Peritoneal Cancer Workup

  • Author: Wissam Bleibel, MD; Chief Editor: Jules E Harris, MD   more...
 
Updated: Aug 11, 2010
 

Laboratory Studies

Malignant peritoneal mesothelioma: Findings from cytologic examination of ascites can suggest the diagnosis, and findings from percutaneous biopsy of the omentum can help verify the diagnosis. This condition is usually confined to the abdomen at the time of diagnosis.

Next

Imaging Studies

  • Standard imaging tests, including ultrasonography and helical CT scans, are notably insensitive for the detection of peritoneal tumors.
    • The sensitivity of CT scans for peritoneal nodules measuring smaller than 1 cm is approximately 15-30%.
    • Ultrasonography is similarly insensitive; rather than relying on solid tumor detection, therefore, it is important to consider findings that may suggest the presence of peritoneal lesions. These include the presence of ascites, fixing together of bowel loops, thickening of mesentery, and omental matting.
  • CT scan findings are nonspecific in primary papillary serous carcinoma of the peritoneum. Consider this diagnosis when findings include ascites, omental caking, diffuse enhancement with nodular thickening of the parietal peritoneum of the pelvis, and normal-sized ovaries, with or without a fine enhancing surface nodularity of the ovary.
  • Malignant peritoneal mesotheliomas produce CT findings that 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.[11]
  • Some studies show that MRI is superior to helical CT scan for the detection of peritoneal and bowel wall abnormalities.
  • Positron emission tomography imaging has not been shown to be sensitive for lesions smaller than 1 cm in the abdominal cavity.
  • Findings from 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 scan, and ultrasound findings are negative.
Previous
Next

Procedures

  • The workup of peritoneal lesions includes peritoneal lavage cytology. 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.
  • Direct visualization of the peritoneal surfaces along with palpation of the abdominal contents is by far the most sensitive modality for detecting peritoneal cancer. This can be accomplished with a minimally invasive approach (ie, laparoscopy), which allows for safe, directed peritoneal lavage for cytology, or with open abdominal exploration and palpation of the peritoneal surfaces. Open abdominal exploration and palpation are extremely sensitive for 1- to 2-mm peritoneal nodules.
Previous
Next

Histologic Findings

Primary peritoneal carcinoma is histologically indistinguishable from primary epithelial ovarian carcinoma; however, primary ovarian cancer can be excluded based on certain criteria. First, both ovaries must be of normal size. Second, the extraovarian involvement must be greater than the involvement on the surface of the ovary. Third, the ovarian component must be smaller than 5 by 5 mm within the ovary or confined to the ovarian surface. Finally, the cytologic characteristics must be of the serous type.

Previous
Proceed to Treatment & Management
 
 
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)

Olga Kozyreva, MD  Fellow, Department of Hematology-Oncology, Tufts Medical Center, Tufts University School of Medicine

Disclosure: Nothing to disclose.

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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 College of Physician Executives, American College of Physicians, American Federation for Clinical Research, American Federation for Medical Research, American Medical Association, American Medical Informatics Association, American Society of Hematology, Association of Clinical Research Professionals, Eastern Cooperative Oncology Group, European Society for Medical Oncology, Massachusetts Medical Society, and Society for Biological Therapy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Benjamin Movsas, MD  Vice-Chairman, Department of Radiation Oncology, Fox Chase Cancer Center

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

Disclosure: Nothing to disclose.

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine; Consulting Staff, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

References

  1. 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. Jul 2003;83(3):147-53. [Medline].

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

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

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

  5. 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].

  6. 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. Mar-Apr 2002;22(2B):1169-70. [Medline].

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

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

  9. 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. Nov 6 2009;[Medline].

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

  11. 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. Sep 2008;191(3):814-25. [Medline]. [Full Text].

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

  13. 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. Aug 2008;17(2):107-12. [Medline].

  14. 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. Dec 20 2009;27(36):6237-42. [Medline].

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

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

  17. 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. Apr-Jun 2005;42(2):78-84. [Medline].

  18. 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. Mar 2006;13(3):405-12. Epub 2006 Jan 30. [Medline].

  19. 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. Jun 2005;54(3):438-42. [Medline].

  20. 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].

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

  22. 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. Feb 2007;81(2):82-6. [Medline].

  23. 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. Jan-Feb 2006;16 Suppl 1:123-8. [Medline].

  24. 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. Jun 2004;182(6):1463-7. [Medline].

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

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

  27. 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. Jan-Feb 2006;16(1):23-8. [Medline].

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

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

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

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

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

  33. 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].

  34. 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. Jan 2003;138(1):26-33. [Medline].

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

  36. 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. Feb 2002;29(1):51-61. [Medline].

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

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.