Peritoneal carcinomatosis

Reingruber B, Boettcher MI, Klein P, Hohenberger W, Pelz JOW (2007) Hyperthermic intraperi-toneal chemoperfusion is an option for treatment of peritoneal carcinomatosis in children. Journal of Pediatric Surgery 42 el7-e21. 

We tested the effect of LPS in a model of peritoneal carcinomatosis (solid tumor) induced by PROb colon cancer cells in syngeneic BDEX rats. We showed that i.p. injections of LPS from E. coli can cure 20 % of the rats [157], Comparing the effect of LPS from different strains in this model, we found that the efficacy depends on the bacterial strain and on the structure of the lipid A used. Whatever the lipid A used, we have shown a correlation with in vitro macrophage secretion of IL-ip but not with NO, TNF-a or IL-6 [83],... 

Suzuki M, Kobayashi H, Tanaka Y, Hirashima Y, Kanayama N, Takei Y, et al. Suppression of invasion and peritoneal carcinomatosis of ovarian cancer cell line by overexpression of bikunin. Int J Cancer 2003 104 289-302. 

In women who present with malignant abdominal effusions (malignant ascites), common abdominal sites include ovaries, endometrium, and cervix, whereas men with malignant ascites typically have primary tumor sites in the gastrointestinal tract, predominantly in the colon, rectum, or stomach. Patients with peritoneal carcinomatosis of nongynecologic origin most often have origins in the stomach, colon, or pancreas and have a median survival of 3 months. 

Sadeghi B, Arvieux C, Glehen O, et al. Peritoneal carcinomatosis from non-gynecologic malignancies results of the EVOCAPE 1 multicentric prospective study. Cancer. 2000 88 358-363. 

Metastatic CUP of peritoneal cavity, including peritoneal papillary serous carcinomatosis in females and peritoneal non-papillary carcinomatosis in males or females... 

Yasumoto K, Koizumi K, Kawashima A, et al. (2006) Role of CXCL12/CXCR4axisin peritoneal carcinomatosis of gastric cancer. Cancer Res 4 2181-2187... 

Snyder EL, Meade BR, Saenz CC, Dowdy SF. Treatment of terminal peritoneal carcinomatosis by a transducible p53-activating peptide. PLoS Biol 2004 2 E36. 

Metastatic involvement of peritoneum (peritoneal carcinomatosis) is by far the most common peritoneal tumor (Walsh and Williams 1971 Bell and Scully 1990). Tumors that preferentially metastasize to the peritoneum include the following adenocarcinomas stomach intestine (colon-rectum) gallbladder or biliary tree pancreas breast lung ovary and uterus (Runyon et al. 1988) as well as lymphoma... 

Table 18.1 summarizes the prevalence of ultrasonographic signs in peritoneal carcinomatosis. 

Table 18.1. Prevalence of ultrasonographic findings in peritoneal carcinomatosis. (From Rioux and Michaud 1995)...

Combined with repeated cytological examination of fluid, ultrasound offers 92% sensitivity in the diagnosis of peritoneal carcinomatosis, thus avoiding laparotomy or laparoscopy (Gerbes 1991 Runyon et al. 1988). 

Peritoneal parietal and serosal implants are visible on ultrasound as soft tissue masses or nodules adhering to the peritoneum, as irregularity or interruption of the anterior hyperechoic peritoneal line (Fig. 18.7). Visualisation is facilitated by the presence of ascites. The ultrasonographic study of the peritoneal line is facilitated by the use of high frequency ultrasound probes, which allow also visualization of very small peritoneal implants (Fig. 18.8 Lorenz et al. 1990). Peritoneal implants, serosal implants, and interruption of the anterior hyperechoic peritoneal line are present at the rates of about 54,19, and 16%, respectively in patients with peritoneal carcinomatosis (Rioux and Michaud 1995). 

Liver metastases are found in about 38% of patients with peritoneal carcinomatosis, but represent a nonspecific finding. In fact,liver metastases are frequendy found even in the absence of peritoneal involvement. Lymphadenopathies are present in about 24% of cases, but like liver metastases, they do not represent a specific sign of peritoneal carcinomatosis (Rioux and Michaud 1995). 

Goerg C, Schwerk WB (1991) Malignant ascites sonographic signs of peritoneal carcinomatosis. Eur J Cancer 27 720-723... 

Rioux M, Michaud C (1995) Sonography detection of peritoneal carcinomatosis a prospective study of 37 cases. Abdom Imaging 20 47-51... 

Spencer JA, Swift SE, Wilkinson R et al (2001) Peritoneal carcinomatosis image-guided peritoneal core biopsy for tumor type and patient care. Radiology 221 173-177 Stein MA (1977) Omental band new sign of metastasis.) Clin Ultrasound 5 410-412... 

Fig. 17.17. Normal appendices epiploi-cae in CT. Appendices epiploicae of the sigmoid colon present pedunculated fat structures, which protrude from the sigmoid surface into the peritoneal cavity (arrow). They are easily visualized because of ascites in this woman with peritoneal carcinomatosis. Small sigmoid diverticula which present air-containing mural outpouchings into the perisigmoid fat tissue are also demonstrated (arrowhead)...

Currently, recommendations for routine application of comprehensive treatment in colorectal cancer with peritoneal seeding are less secure. Certainly, systemic chemotherapy does not provide any patient with a hope for cure. The combined approach when used in peritoneal carcinomatosis from colorectal cancer is supported by results from numerous phase II studies at different institutions. The 5-year survival rate of approximately 30% is consistent in all reports. 

---