Malignant neoplasms of almost any organs lead to the appearance of metastases. Secondary foci significantly reduce the patient's chances of a full recovery.
Metastases include peritoneal carcinomatosis, manifested mainly as ascites, increasing symptoms of intoxication and weight loss. Carcinomatosis is considered to be an extremely unfavorable disease, with such a complication, mainly using palliative, that is, life-supporting therapy.
What is peritoneal carcinomatosis?
Cancer - oncological, secondary pathology resulting from the transfer of cancer cells from the primary focus.
The cancer cells trapped in the serous cavity are fixed in them and begin to form formations, in shape they resemble the millet grains. Gradually, these new growths expand in size, occupy new areas and eventually merge, creating a large tumor.
The photo shows an open carcinomatosis of the peritoneum
Malignant process leads to disruption of the resorptive and exudative functions of the serous membrane of the peritoneum. This change causes accumulation of excess fluid that accumulates and leads to ascites.
Survey of patients with peritoneal carcinomatosis allowed to find out that this complication is most often found in patients with gastrointestinal tract cancer - stomach, pancreas.
In second place among the causes of cancer necrosis is ovarian cancer, which indicates that women are exposed to this complication several times more compared to men.
Peritoneal injury in cancer of any of the organs is considered an unfavorable sign. Many types of treatment with this diagnosis can not be used, so the patient does not live long.
Causes of
The primary cause of the formation of the peritoneal carcinomatosis is the already existing primary cancerous focus. Tumor cells inevitably acquire mobility as a result of their development, and thus can separate and move.
Their spreading takes place:
- With blood or lymph flow.
- By germination of the primary malignant neoplasm in the peritoneum.
- With surgical intervention undertaken to remove the primary cancerous tumor.
The area of the peritoneum and, accordingly, the serous membrane, where tumor cells can reach, reaches two square meters in some people. Similar dimensions determine the location of the peritoneum in the abdominal cavity, that is, it has contiguous folds.
This anatomical structure contributes to the fact that a significant part of the peritoneum is immediately affected by a malignant process.
The rapid development of carcinomatosis is facilitated by several disease-provoking factors:
- Close contact of the peritoneum with most digestive organs.
- Permanent close contact of the folds of the peritoneum with each other.
- The presence of an extensive network of lymphatic and blood vessels in the organ.
Cancer cells that enter the peritoneum try to gain a foothold where the organ is least affected by intestinal motility. The likelihood of carcinomatosis also depends on the size of the primary tumor, the degree of its penetration deep into the organ.
With undifferentiated stomach cancer, the peritoneum is affected by tumor cells in more than half of the patients.
Signs and classification of
Since peritoneal carcinomatosis is a secondary cancerous lesion, the person initially has symptoms that are characteristic of a primary malignant tumor.
But in some cases it is the lesion of the serous membrane with the corresponding clinical picture that allows the diagnosis of cancer.
The main signs indicating the development of malignant lesions of the peritoneum include:
- Appearance of stupid, aching pains. They can be either persistent or disturbing a patient for several hours or days.
- Increase in the abdomen on the background of a sharp decrease in weight. An enlarged abdomen is formed due to accumulation of fluid in the abdominal cavity, this pathology is designated as ascites.
- Severe dyspepsia. The patient has nausea, pain and colic in the abdomen, vomiting is possible. There are difficulties with evacuation of the intestine, often constipation is replaced by diarrhea.
- Intensifying symptoms of intoxication. Severe weakness, heavy sweats, chills, fever, pain in the muscles and head - all these signs are characteristic of developing peritoneal carcinomatosis.
In medicine, a classification of peritoneal carcinomatosis is used, based on the localization of metastases and their number:
- P1 is a local, that is, a one-site lesion of the peritoneum.
- P2 - revealing several foci, indicating a carcinomatosis. Between these foci there are patches of unchanged peritoneum.
- P3 - numerous, confluent malignant foci.
Diagnostic measures
An oncologist is likely to suspect oncological carcinosis of the peritoneum on symptoms in those who have a history of cancer.
But in any case, with unclear pain in the abdomen, weight loss and other signs of cancer education, the doctor must send his patient to a number of diagnostic procedures to confirm or exclude the diagnosis.
Assigns:
- ultrasound of the abdominal cavity organs, pelvic organs. This method allows you to detect the localization of the primary tumor, reveals changes in the peritoneum, their location, size.
- Computed tomography examines the abdominal region layer by layer, revealing all pathological foci, their structure, location.
- MSCT with contrast is necessary to assess the prevalence of the tumor process, detection of lesions of lymph nodes.
- Laparoscopy allows not only to examine the peritoneum, but also takes the modified tissue for biopsy.
- The blood test of RT-PCR sets the localization site of the primary focus with a high percentage of accuracy.
Approximately 5% of cases occur when a primary cancerous tumor is detected, sometimes its size is so minimal that it can not be detected in vivo.
Medical care
Treatment of patients with revealed carcinomatosis of the peritoneum is rather complicated and not always effective.
If possible, a surgical operation is prescribed, combined with chemotherapy.
Many new methods of anti-cancer treatment are used, so it can not be said that in the future there will be no way to defeat the peritoneal malignancy.
Surgical treatment
Surgical treatment consists primarily in removing the primary focus, affected lymph nodes and foci of insemination with tumor cells in the peritoneum. The operation is often combined with the simultaneous removal of the uterus and its appendages, gall bladder, sigmoid colon, part of the large or small intestine.
Chemotherapy
In the treatment of patients with carcinomatosis, the peritoneum is now using one of the modern methods - intraperitoneal hyperthermia chemotherapy. This method is introduced in the introduction of chemotherapy with the help of hot air directly into the peritoneum, which is possible immediately during the operation.
The solution with chemotherapy is in the peritoneum for about an hour, during which time it continuously circulates and destroys the cancer cells. Hyperthermic chemotherapy increases the effectiveness of treatment several times.
Treatment of the primary focus of
In case of peritoneal carcinomatosis it is necessary to detect the primary focus and to evaluate its stage, localization, prevalence of metastases in the body. The decision on treatment is taken after all studies.
If the stage of the cancer process and the location of the tumor allows, then an operation is performed to remove the tumor. In addition, sessions of chemotherapy, radiation exposure are prescribed.
Symptomatic therapy
Symptomatic therapy is a treatment aimed at eliminating or reducing the underlying symptoms of the disease. When carcinomatosis is most often performed:
- Treatment of ascites. It consists in the removal of accumulated fluid through a puncture in the abdominal wall.
- Analgesia , in neglected cases, pain relief is helped only by a narcotic analgesic.
- Improving the work of the digestive system. It is necessary to strengthen peristalsis, improve digestion and digestibility of food.
- Intravenous infusion of solutions. This treatment has a detoxification effect and normalizes the electrolyte composition of the blood.
- Treatment with diuretics , which contribute to the withdrawal of excess fluid.
If necessary, patients are prescribed drugs to improve the work of the heart and blood vessels, enzymes, antispasmodics. The patient is necessarily under observation with periodic repeated diagnostic examination.
Duration and life expectancy of
Identification of peritoneal carcinomatosis in patients with cancerous tumors significantly worsens the prognosis of their life.
If carcinomatosis captures most of the peritoneum, then the patient's death occurs within a few months. Palliative medicine allows only a few to ease his health.