you, habee, for your good advice.

Varun Sharma on January 04, 2010:

It is quite scary!

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