This is a rare type of cancer that develops in a layer of tissue lining the abdominal area (the peritoneum). It is called primary peritoneal cancer, and in the early stage usually does not cause any symptoms. That’s why most people with this condition are diagnosed in advanced stages. The primary treatment for this type of cancer is surgery, but doctors may also prescribe chemotherapy or targeted therapy.
Furthermore, the peritoneum also covers other organs in the body. For example, the bladder, bowels, rectum, and uterus. This layer of tissue is made of epithelial cells that protect the surfaces of the body. It also makes fluid that lets the organs move inside the abdomen (belly).
Generally, this type of cancer occurs quite rarely and affects about 7 in 1 million people per year. In some cases, the exact number of people with primary peritoneal cancer is difficult to estimate because a lot of people do not experience symptoms. According to some research, about 15% of females diagnosed with advanced ovarian cancer may also have peritoneal cancer.
Types of Peritoneal Cancer
Physicians have divided this condition into 2 categories based on where the tumor first develops. For example:
- Primary peritoneal cancer – This type of peritoneal cancer begins in the cells that make up the peritoneum.
- Secondary peritoneal cancer – In such cases, the cancer begins in other parts of the body and then spreads to the peritoneum.
Symptoms
Similar to ovarian cancer, people with primary peritoneal cancer do not experience any symptoms in the early stages. Check below for symptoms that some people may experience in the early stages:
- Abdominal or pelvic pain
- Unusual vaginal bleeding or discharge
- Bowel changes (such as increased constipation or bloating)
- Rectal bleeding
- Frequent urination
- Indigestion
- Appetite changes
- Unexplained weight gain or loss
When the cancer advances, you may experience additional symptoms. These include:
- Extreme tiredness (fatigue)
- Ascites (fluid buildup in the abdominal area)
- Nausea
- Vomiting
- Dyspnea (shortness of breath)
- Swelling in the legs (edema)
If any of the previous symptoms occur, immediately contact your healthcare professional because it may indicate primary peritoneal cancer.
Causes
Nowadays, experts do not fully understand what causes this type of cancer. However, it usually appears like other types of cancer when specific cells develop DNA changes (mutations). In normal circumstances, DNA holds instructions that tell cells when to grow, multiply, and die. A mutated DNA gives the cells different instructions that make them grow and multiply abnormally. When these abnormal cells become too numerous, they form a mass also known as a tumor. Without treatment, this tumor can break and spread to other parts of the body (such as the lungs, bones, and others). In such cases, the cancer is called metastatic primary peritoneal cancer.
Risk Factors
Anyone can develop primary peritoneal cancer, but there are some factors that could increase your risk of developing it. In general, most risk factors are similar to those of ovarian cancer.
- Age – Most diagnosed cases are in people over 60 years old.
- Endometriosis – Females who suffer from this condition are at increased risk of developing primary peritoneal cancer.
- Genetics – If you have a family history of primary peritoneal cancer, your risk of developing it significantly increases. Furthermore, people who have fallopian tube or ovarian cancer are also at increased risk of peritoneal cancer. In addition, there is an increased risk of developing this type of cancer in women with BRCA1 and BRCA2 gene mutations or Lynch syndrome.
- Height – The risk of developing primary peritoneal cancer increases in taller people.
- Hormone replacement therapy – Women who use hormone therapy after menopause are also at increased risk of primary peritoneal cancer.
- Obesity – People with excessive body weight may also develop this type of cancer.
- Reproductive history – People who suffer from infertility or do not have biological children are also at increased risk.
What Are The Possible Complications of Primary Peritoneal Cancer?
People who develop primary peritoneal cancer can also experience some complications, especially if they do not get treatment. Check below some examples:
- Bowel obstruction
- Malabsorption
- Urinary blockage
- Pain in the abdominal area
- Inability to eat or drink
- Severe nausea and vomiting
This article does not contain a full list of primary peritoneal cancer complications. In any case, you can talk with your doctor about ways to reduce the risk or even prevent the previous complications.
How to Prevent Primary Peritoneal Cancer?
While it is not possible to prevent this type of cancer, doctors may recommend some tips to reduce the risk. For example:
- Dietary changes – Doctors often recommend adding more fresh fruits, vegetables, and whole grains to your diet. You should also limit or avoid alcoholic drinks and foods high in saturated fats.
- Quit smoking – If you have problems with smoking cessation, discuss it with your healthcare professional.
- Regularly perform physical exercise – Generally, it is recommended to aim for 30 minutes of physical exercise per day, at least 5 days a week.
- Try to get and maintain a healthy weight
The risk of primary peritoneal cancer also decreases if you have ever breastfed, given birth, taken birth control pills, undergone removal of the fallopian tubes, or ovaries. The only way to understand the risks of developing primary peritoneal cancer is genetic testing. Doctors will take a sample of blood to check for abnormal genes (including BRCA gene mutations) associated with this type of cancer.
Diagnosis
First, doctors will evaluate your family history and perform a physical examination to check for irregularities linked to the disease. They can also ask some questions about the symptoms. However, to confirm or rule out primary peritoneal cancer, physicians usually perform the following tests. Examples include:
- Blood tests – These tests are often done to check for cancer cells known as CA-125. The level of this chemical is often high in people with peritoneal cancer. They may also look for a protein (HE4) that is produced by cancerous cells.
- Imaging tests – The following tests are used to get detailed images of different structures and organs in the body. Usually, doctors perform ultrasound, CT (computed tomography) scans, or MRI (magnetic resonance imaging) scans.
- Laparoscopy – During this test, doctors use a laparoscopy (a long and flexible tube with a lighted camera on the end) to examine the abdominal area. This device is inserted in the abdomen through several small cuts (incisions). Furthermore, doctors may take a sample of the affected tissue during laparoscopy to perform a biopsy.
- Paracentesis – This test is used in people with ascites. It helps get a sample of fluid for testing.
- Pelvic examination – During this procedure, doctors will examine the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum.
Sometimes, you may be referred to a genetic counselor to check for abnormal genes. They often perform a genetic test to check for disorders linked to primary peritoneal cancer. These include lynch syndrome, mutations in the BRCA1 and BRCA2 genes, and others.
Furthermore, once you are diagnosed with primary peritoneal cancer, doctors will perform additional tests to determine the extent (stage) of the cancer. It helps make the best treatment plan for you.
Treatment
The treatment for people with this type of cancer is often different because it depends on several factors. For example, the exact location and size of the tumor, cancer stage, existing health problems, age, and preferences. In general, the primary treatment is surgery to remove the tumor. They often perform a cytoreductive surgery to remove as much cancer as possible. During this procedure, surgeons may also remove the fallopian tubes and ovaries (oophorectomy), uterus (hysterectomy), fatty tissue around the intestines (omentectomy), or other abnormal tissues. Moreover, your doctor may also recommend other treatments to destroy cancerous cells that may remain even after a successful surgery. For example:
- Chemotherapy – This is a cancer treatment that involves strong medicines to destroy cancerous cells throughout the body. It can be used before surgery to shrink a large tumor or after surgery to kill cancer cells that may remain. In most cases, these medicines are given to patients intravenously (IV), but a pill form is also available.
- Targeted therapy – This treatment uses specific medicines that find and destroy a protein in cancerous cells, causing them to die. Doctors usually recommend this treatment for people with advanced stages of cancer or when other treatments do not work.
- Hormonal therapy – In more severe cases, you may get a prescription for hormonal therapy in combination with chemotherapy to improve the effectiveness of treatment.
- Radiation therapy – This therapy uses powerful energy beams to destroy cancer cells. This energy often comes from X-rays, protons, or other sources. Usually, physicians recommend this treatment for people with recurrent primary peritoneal cancer.
Frequently Asked Questions
How does peritoneal cancer differ from ovarian cancer?
While ovarian cancer begins in the ovaries or in the cells at the far end of the fallopian tubes, peritoneal cancer appears in the cells lining the abdominal area (peritoneum). Sometimes, these types of cancer can be confused because both affect the epithelial cells that cover the ovaries and the abdominal area.
What is the life expectancy of someone with peritoneal cancer?
The survival rate for people with this type of cancer varies because it depends on several factors. However, the median survival can range from 11 to 17 months for primary peritoneal cancer and 2 to 10 months for secondary peritoneal cancer. There are some people who have lived more than 5 years after diagnosis because of early diagnosis and proper treatment.
Is primary peritoneal cancer treatable?
While about 80% of people will have recurrent cancer at some point, only 10% of people are cured after the primary treatment. Ask your healthcare professional if you have additional questions.
