In peritoneal carcinomatosi

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)...

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. 

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],... 

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. 

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). 

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)...

Glehen O, Gilly FN, Sugarbaker PH (2003a) New perspectives in the management of colorectal cancer what about peritoneal carcinomatosis Scand J Surg 92 178-179... 

Glehen O, Mithieux F, Osinsky D et al (2003b) Surgery combined with peritonectomy procedures and intraperitoneal chemohyperthermia in abdominal cancers with peritoneal carcinomatosis a phase II study. J Clin Oncol 21 799-806... 

Fig. 6.2.8. Extension of gastric cancer. Oblique coronal reformation performed to display fundus, corpus and antrum of the stomach. Surgical proven advanced cancer in the gastric body with ascites and peritoneal carcinomatosis (arrowheads)...

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

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