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The Large Bowel and the Anal Canal
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
The incidence of peritoneal carcinomatosis as a site of treatment failure is considered to be common. Pharmacokinetics studies have shown that high levels of 5-FU in the peritoneal cavity can be tolerated, and 90% of the drug passes through the portal vein to the hepatic venous system to the systemic circulation.71 Early studies by Sugarbaker at the National Institutes of Health clearly indicate that large doses of 5-FU can be given safely i.p. with less hematological toxicity and higher response rates than systemic administration. The i.p. approach seems to be better tolerated than the i.v. route if radiation therapy is added. However, we are still lacking controlled studies to confirm these theories.
Imaging in peritoneal malignancy
Published in Tom Cecil, John Bunni, Akash Mehta, A Practical Guide to Peritoneal Malignancy, 2019
Anuradha Chandramohan, Andrew Thrower
Earlier studies, performed with single-slice CT scanners, reported low sensitivity of 60%–79% and poor inter-observer agreement for peritoneal carcinomatosis [1,2]. However, studies on new generation CT scanners have shown improved sensitivity of 88%–93%, although sensitivity for detection of peritoneal metastases <1 cm remains poor (25%–50%), when compared to the gold standard of surgical exploration [3]. Despite these limitations, CT is very useful to obtain a general overview of the disease extent and in the initial screening of patients being considered for CRS and HIPEC. It is a good test to exclude patients with advanced disease who may not benefit from such procedures, especially patients with distant metastases.
Other Tumours of the Colon and Rectum
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
The primary peritoneal serous carcinoma is a very rare disease (217 cases reported worldwide between 1974 and 2006), involving mainly females aged between 33 and 70 years.39 The differential diagnosis with peritoneal carcinomatosis of ovarian origin and peritoneal mesothelioma is extremely difficult. The symptoms are that of classical peritoneal carcinomatosis with abdominal distension and non-specific abdominal pain. The diagnosis is a diagnosis of exclusion and requires histological typing-assisted immunohistochemical analysis (positivity for CEA, B72.3, BER-EP4, CD-15 and MI-LEU negativity for vimentin and calretinin) and biomolecular analysis (chromosome deletion, suppression 6q 23–24).48 Treatment is by the peritonectomy with systemic chemotherapy and/or intra-abdominal chemotherapy and hyperthermia (HIPEC). However, the prognosis is poor with a median overall survival of ten months.
Intraperitoneal perfusion chemotherapy and whole abdominal hyperthermia using external radiofrequency following radical D2 resection for treatment of advanced gastric cancer
Published in International Journal of Hyperthermia, 2019
Lucheng Zhu, Yasi Xu, Yuqiang Shan, Ruzhen Zheng, Zhibing Wu, Shenglin Ma
Gastric cancer is the most common cancer and the leading cause of cancer death worldwide [1]. It is estimated that approximately 679 million new gastric cancer cases occurred in China each year [2]. Curative resection has been considered as the only way to cure gastric cancer. The peritoneum is the most frequent site of disease metastases or recurrences in gastric cancer patients [3,4]. Moreover, 20–50% of gastric cancer patients will suffer a peritoneal recurrence or failure even after complete resection [5,6]. Although various approaches have been attempted, such as extended resection, combination chemotherapy, heated intraperitoneal (IP) chemotherapy and immunotherapy, the prognosis of patients with peritoneal carcinomatosis (PM) remains unsatisfactory. Therefore, it is necessary to explore an appropriate treatment to avoid or delay peritoneal recurrence in high-risk patients.
Adjuvant intraperitoneal chemotherapy for the treatment of colorectal cancer at risk for peritoneal carcinomatosis: a systematic review
Published in International Journal of Hyperthermia, 2018
Paul L. Feingold, Nicholas D. Klemen, Mei Li M. Kwong, Barry Hashimoto, Udo Rudloff
Cytoreductive surgery (CRS) in combination with intraperitoneal (IP) chemotherapy has become a clinically proven treatment in the management of overt peritoneal carcinomatosis from colorectal cancer. This trend follows the established management of peritoneal involvement of appendiceal cancer, ovarian cancer and other primary peritoneal surface malignancies [15–19]. There is also a growing body of evidence supporting (IP) chemotherapy as a preventative strategy in gastrointestinal (GI) malignancies, including gastric cancer [20,21]. Preclinically, this strategy is supported by finding that cells undergo epithelial-mesenchymal transition during the peritoneal metastatic process. Recent studies have shown that this cell population acquires an increased ability to migrate and invade, and becomes exquisitely resistant to systemic chemotherapy [22,23]. Additionally, following implantation at distant sites, these metastatic deposits frequently have already created a microenvironment favourable for further growth and spread. They have been shown to attract tumour-promoting cell populations such as M2-tumour associated macrophages, T-regulatory cells, stellate cells and cancer-associated fibroblasts [24]. These factors are thought to mediate additional resistance to chemotherapy which may in part explain the failure of systemic intravenous chemotherapy to treat peritoneal carcinomatosis [25].
Peritoneal dissemination of ovarian cancer: role of MUC16-mesothelin interaction and implications for treatment
Published in Expert Review of Anticancer Therapy, 2018
Ricardo Coelho, Lara Marcos-Silva, Sara Ricardo, Filipa Ponte, Antonia Costa, Jose Manuel Lopes, Leonor David
Peritoneal dissemination is a particular form of metastasis of several malignancies, such as gynecological, pancreatic, and gastrointestinal. In this particular form of cancer dissemination, cancer cells detach from the primary tumor in the ovary or, in agreement to recently proposed, in the fallopian tube [1–3], circulate through the peritoneal fluid, and implant through the mesothelial layer with subsequent peritoneal carcinomatosis. The intraperitoneal neoplastic masses entail accumulation of ascites and are frequently associated to visceral dysfunction, being the most frequent cause of bowel obstruction. The presence of peritoneal carcinomatosis is considered an adverse prognostic factor. Specifically, in ovarian cancer, this form of malignant progression is the initial step of neoplastic metastasis, preceding hematogenic or lymphatic dissemination. Thus, prevention of peritoneal implantation of cancer cells could inhibit neoplastic dissemination and therefore prolong disease remission and patient’s survival. In vitro studies already demonstrated that interfering with the adhesion of cancer cells to the mesothelial layer inhibits metastasis and increases the overall survival of mice injected with ovarian cancer cells [4,5].