Peritoneal Carcinomatosis

Peritoneal carcinomatosis is an advanced stage of cancer which can sometimes be diagnosed on imaging studies.  Often a diagnosis of cancer is already present.  Peritoneal carcinomatosis implies a poor prognosis.

What is peritoneal carcinomatosis?

Peritoneal carcinomatosis is when a tumor spreads from somewhere else in the body to the lining of the abdominal cavity.  The peritoneal cavity is where organs and bowel are located.  The tumors are often of gynecologic or gastrointestinal origin.

Symptoms of peritoneal carcinomatosis

Peritoneal carcinomatosis can be asymptomatic in early disease.  More advanced disease can cause discomfort, pain, bloating, nausea, vomiting, and bowel blockage to name some.

What does peritoneal carcinomatosis look like on imaging?

We typically see peritoneal carcinomatosis when we image patients with CT or MRI of the abdomen.  Often we see the peritoneum or lining of the abdomen involved by nodules, masses, or stranding densities.  There can be enhancement of the peritoneum.  We can see ascites or fluid.

There are times when the involvement of the lining or peritoneum is not visible on imaging and only identified at surgery.

PET scans can detect peritoneal involvement.  We will see areas of hypermetabolic activity along the peritoneum.

US will show fluid in the abdomen.  We can sometimes see nodules and masses in the peritoneal cavity.

X-rays are not typically used to detect peritoneal carcinomatosis.

What else can look like peritoneal carcinomatosis in radiology?

Not all abnormalities of the peritoneum represent carcinomatosis.

Infections like tuberculosis can have a similar appearance.

Peritonitis or an inflamed abdominal lining can occur from various causes.  A ruptured appendicitis can cause a peritonitis and cause thickening of the abdominal lining on imaging.  Perforated bowel or an abdominal wound can cause peritonitis.

A primary tumor called mesothelioma can arise from the abdominal lining and cause a similar appearance.  This is a rare tumor which can occur in middle to old age.  It is associated with prior asbestos exposure and has a poor prognosis.

What causes peritoneal carcinomatosis?

This is caused by tumor spread from somewhere else in the body.   Gynecologic and gastrointestinal tumors are common causes.  Other tumors can spread by the blood like lung, melanoma and breast.

We often know there is a diagnosis of cancer when we see peritoneal carcinomatosis.  Occasionally patients present with advanced cancer and have peritoneal carcinomatosis.

Peritoneal carcinomatosis survival rate

The prognosis is poor.  Survival rates vary but often under 3 years.

Peritoneal carcinomatosis treatment

Some patients receive systemic chemotherapy.  Some patients can benefit from cytoreductive surgery.  This is a long difficult procedure where the tumor masses are removed from the abdominal cavity.  Hyperthermic intraperitoneal chemotherapy (HIPEC) is often combined with surgery and is another therapy where heated chemotherapy is circulated in the peritoneal cavity.

Peritoneal carcinomatosis: summary

Peritoneal carcinomatosis is when tumor spreads to the abdominal lining.  This is often from a tumor of gynecologic or gastrointestinal origin.

We can best see peritoneal carcinomatosis on imaging studies like CT or MRI.  This is seen as nodules or masses along the peritoneum.    Peritoneal carcinomatosis is sometimes not visible on imaging and diagnosed at surgery.  Other conditions can mimic carcinomatosis like infections, peritonitis and primary tumors of the peritoneum.

Prognosis is poor.  More aggressive treatments like surgery and directly placing chemotherapy in the abdominal cavity have offered promise to some patients.

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