Peritoneal carcinomatosis

WikiDoc Resources for Peritoneal carcinomatosis
Articles
Most recent articles on Peritoneal carcinomatosis Most cited articles on Peritoneal carcinomatosis Review articles on Peritoneal carcinomatosis Articles on Peritoneal carcinomatosis in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Peritoneal carcinomatosis Images of Peritoneal carcinomatosis Photos of Peritoneal carcinomatosis Podcasts & MP3s on Peritoneal carcinomatosis Videos on Peritoneal carcinomatosis
Evidence Based Medicine
Cochrane Collaboration on Peritoneal carcinomatosis Bandolier on Peritoneal carcinomatosis TRIP on Peritoneal carcinomatosis
Clinical Trials
Ongoing Trials on Peritoneal carcinomatosis at Clinical Trials.gov Trial results on Peritoneal carcinomatosis Clinical Trials on Peritoneal carcinomatosis at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Peritoneal carcinomatosis NICE Guidance on Peritoneal carcinomatosis NHS PRODIGY Guidance FDA on Peritoneal carcinomatosis CDC on Peritoneal carcinomatosis
Books
Books on Peritoneal carcinomatosis
News
Peritoneal carcinomatosis in the news Be alerted to news on Peritoneal carcinomatosis News trends on Peritoneal carcinomatosis
Commentary
Blogs on Peritoneal carcinomatosis
Definitions
Definitions of Peritoneal carcinomatosis
Patient Resources / Community
Patient resources on Peritoneal carcinomatosis Discussion groups on Peritoneal carcinomatosis Patient Handouts on Peritoneal carcinomatosis Directions to Hospitals Treating Peritoneal carcinomatosis Risk calculators and risk factors for Peritoneal carcinomatosis
Healthcare Provider Resources
Symptoms of Peritoneal carcinomatosis Causes & Risk Factors for Peritoneal carcinomatosis Diagnostic studies for Peritoneal carcinomatosis Treatment of Peritoneal carcinomatosis
Continuing Medical Education (CME)
CME Programs on Peritoneal carcinomatosis
International
Peritoneal carcinomatosis en Espanol Peritoneal carcinomatosis en Francais
Business
Peritoneal carcinomatosis in the Marketplace Patents on Peritoneal carcinomatosis
Experimental / Informatics
List of terms related to Peritoneal carcinomatosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Synonyms and keywords: Peritoneal metastases

Overview

Peritoneal carcinomatosis (also known as peritoneal metastases) is defined as a malignant tumoral seeding of the peritoneum. Peritoneal carcinomatoses are the most common peritoneal malignancy, these commonly arise from ovarian cancer, colon cancer, gastric cancer, and pancreatic cancer. Calcified peritoneal carcinomatosis may occur in serous ovarian adenocarcinoma, colon cancer, and gastric cancer.

Historical Perspective

• Peritoneal carcinomatosis was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
• In [year], [gene] mutations were first identified in the pathogenesis of peritoneal carcinomatosis.
• In [year], the first [discovery] was developed by [scientist] to treat/diagnose peritoneal carcinomatosis.

Classification

• Peritoneal carcinomatosis may be classified according to [classification method] into [number] subtypes/groups:

• [group1]
• [group2]
• [group3]

• Other variants of peritoneal carcinomatosis include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

Pathophysiology

• The pathogenesis of peritoneal carcinomatosis is characterized by the malignant seeding of a tumor in the peritoneal cavity.
• The mutation on BRCA1/BRCA2 has been associated with the development of peritoneal carcinomatosis.
• On gross pathology, characteristic findings of peritoneal carcinomatosis, include:

• Multilocular thin-walled cysts containing serous fluid
• Occasionally unilocular
• May be up to 15 cm.
• Adherent to the surface

• On microscopic histopathological analysis, characteristic findings of peritoneal carcinomatosis, include:

• Thin-walled, irregular-shaped cysts
• Mesothelial lining
• Squamous metaplasia
• Eosinophilic fluid

Causes

• Common causes of peritoneal carcinomatosis, include:

• Colon cancer
• Gastric cancer
• Pancreatic cancer

• Peritoneal carcinomatosis may also be caused by a mutation in the BCRA1 or BCRA2 genes.

Differentiating Peritoneal Carcinomatosis from Other Diseases

• Peritoneal carcinomatosis must be differentiated from other diseases that cause abdominal pain, ascites, and weight loss, such as:

• Peritoneal mesothelioma
• Peritoneal tuberculosis
• Pseudomyxoma peritonei

Epidemiology and Demographics

• The prevalence of peritoneal carcinomatosis is approximately 0.03 per 100,000 individuals worldwide.

Age

• Peritoneal carcinomatosis is more commonly observed among patients aged 50 - 70 years.
• Peritoneal carcinomatosis is more commonly observed among adults.

Gender

• Females are more commonly affected with peritoneal carcinomatosis than males.

Race

• There is no racial predilection for peritoneal carcinomatosis.

Risk Factors

• Common risk factors in the development of peritoneal carcinomatosis are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

• The majority of patients with peritoneal carcinomatosis may be initially asymptomatic.
• Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
• If left untreated, [#%] of patients with peritoneal carcinomatosis may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
• Common complications of peritoneal carcinomatosis include [complication 1], [complication 2], and [complication 3].
• Prognosis is generally poor, and the 5 year survival rate of patients with peritoneal carcinomatosis is approximately

Diagnosis

Diagnostic Criteria

• The diagnosis of peritoneal carcinomatosis is made when at least the following diagnostic criteria are met:

• Imaging findings compatible with peritoneal carcinomatosis (see below)
• Elevated protein concentration (more than 4.0 g/dL)
• Abnormal serum-ascites albumin gradient ( less than 1.1 g/dL )
• High cell count (lymphocyte predominance)

Symptoms

• Peritoneal carcinomatosis is usually asymptomatic.
• Symptoms of peritoneal carcinomatosis may include the following:

• Abdominal distension
• Nausea
• Bloating
• Intermittent abdominal pain
• Vomiting
• Alternating diarrhea and constipation

Physical Examination

• Patients with peritoneal carcinomatosis usually appear pale and lethargic.
• Physical examination may be remarkable for:

Inspection

• Enlarged abdomen
• Abdominal distension

Palpation

• Bulging of the flanks or shifting dullness
• Fluid thrill or fluid wave

• Other physical examination findings may include:

• Leg swelling
• Bruising
• Gynecomastia

Laboratory Findings

• Laboratory findings consistent with the diagnosis of peritoneal carcinomatosis, include:

• Elevated carcinoembryonic antigen (unspecific)
• Elevated cancer antigen 125

Imaging Findings

• Enhanced CT scan is the imaging modality of choice for peritoneal carcinomatosis.
• On CT, peritoneal carcinomatosis is characterized by the following findings:

• Smooth or nodular peritoneal thickening and enhancement.
• Implants on the liver and the splenic surfaces are frequently seen and result in scalloping of the surface by the masses.
• Sites of tumor implantation are the intersegmental fissure, superior recess of the lesser sac, subphrenic space, and Morison pouch.
• Usually there is large ascites, which is often loculated.

• The images below demonstrate a case of peritoneal carcinomatosis.

• 
• 
• 

Other Diagnostic Studies

• Peritoneal carcinomatosis may also be diagnosed using abdominal paracentesis.
• Findings on paracentesis may include:

• Opalescent appearance
• Elevated protein concentration (more than 4.0 g/dL)
• Abnormal serum-ascites albumin gradient ( less than 1.1 g/dL )

Treatment

Medical Therapy

• There is no treatment for peritoneal carcinomatosis; the mainstay of therapy is supportive care.

• The mainstay of therapy for peritoneal carcinomatosis is [medical therapy 1] and [medical therapy 2].
• [Medical therapy 1] acts by [mechanism of action1].
• Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

• Surgery is the mainstay of therapy for peritoneal carcinomatosis.
• [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of peritoneal carcinomatosis.
• [Surgical procedure] can only be performed for patients with [disease stage] peritoneal carcinomatosis.

Prevention

• There are no primary preventive measures available for peritoneal carcinomatosis.
• Once diagnosed and successfully treated, patients with peritoneal carcinomatosis are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].