Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Peritoneal Cancer Clinical Presentation

  • Author: Wissam Bleibel, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
 
Updated: Apr 28, 2015
 

History

See the list below:

  • Primary peritoneal carcinoma usually manifests with abdominal distention and diffuse nonspecific abdominal pain secondary to ascites. This tumor is described almost exclusively in women. Atypical presentations of primary peritoneal carcinoma have been described, including a case of severe glandular dysplasia on a screening Papanicolaou test (Pap smear).
  • Malignant peritoneal mesothelioma usually manifests with symptoms and signs of advanced disease, including pain, ascites, weight loss, or an abdominal mass.
    • These tumors tend to manifest with diffuse involvement of the peritoneal cavity, including omental caking and diaphragmatic and pelvic tumor deposits.
    • Thrombocytosis is common and is associated with a poor prognosis.
    • Other common clotting abnormalities include phlebitis, emboli, hemolytic anemia, and disseminated intravascular coagulation.
    • Esophageal achalasia, secondary amyloidosis, and dermatomyositis have been reported.
    • Most patients die without metastasis or involvement of the chest.
  • Desmoplastic small round cell tumors occur typically in young patients and manifest with extensive involvement of the peritoneal surfaces. Rapid multifocal growth and hematogenous metastasis to the liver, lungs, and lymph nodes are common.
  • Leiomyomatosis peritonealis disseminata is found most commonly in women of reproductive age who are pregnant; these patients are usually asymptomatic, have a long-term history of oral contraceptive use, or have uterine leiomyomas at the time of diagnosis. All cases of this disease have been discovered intraoperatively during obstetric and gynecologic surgical procedures.
  • Peritoneal hemangiomas are usually associated with hemangiomas of the GI tract. They are rare and can manifest with ascites, anemia (from chronic blood loss), thrombocytopenia, and coagulopathy.
Next

Causes

See the list below:

  • A chromosomal translocation, which results in the fusion of the Ewing sarcoma gene with the Wilms tumor gene, has been identified and implicated in desmoplastic small round cell tumors.
  • Hereditary predisposition may play a role in primary peritoneal carcinoma; patients with the BRCA1 mutation have an increased risk.
  • Susceptibility to mesothelioma may be influenced by genetic makeup.[8]
  • Although conventional wisdom dictates that asbestos is the environmental factor most commonly associated with mesothelioma, asbestos does not transform human mesothelial cells in tissue culture. This suggests that additional carcinogens act in concert with asbestos to cause mesothelioma. Simian virus 40 has been proposed as an etiologic agent; however, the evidence for this hypothesis is weakening.[8]
Previous
 
 
Contributor Information and Disclosures
Author

Wissam Bleibel, MD Staff Physician, Department of Internal Medicine, Caritas Carney Hospital / Tufts University School of Medicine

Wissam Bleibel, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Sarah K May, MD Consulting Staff, Department of Hematology-Oncology, Caritas Carney Hospital, Commonwealth Hematology-Oncology PC

Disclosure: Nothing to disclose.

Olga Kozyreva, MD Attending Physician, Division of Hematology-Oncology, St Elizabeth's Medical Center; Assistant Professor, Tufts University School of Medicine

Disclosure: Nothing to disclose.

Asif Mahmood, MD Research Associate, Medical College of Virginia Cancer Center

Asif Mahmood, MD is a member of the following medical societies: Society of Hospital Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Benjamin Movsas, MD 

Benjamin Movsas, MD is a member of the following medical societies: American College of Radiology, American Radium Society, American Society for Radiation Oncology

Disclosure: Nothing to disclose.

Chief Editor

N Joseph Espat, MD, MS, FACS Harold J Wanebo Professor of Surgery, Assistant Dean of Clinical Affairs, Boston University School of Medicine; Chairman, Department of Surgery, Director, Adele R Decof Cancer Center, Roger Williams Medical Center

N Joseph Espat, MD, MS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Parenteral and Enteral Nutrition, American Society of Clinical Oncology, Americas Hepato-Pancreato-Biliary Association, Association for Academic Surgery, Central Surgical Association, Chicago Medical Society, International Hepato-Pancreato-Biliary Association, Pancreas Club, Sigma Xi, Society for Leukocyte Biology, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Surgical Oncology, Society of University Surgeons, Southeastern Surgical Congress, Southern Medical Association, Surgical Infection Society

Disclosure: Nothing to disclose.

Additional Contributors

Robert C Shepard, MD, FACP Associate Professor of Medicine in Hematology and Oncology at University of North Carolina at Chapel Hill; Vice President of Scientific Affairs, Therapeutic Expertise, Oncology, at PRA International

Robert C Shepard, MD, FACP is a member of the following medical societies: American Association for Cancer Research, American Association for Physician Leadership, European Society for Medical Oncology, Association of Clinical Research Professionals, American Federation for Clinical Research, Eastern Cooperative Oncology Group, Society for Immunotherapy of Cancer, American Medical Informatics Association, American College of Physicians, American Federation for Medical Research, American Medical Association, American Society of Hematology, Massachusetts Medical Society

Disclosure: Nothing to disclose.

References
  1. Park JY, Kim KW, Kwon HJ, Park MS, Kwon GY, Jun SY, et al. Peritoneal mesotheliomas: clinicopathologic features, CT findings, and differential diagnosis. AJR Am J Roentgenol. 2008 Sep. 191(3):814-25. [Medline]. [Full Text].

  2. Deraco M, Casali P, Inglese MG, Baratti D, Pennacchioli E, Bertulli R, et al. Peritoneal mesothelioma treated by induction chemotherapy, cytoreductive surgery, and intraperitoneal hyperthermic perfusion. J Surg Oncol. 2003 Jul. 83(3):147-53. [Medline].

  3. Szollosi A, Ferenc C, Pinter T, Erenyi A, Nagy A. [Benign cystic mesothelioma, a rare tumor of the peritoneum]. Magy Seb. 2005 Feb. 58(1):35-7. [Medline].

  4. Wong WL, Johns TA, Herlihy WG, Martin HL. Best cases from the AFIP: multicystic mesothelioma. Radiographics. 2004 Jan-Feb. 24(1):247-50. [Medline].

  5. Chang F. Desmoplastic small round cell tumors: cytologic, histologic, and immunohistochemical features. Arch Pathol Lab Med. 2006 May. 130(5):728-32. [Medline].

  6. Takano M, Yoshokawa T, Kato M, Aida S, Goto T, Furuya K, et al. Primary clear cell carcinoma of the peritoneum: report of two cases and a review of the literature. Eur J Gynaecol Oncol. 2009. 30(5):575-8. [Medline].

  7. Bodner K, Bodner-Adler B, Mayerhofer S, Grunberger W, Wierrani F, Czerwenka K, et al. Malignant fibrous histiocytoma (MFH) of the mesentery: a case report. Anticancer Res. 2002 Mar-Apr. 22(2B):1169-70. [Medline].

  8. Rudd RM. Malignant mesothelioma. Br Med Bull. 2010 Jan 4. [Medline].

  9. Sebbag G, Shmookler BM, Chang D, Sugarbaker PH. Peritoneal carcinomatosis from an unknown primary site. Management of 15 patients. Tumori. 2001 Mar-Apr. 87(2):67-73. [Medline].

  10. Pentheroudakis G, Pavlidis N. Serous papillary peritoneal carcinoma: Unknown primary tumour, ovarian cancer counterpart or a distinct entity? A systematic review. Crit Rev Oncol Hematol. 2009 Nov 6. [Medline].

  11. Clement PB. Reactive tumor-like lesions of the peritoneum. Am J Clin Pathol. 1995 Jun. 103(6):673-6. [Medline].

  12. Filippi L, D'Arienzo M, Scopinaro F, Salvatori R, Bagni O. Usefulness of Dual-Time Point Imaging After Carbonated Water for the Fluorodeoxyglucose Positron Emission Imaging of Peritoneal Carcinomatosis in Colon Cancer. Cancer Biother Radiopharm. 2012 Nov 7. [Medline].

  13. McConnell YJ, Mack LA, Francis WP, Ho T, Temple WJ. HIPEC + EPIC versus HIPEC-alone: Differences in major complications following cytoreduction surgery for peritoneal malignancy. J Surg Oncol. 2012 Nov 5. [Medline].

  14. Iversen LH, Rasmussen PC, Laurberg S. Value of laparoscopy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis. Br J Surg. 2012 Nov 2. [Medline].

  15. Stuart-Buttle CE, Smart CJ, Pritchard S, Martin D, Welch IM. Desmoplastic small round cell tumour: a review of literature and treatment options. Surg Oncol. 2008 Aug. 17(2):107-12. [Medline].

  16. Yan TD, Deraco M, Baratti D, Kusamura S, Elias D, Glehen O, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience. J Clin Oncol. 2009 Dec 20. 27(36):6237-42. [Medline].

  17. Abeloff MD, Armitage JO, Lichter AS, Niederhuber JE. Clinical Oncology. 2nd ed. Philadelphia, Pa: Churchill Livingstone; 2000.

  18. Al Balushi Z, Bulduc S, Mulleur C, Lallier M. Desmoplastic small round cell tumor in children: a new therapeutic approach. J Pediatr Surg. 2009 May. 44(5):949-52. [Medline].

  19. Bani-Hani KE, Gharaibeh KA. Malignant peritoneal mesothelioma. J Surg Oncol. 2005 Jul 1. 91(1):17-25. [Medline].

  20. Barclay L. Benefit From CS/HIPEC in Advanced Abdominal Cancers. Medscape Medical News. Available at http://www.medscape.com/viewarticle/806289. Accessed: July 15, 2013.

  21. Biswas G, Laskar S, Banavali SD, Gujral S, Kurkure PA, Muckaden M, et al. Desmoplastic small round cell tumor: extra abdominal and abdominal presentations and the results of treatment. Indian J Cancer. 2005 Apr-Jun. 42(2):78-84. [Medline].

  22. Brigand C, Monneuse O, Mohamed F, Sayag-Beaujard AC, Isaac S, Gilly FN, et al. Peritoneal mesothelioma treated by cytoreductive surgery and intraperitoneal hyperthermic chemotherapy: results of a prospective study. Ann Surg Oncol. 2006 Mar. 13(3):405-12. Epub 2006 Jan 30. [Medline].

  23. Chouli M, Viala J, Dromain C, Fizazi K, Duvillard P, Vanel D. Intra-abdominal desmoplastic small round cell tumors: CT findings and clinicopathological correlations in 13 cases. Eur J Radiol. 2005 Jun. 54(3):438-42. [Medline].

  24. Cormio G, Di Vagno G, Di Gesu G, Mastroianni M, Melilli GA, Vimercati A, et al. Primary peritoneal carcinoma: a report of twelve cases and a review of the literature. Gynecol Obstet Invest. 2000. 50(3):203-6. [Medline].

  25. Devita VT, Hellman S, Rosenthal SA. Cancer. Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins (LWW); 2005.

  26. Gómez Portilla A, Cendoya I, Muriel J, Olabarria I, Guede N, Moraza N, et al. [Malignant peritoneal mesothelioma. Our experienced with triple combined therapy: cytoreduction, intraperitoneal perioperative chemotherapy and hyperthermia]. Cir Esp. 2007 Feb. 81(2):82-6. [Medline].

  27. Haslinger M, Francescutti V, Attwood K, et al. A contemporary analysis of morbidity and outcomes in cytoreduction/hyperthermic intraperitoneal chemoperfusion. Cancer Med. 2013 Jun;2(3):334-42.

  28. Jaaback KS, Ludeman L, Clayton NL, Hirschowitz L. Primary peritoneal carcinoma in a UK cancer center: comparison with advanced ovarian carcinoma over a 5-year period. Int J Gynecol Cancer. 2006 Jan-Feb. 16 Suppl 1:123-8. [Medline].

  29. Kim HC, Lee JM, Kim SH, Kim KW, Lee M, Kim YJ, et al. Primary gastrointestinal stromal tumors in the omentum and mesentery: CT findings and pathologic correlations. AJR Am J Roentgenol. 2004 Jun. 182(6):1463-7. [Medline].

  30. Ko SF, Chou FF, Huang CH, Ng SH, Wan YL, Lee TY, et al. Primary synovial sarcoma of the gastrocolic ligament. Br J Radiol. 1998 Apr. 71(844):438-40. [Medline].

  31. Mohamed F, Sugarbaker PH. Peritoneal mesothelioma. Curr Treat Options Oncol. 2002 Oct. 3(5):375-86. [Medline].

  32. Nam JH, Kim YM, Jung MH, Kim KR, Yoo HJ, Kim DY, et al. Primary peritoneal carcinoma: experience with cytoreductive surgery and combination chemotherapy. Int J Gynecol Cancer. 2006 Jan-Feb. 16(1):23-8. [Medline].

  33. Ordóñez NG. Pathologic characterization and differential diagnosis of malignant peritoneal mesothelioma. Recent Results Cancer Res. 2007. 169:123-36. [Medline].

  34. Papadatos D, Taourel P, Bret PM. CT of leiomyomatosis peritonealis disseminata mimicking peritoneal carcinomatosis. AJR Am J Roentgenol. 1996 Aug. 167(2):475-6. [Medline].

  35. Pavlidis N, Briasoulis E, Hainsworth J, Greco FA. Diagnostic and therapeutic management of cancer of an unknown primary. Eur J Cancer. 2003 Sep. 39(14):1990-2005. [Medline].

  36. Pickhardt PJ, Bhalla S. Primary neoplasms of peritoneal and sub-peritoneal origin: CT findings. Radiographics. 2005 Jul-Aug. 25(4):983-95. [Medline].

  37. Pickhardt PJ, Bhalla S. Unusual nonneoplastic peritoneal and subperitoneal conditions: CT findings. Radiographics. 2005 May-Jun. 25(3):719-30. [Medline].

  38. Popovska S, Veselinova T, Gorchev G, Tomov S, Elenchev L. [Primary peritoneal carcinoma: a report of two cases and a review of the literature]. Akush Ginekol (Sofiia). 2005. 44(1):8-10. [Medline].

  39. Shen P, Levine EA, Hall J, Case D, Russell G, Fleming R, et al. Factors predicting survival after intraperitoneal hyperthermic chemotherapy with mitomycin C after cytoreductive surgery for patients with peritoneal carcinomatosis. Arch Surg. 2003 Jan. 138(1):26-33. [Medline].

  40. Stafford-Johnson DB, Bree RL, Francis IR, Korobkin M. CT appearance of primary papillary serous carcinoma of the peritoneum. AJR Am J Roentgenol. 1998 Sep. 171(3):687-9. [Medline].

  41. Sugarbaker PH, Acherman YI, Gonzalez-Moreno S, Ortega-Perez G, Stuart OA, Marchettini P, et al. Diagnosis and treatment of peritoneal mesothelioma: The Washington Cancer Institute experience. Semin Oncol. 2002 Feb. 29(1):51-61. [Medline].

  42. Suh-Burgmann E, Powell CB. Cytoreductive surgery for gynecologic malignancies-new standards of care. Surg Oncol Clin N Am. 2007 Jul. 16(3):667-82. [Medline].

Previous
Next
 
Dr. Oliver Zivanovic, MD, PhD, discusses the role of hyperthermic intraperitoneal chemotherapy in ovarian cancer. Courtesy of Memorial Sloan-Kettering Cancer Center.
Dr. Oliver Zivanovic, MD, PhD, demonstrates hyperthermic intraperitoneal chemotherapy for ovarian cancer. Courtesy of Memorial Sloan-Kettering Cancer Center.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.