Close
New

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

 

Peritoneal Cancer

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

Practice Essentials

Peritoneal neoplasia can originate de novo from the peritoneal tissues (primary) or invade or metastasize into the peritoneum from adjacent or remote organs (secondary). Primary peritoneal cancers, some of which have been implicated in many cases of carcinomas of unknown primary origin, include ovarian cancer arising in women several years after bilateral oophorectomy. Other described primary peritoneal cancers and tumors include malignant mesothelioma, benign papillary mesothelioma, desmoplastic small round cell tumors, peritoneal angiosarcoma, leiomyomatosis peritonealis disseminata (LPD), and peritoneal hemangiomatosis.

Signs and symptoms

Primary peritoneal carcinoma usually manifests with abdominal distention and diffuse nonspecific abdominal pain secondary to ascites. This tumor is described almost exclusively in women.

Patients with malignant peritoneal mesothelioma usually manifest with symptoms and signs of advanced disease, including the following:

  • Abdominal pain
  • Ascites
  • Weight loss
  • An abdominal mass

See Clinical Presentation for more detail.

Diagnosis

The workup of peritoneal lesions includes peritoneal lavage cytology, as follows:

  • Peritoneal lavage can be performed using a percutaneous closed technique or at the time of laparoscopy or laparotomy
  • The sensitivity of the test results depends on the ability to completely lavage all regions of the peritoneal cavity and the ability to detect cancer cells being shed into the peritoneal cavity by the tumor

Laparoscopy or laparotomy

  • Direct visualization of the peritoneal surfaces along with palpation of the abdominal contents is by far the most sensitive modality for detecting peritoneal cancer
  • Laparoscopy is minimally invasive and allows for safe, directed peritoneal lavage
  • Open abdominal exploration and palpation are extremely sensitive for 1- to 2-mm peritoneal nodules

Studies for malignant peritoneal mesothelioma include the following:

  • Cytologic examination of ascites can suggest the diagnosis
  • Percutaneous biopsy of the omentum can help verify the diagnosis

Standard imaging tests, including ultrasonography and helical CT scans, are notably insensitive for the detection of peritoneal tumors. Ultrasonography findings that may suggest the presence of peritoneal lesions include the following:

  • Ascites
  • Fixing together of bowel loops
  • Thickening of mesentery
  • Omental matting

CT scan findings that suggest primary papillary serous carcinoma of the peritoneum include the following:

  • Ascites
  • Omental caking
  • Diffuse enhancement with nodular thickening of the parietal peritoneum of the pelvis
  • Normal-sized ovaries, with or without a fine enhancing surface nodularity of the ovary

CT findings in patients with malignant peritoneal mesotheliomas range from peritoneum-based masses (a so-called "dry" appearance) to ascites, irregular or nodular peritoneal thickening, and an omental mass (a so-called "wet" appearance). Scalloping of the peritoneum or direct invasion of adjacent abdominal organs may also be seen.[1]

Radionuclide scan studies can help confirm the diagnosis of peritoneal hemangiomas; the isotope concentrates in the area where platelets are being sequestered. A CT scan and ultrasound also may detect larger hemangiomas. Angiographic evaluation is a more precise, although invasive, procedure that may be considered when radionuclide scans, CT scans, and ultrasound findings are negative.

See Workup for more detail.

Management

Multimodality therapy is currently the most commonly accepted therapeutic approach for peritoneal mesothelioma. This includes using the combination of the following:

  • Surgical cytoreduction
  • Intraperitoneal perioperative chemotherapy
  • Hyperthermia

Heated chemotherapeutic drugs used intraoperatively include the following:

  • Cisplatin
  • Mitomycin
  • Doxorubicin

For patients with unresectable or recurrent malignant mesothelioma, palliative systemic chemotherapy should be considered. Palliative regimens may include the following:

  • Cisplatin plus pemetrexed
  • Cisplatin plus paclitaxel or mitomycin, doxorubicin, and irinotecan
  • Intraperitoneal instillation of radioactive colloidal gold (Au-198)

Primary peritoneal carcinoma is treated with tumor debulking followed by chemotherapy with 5-fluorouracil, doxorubicin, or cisplatin. Newer approaches include the following:

  • Taxanes, topoisomerase I inhibitors, gemcitabine, and vinorelbine, alone or in combinations
  • Adjunctive antiangiogenic drugs such as bevacizumab and erlotinib

Surgical care

  • Treatment of primary peritoneal carcinoma consists of total abdominal hysterectomy and bilateral salpingo-oophorectomy as needed, with debulking of tumor and follow-up chemotherapy
  • Treatment of malignant peritoneal mesothelioma consists primarily of surgical palliation; complete surgical resection is rarely, if ever, feasible
  • Benign cystic mesothelioma tends to recur even with aggressive surgical removal; however, among recorded cases, no deaths have been attributable to this disorder
  • In patients with desmoplastic small cell tumors, the combination of aggressive surgical debulking and systemic chemotherapy with cyclophosphamide, doxorubicin, and vincristine interspersed with ifosfamide, etoposide, and mesna (P6 protocol) appears to lead to an improved outcome
  • Treatment of peritoneal and GI hemangiomas has involved surgical removal

See Treatment and Medication for more detail.

Next

Background

The peritoneum is a serous lining of mesothelial cells with a rich vascular and lymphatic capillary network that covers the abdominal and pelvic walls and organs. Peritoneal neoplasia can originate de novo from the peritoneal tissues (primary) or invade or metastasize into the peritoneum from adjacent or remote organs (secondary).

A number of primary cancers have been described to originate from the peritoneum, some of which have been implicated in many cases of carcinomas of unknown primary origin. Ovarian cancer arising in women several years after bilateral oophorectomy is believed to be one of these primary peritoneal cancers. Other described primary peritoneal cancers and tumors include malignant mesothelioma, benign papillary mesothelioma, desmoplastic small round cell tumors, peritoneal angiosarcoma, leiomyomatosis peritonealis disseminata (LPD), and peritoneal hemangiomatosis.

Previous
Next

Pathophysiology

The peritoneal cavity, enclosed by visceral and parietal peritonea, is the largest potential space in the body. Any pathologic process involving the peritoneal cavity can easily disseminate throughout this space by means of unrestricted movement of fluid and cells.

Primary malignant diseases arising from the peritoneal cavity include malignant mesothelioma, cystic mesothelioma, primary peritoneal carcinoma, and desmoplastic small round cell tumor.

Malignant mesothelioma

Malignant peritoneal mesothelioma is a rare but aggressive tumor derived from the peritoneal mesothelium. Although most mesotheliomas involve the pleural surface, 20-30% arise from the peritoneum and are associated with asbestos exposure and abdominal therapeutic radiation. Association of malignant peritoneal mesothelioma and asbestos exposure has been reported to be as high as 83%.

Mesotheliomas are composed of strands of connective tissue covered by cells that react positively to periodic acid-Schiff staining in the cytoplasm. These cells grow in multiple layers, forming papillary or tubular formations. Histologically, malignant mesothelioma is classified into epithelial, sarcomatoid, and mixed. Clinical features of malignant mesothelioma include abdominal pain, abdominal or pelvic masses, and thrombocytosis; ascites is the major factor in the disease morbidity and mortality. Rarely, the tumor spreads into the pleural space.

On CT scan, this neoplasm can appear as peritoneum-based masses or abdominal ascites with associated nodular or diffuse peritoneal thickening.

This locally aggressive disease is difficult to treat or palliate. Commonly, treatment regimens combine aggressive cytoreductive surgery with intraperitoneal chemotherapy. Thorough cytoreductive surgery is the cornerstone of current treatment, while hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) is a promising strategy in suitable patients.[2]

Cystic mesothelioma

Cystic mesothelioma is a rare intermediate-grade tumor with a predilection for surfaces of the pelvis.[3] Typically, these lesions consist of multiple grapelike clusters of mesothelium-lined cysts separated by fibrous tissue. The nomenclature for this entity is confusing, and several synonyms (eg, multilocular peritoneal inclusion cyst, cystic mesothelioma) are used interchangeably in the literature.

This rare tumor commonly occurs in young to middle-aged women and typically presents with abdominal pain, tenderness, or distension.

Radiologic tests demonstrate thin-walled cysts containing watery secretions, easily seen on ultrasound, CT scan, and MRI.[4]

Some authors reported effective intraperitoneal chemotherapy, but no clinical study is available about long-term outcome. The short-term prognosis is favorable, although the tumor recurs in 25–50% of cases.

The differential diagnosis includes lymphangioma, mesenteric-omental cysts, ovarian cystadenoma and cystadenocarcinoma, cystic teratoma, pseudomyxoma peritonei, cystic smooth muscle tumors, visceral cysts, and endometriosis.

Primary peritoneal carcinoma

Primary peritoneal carcinoma (ie, serous surface papillary carcinoma) arises primarily from peritoneal cells. The mesothelium of the peritoneum and the germinal epithelium of the ovary arise from the same embryologic origin; therefore, the peritoneum may retain the multipotentiality allowing the development of a primary carcinoma.

This rare malignancy predominantly affects postmenopausal women and typically displays multicentric peritoneal and omental involvement. Pathologically and clinically, it resembles papillary serous ovarian carcinoma. This malignancy is differentiated from its ovarian counterpart by the fact that it involves the extraovarian peritoneum significantly and the ovarian surface minimally or not at all. Extensive calcification or omental caking is present in many cases and is a useful CT finding to exclude mesothelioma. The absence of an ovarian mass is critical for excluding metastatic papillary serous ovarian carcinoma, which otherwise has a similar CT appearance.

Treatment of this malignancy is very similar to that of epithelial ovarian cancer, which includes combination chemotherapy after optimal cytoreductive surgery.

Desmoplastic small round cell tumor

This tumor is a highly aggressive malignancy that has recently been described. It involves the peritoneal cavity in most cases. Unlike the other primary peritoneal neoplasms, desmoplastic small round cell tumor (DSRCT) most often affects young adults. This malignancy extensively and rapidly invades the peritoneal surfaces with hematogenous metastasis to the liver, lungs, and lymph nodes.

Cytologically, DSRCT is a highly cellular tumor composed of small round cells with granular chromatin, nuclear molding, and inconspicuous nucleoli that are arranged singly and in clusters.[5] This tumor exhibits a unique immunohistochemical profile, characterized by coexpression of epithelial (keratin and epithelial membrane antigen), neural (neuron-specific enolase and CD56), mesenchymal (vimentin), and myogenic (desmin) markers. The reciprocal chromosomal translocation t (11; 22)(p13; q12) is also specific for DSRCT.

Radiological investigation shows multiple rounded peritoneal masses with or without ascites. The omentum and paravesical regions are often involved.

The recommended treatment is a combination of multiagent chemotherapy with adjuvant surgery and radiation. The overall survival for people with this disease is poor despite aggressive treatment.

Other neoplasms

Although clear cell carcinoma is often derived from the ovary and associated with endometriosis, cases of peritoneal origin have been reported. Residual tumor volume appears to determine survival in these patients. These tumors are typically resistant to conventional platinum-based chemotherapy but in one case, adjuvant chemotherapy using irinotecan and cisplatin was effective.[6]

In addition to the above-mentioned primary peritoneal malignancies arising from the peritoneal lining, various types of neoplasms may develop from mesenchymal and lymphatic tissues of the abdominal and pelvic cavities. This includes different forms of sarcomas, histiocytoma,[7] gastrointestinal stromal tumors (GIST), and lymphoproliferative malignancies. Moreover, the differential of peritoneal malignancies includes many benign tumors derived from lymphatic, vascular, neuromuscular, or fatty tissues.

Previous
Next

Frequency

United States

All of the primary peritoneal cancers are rare. Primary peritoneal carcinoma is very uncommon. Peritoneal mesotheliomas are also rare, with 2 cases per 1 million population reported each year. However, the incidence appears to be increasing. Based on the prior use of asbestos, more than 8 million people in the United States were exposed and at risk. Benign cystic peritoneal mesotheliomas are rare.

Previous
Next

Mortality/Morbidity

See the list below:

  • Survival is poor for patients with primary peritoneal carcinoma, with 100% mortality; the median survival reported is 12-25 months, even with extensive surgery and chemotherapy.
  • Benign cystic peritoneal mesotheliomas are associated with prolonged survival despite bulky disease.
  • Desmoplastic small round cell tumors are associated with a reported median survival of 17 months.

Sex

See the list below:

  • Primary peritoneal carcinoma is a rare tumor that occurs almost exclusively in women.
  • Malignant mesotheliomas show extreme male predominance (93% in one series).

Age

See the list below:

  • Primary peritoneal carcinoma occurs in older patients than do epithelial ovarian cancers.
  • Desmoplastic small round cell tumors occur in adolescent persons and young men.
  • Benign cystic peritoneal mesotheliomas are rare and are found predominantly in younger women.
  • Most cases of leiomyomatosis peritonealis disseminata have been discovered in reproductive-aged women (mean age 37 y), in young pregnant women, and in women who have hormonal excess for any other reason. In most reported cases, nodules either regress or exhibit growth once the hormonal stimulation has been removed.
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.