Peritoneal Cancer Clinical Presentation

Updated: Dec 22, 2019
  • Author: Wissam Bleibel, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Presentation

History

Primary peritoneal carcinoma usually manifests as 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).

Patients with malignant peritoneal mesothelioma usually present with symptoms and signs of advanced disease, including pain, ascites, weight loss, or an abdominal mass. Diffuse involvement of the peritoneal cavity is typical, often 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.