The peritoneum is a membrane that covers the inner lining of the abdominal cavity and the organs lying in there. It helps to support these organs and contains the blood vessels and nerves that supply them. The space in the abdominal cavity covered by the peritoneum is known as the peritoneal cavity (Figure 1).
Figure 1: Peritoneal Cavity
Metastasis occurs when cancer spreads from its original site to other parts of the body. Peritoneal metastases refer to cancer that has spread to the peritoneum from other organs. When cancer spreads from other organs, it is considered advanced and denote Stage IV disease in most cases.
Cancers that develop from the peritoneum itself, such as primary peritoneal cancer or peritoneal mesothelioma, are very rare.
Patients who suffer from cancers mainly of abdominal origins such as gastric (stomach), ovarian, colorectal, appendix and pancreas cancers are at risk of developing peritoneal metastases. Less commonly, other cancers can also spread to the peritoneum.
*People who think they may be at risk should discuss this with their doctor.Complications related to peritoneal metastases:
- Ascites: Peritoneal metastases tend to produce fluid in the abdomen, known as ascites, which causes abdominal distension (Figure 2).
- Intestinal obstruction: Peritoneal metastases may cause blockage of the intestines.
- Hydronephrosis: The kidney ureters may be blocked by peritoneal metastases. This may affect the kidney function.
Some common symptoms include:
- Bloating
- Abdominal pain
- Nausea and vomiting
- Constipation
- Loss of appetite
- Weight loss
Figure 2: Ascites due to peritoneal metastasis
*A doctor should be consulted if the above symptoms occur.
Peritoneal metastases develop as cancer spreads. Presently, besides controlling the original cancer, there is little more that can be done to prevent peritoneal metastases. Patients who experience the symptoms mentioned above should seek medical assistance for a thorough evaluation.
The diagnosis of peritoneal cancer can be difficult. Imaging (such as CT or MRI scans), needle drainage of ascitic fluid for analysis, keyhole surgery, or a combination of these may be required to confirm the diagnosis of peritoneal metastases.
Peritoneal metastasis is difficult to treat and is best managed by a multi-disciplinary team that includes surgeons and medical oncologists.
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Systemic chemotherapy: Chemotherapy drugs given intravenously or sometimes in combination with oral tablets circulate through the whole body. This type of treatment is suitable for cancers that have metastasised to multiple parts of the body.
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Cytoreductive Surgery (CRS) with Hyperthermic lntraperitoneal Chemotherapy (HIPEC):
CRS is an extensive surgery that removes all visible cancers within the abdominal cavity. At the end of CRS, a heated chemotherapy solution is applied in the peritoneal cavity to destroy the remaining cancer cells that cannot be seen with the naked eye.
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Intra-peritoneal (IP) chemotherapy: IP chemotherapy (Figure 3) is injected into the peritoneal cavity via an intraperitoneal port that is inserted via keyhole surgery. The port is buried under the skin and connected to a catheter that enters the peritoneal space.
- Find out more about the clinical trial at this
page.
- Read about IP chemotherapy in the news
here.
Figure 3: Set-up of IP Chemotherapy
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Pressurised Intra-Peritoneal Aerosol Chemotherapy (PIPAC): PIPAC (Figure 4) is a novel method of delivering chemotherapy directly into the peritoneal cavity in an aerosol form. It utilises the physical properties of pressurized gas to distribute the drug evenly and deeply. This allows greater penetration of the drug into the cancer cells, with reduced systemic side effects of the chemotherapy agent. PIPAC is performed as a short and simple laparoscopic (keyhole) surgery. Under general anaesthesia, small instruments will be placed into the abdomen. A micro-pump will deliver the chemotherapy drug into the peritoneal cavity as an aerosol. At the end of the procedure, any residual gas within the peritoneal cavity will be removed.
Currently, PIPAC is a minimally-invasive palliative procedure that aims to prolong survival and preserve quality of life. Due to the low dosage applied, PIPAC can be combined with systemic palliative chemotherapy and has minimal organ toxicity. This procedure can be repeated at intervals of 6 weeks to 3 months. More information on PIPAC can be found
here.
Find out more about the clinical trials at this page.
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Figure 4: Set-up of Pressurised Intra-Peritoneal Aerosol Chemotherapy (PIPAC)
Video Demonstration of PIPAC treatment
A video guide to provide a basic understanding of a novel method in Pressurised Intra-Peritoneal Aerosol Chemotherapy (PIPAC) treatment of peritoneal cancer.
At NCIS, patients with peritoneal metastases (peritoneal cancer) will be managed by a multidisciplinary team. This team includes oncologists, surgeons, radiologists, pathologists, dieticians and other allied health workers. Patients are discussed at a multidisciplinary meeting to ensure that the best treatment options are offered to patients. Multiple ongoing research initiatives and trials ongoing at NCIS allow our patients access to cutting-edge treatments.
Health Matters - Novel Drug Delivery Technique for Advanced Cancer Patients
CNA938 interviewed Dr Kim Guowei, Consultant, NUH’s Division of General Surgery (Gastrointestinal Surgery), who shared that the Pressurised Intraperitoneal Aerosol Chemotherapy (PIPAC) procedure is a novel method of anti-cancer drug delivery that has been successfully introduced to Singapore at NUH and the National University Cancer Institute, Singapore (NCIS). This new approach to cancer treatment could potentially bring hope to patients with advanced cancer who suffer many side-effects and still do poorly on conventional chemotherapy. NUH and NCIS have been performing this novel cancer treatment in Asia since December 2016.
NUH trials new form of chemotherapy for late-stage patients
A novel method of anti-cancer drug delivery that allows targeted, more even and greater penetration into the cancer cells has been successfully introduced to Singapore at NUH and National University Cancer Institute, Singapore (NCIS). This new approach to cancer treatment could potentially bring hope to patients with advanced cancer who suffer many side-effects and still do poorly on conventional chemotherapy.
Led by Professor Jimmy So, Head and Senior Consultant with NUH’s Division of General Surgery (Upper Gastrointestinal Surgery) and Dr Yong Wei Peng, Senior Consultant from the Department of Haematology-Oncology, NCIS, NUH and NCIS have been performing this novel cancer treatment in Asia since December 2016. To date, 49 PIPAC procedures for 31 patients have been performed.
Trial treatment for stomach cancer extending lives
Dr Yong Wei Peng, Senior Consultant, Division of Haematology-Oncology, NCIS and Professor Jimmy So, Head, Division of General Surgery (Upper Gastrointestinal Surgery) NUH were interviewed on two stomach cancer trials. The first is an ongoing trial where the chemotherapy drug was injected directly into the abdominal cavity of patients with a particular type of stomach cancer. The second study, which is about precision medicine, found that oxaliplatin worked better in patients with the intestinal sub-type than the diffuse sub-type. A participant of the first trial, Mdm Cindy Chia also shared her experience.
将化疗药水导入胃部 新疗法助胃癌末期病患延长寿命
The NCIS has come up with a new treatment, using Intraperitoneal
Chemotherapy for patients with late-stage stomach cancer. Under this targeted
treatment, the chemo fluid will be inserted directly into the stomach area. Of
the 22 patients who participated in the clinical trial, more than half of the
patients had their lifespan extended more than 16 months, which was
comparatively longer than the usual three to six months for such patients undergoing
the traditional treatment. Prof Jimmy So, Head & Senior Consultant,
Division of Surgical Oncology, NCIS, was interviewed for this exclusive story.
