Peritoneal carcinosis

Classification according to ICD-10
C78.6	Secondary malignant neoplasm of the retroperitoneum and peritoneum
ICD-10 online (WHO version 2019)

As peritoneal or carcinomatosis of the peritoneum (also Carcinosis peritonei or peritonitis carcinomatosa ) is a planar infestation of the peritoneum ( the peritoneum ) with malignant tumor cells , respectively.

Primary tumor

As a rule, these are metastases from other tumors located in the abdomen . In 10 to 20% of all patients with a malignant tumor of the stomach , intestines and ovaries , the cancer cells have spread to the abdominal cavity and the peritoneum lining the abdominal cavity at the initial diagnosis.

Symptoms

The growing tumor volume can impair the function of other abdominal organs in the later stages. Often there is an intestinal obstruction due to constriction of the intestine from the outside or kidney congestion due to the obstruction of the urine flow. In addition, the metastases can provoke a local release of inflammatory factors, which increase the permeability of the vessel walls in the abdominal cavity, so that a malignant ascites ( ascites ) develops. Peritoneal carcinomas represent a late stage of cancer and are associated with a significantly reduced life expectancy.

therapy

Peritoneal cancers are very difficult to treat because surgical removal is often impossible. Even conventional chemotherapy is unlikely to be cured. On the one hand, this is due to the fact that the cytostatics are administered via the blood vessel system and thus mainly reach organs with good blood circulation. However, the peritoneum is comparatively poorly supplied with blood, so that the cytostatics cannot be dosed in high enough amounts there. On the other hand, peritoneal carcinosis is often a recurrence with corresponding resistance .

Intraoperative chemotherapy has been established in various clinics for several years. This procedure combines an operation with local chemotherapy, whereby the cell-destroying drugs are flushed directly into the abdomen after the tumor has been surgically removed. The liquid is heated to 41 - 42 ° C beforehand, which is intended to increase the blood flow to the abdomen and thus the effectiveness of the cytostatics. The procedure, called HIPEC (hyperthermic intraperitoneal chemotherapy) is technically and personnel-intensive and requires the cooperation of different medical specialties.

Another combined procedure of surgery and local chemotherapy is Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC). Here, the chemotherapeutic agent is not flushed into the abdominal cavity in liquid form, but by a microinjection pump (MIP) with a special nozzle (nebulizer, nebulizer) directly in the Abdominal cavity atomized into an aerosol. This increases the penetration depth of the active ingredient into the peritoneum, the duration of the operation is reduced and the chemotherapy can be repeated if necessary due to the low side effects. PIPAC can be used as an exclusively minimally invasive or as a combined open surgical / laparoscopic procedure.

literature

• Philipp Kiewe, Eckhard Thiel (ed.): Peritoneal carcinosis and malignant ascites. 1st edition. UNI-MED, Bremen, London, Boston 2010, ISBN 978-3-8374-2113-2 .
• Marc A. Reymond, Wiebke Solass (Ed.): PIPAC - Pressurized IntraPeritoneal Aerosol Chemotherapy - Cancer under Pressure . 1st edition. De Gruyter, Berlin 2014, ISBN 978-3-11-034594-0 .

Web links

• Chemotherapy directly in the abdominal cavity improves the chances of therapy: Double chemotherapy for more effective treatment of ovarian cancer .
• TV report WDR local time Ruhr: PIPAC .
• Animation: Aerosol chemotherapy shortens the treatment time and reduces side effects: PIPAC / MIP

Individual evidence

1. ↑ Surgical University Clinic Würzburg: Peritoneal Carcinosis ( Memento from February 22, 2011 in the Internet Archive ) .
2. ↑ Schwenk, Mall, Neudecker: Peritonealkarzinose ( Memento from September 16, 2012 in the Internet Archive ) .
3. ^ Alfred Königsrainer: Better chances of recovery in peritoneal carcinosis ( memento from September 17, 2012 in the Internet Archive ) .
4. ↑ Marc Reymond: IntraPeritoneal Pressure Aerosol Chemotherapy (PIPAC) with oxaliplatin in colorectal cancer with advanced peritoneal cancer .
5. ↑ Jürgen Zieren: The Pressure Aerosol Chemotherapy (PIPAC) - Less is sometimes more ( Memento from January 19, 2015 in the Internet Archive ) .

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !