Peritoneal metastases

Ovarian cancer usually is confined to the abdominal cavity, but spread can occur to the lung, liver, and less commonly, bone or brain. Disease is spread by direct extension, peritoneal seeding, lymphatic dissemination, and blood-borne metastasis. 

Tumor involves one or both ovaries with microscopic confirmed peritoneal metastasis outside pelvis and/or regional lymph node metastasis... 

It appears that activated carbon might be a potential carrier for lymphatic delivery, or to peritoneal or pleural cavities, the most common sites in cancer metastasis. Minimal side effects are expected, since constant low concentrations of drug are maintained in the general circulation. 

Blood vessels penetrating tumors provide malignant cells with another point at which to enter the circulation. Evidence exists that in situation where cancers disseminate predominantly by the blood, the extent of metastasis depends upon the vasculature of the primary tumor. Thin-walled capillaries, especially those newly formed, provide poor resistance to invading cancer cells. Also, data from microscopy studies show that the endothelium of tumor vessels, particularly in areas of poor oxygenation, is often abnormal (Kl). These abnormalities may permit invasion by neoplastic cells (P3). Finally, tumors can spread by direct extension into body cavities such as pleural and peritoneal spaces. An example of this is the formation of peritoneal metastases from ovarian carcinoma. 

Fig. 37.21 Pronounced peritoneal metastasis (with simultaneous liver metastases) in ovarian carcinoma...

MMPs also act as predictors of recurrence or metastatic risk. High preoperative serum levels of MMP-2 or MMP-3 are predictive of recurrence in patients with advanced urotheliai carcinoma. Furthermore, high levels of MMP-2 in ovarian tumor cells can predict tumor recurrence. The expression of certain MMPs is predictive of metastatic risk. For example, expression of MMP-1 is associated with lymph node metastasis in cervical and peritoneal metastasis in gastric cancer. MMP inhibition may be a therapeutic strategy for cancer. ... 

The two primary pathways of metastasis are hematogenous and lymphatic. Other, less-common modes of disease spread include dissemination via cerebrospinal fluid and transabdominal spread within the peritoneal cavity. Tumors are constantly shedding neoplastic cells into the systemic circulation or surrounding lymphatics. This process may begin early in the hfe of the tumor and often increases with time. The time course for metastasis depends largely on the biology of the tumor. Breast cancer, for example, tends to metastasize very early. Not all of the shed cancer cells, or seeds, result in a metastatic lesion. The seed must first find the appropriate soU, or an environment suitable for growth. This process is illustrated in the diverse patterns... 

Radiographic imaging studies evaluate the extent of disease involvement. A chest x-ray should be performed to rule out the presence of metastatic spread to the lungs. A CT scan of the abdomen and pelvis is often performed to evaluate hepatic and retroperitoneal involvement and occult abdominal and pelvic disease, and to determine the depth of tumor penetration into the bowel wall and/or invasion to adjacent organs. Detection of lymph node involvement with either smdy is limited by the difficulty of distinguishing inflammatory or reactive lymph nodes from those infiltrated with tumor. Because CT scans may not adequately detect peritoneal seeding, small distant lymph node metastasis, or liver metastasis in colon cancer, an occasional patient may... 

KajiyamaH., ShibataK., Terauchi M., et al. (2008) Involvement of SDF-lalpha/CXCR4 axis in the enhanced peritoneal metastasis of epithelial ovarian carcinoma. Int J Cancer., 122, 91-9. 

Fukui, R., H. Nishimori, F. Hata, T. Yasoshima, K. Ohno, H. Nomura, Y. Yanai, H. Tanaka, K. Kamiguchi, R. Denno, N. Sato, and K. Hirata. 2005. Metastases-related genes in the classification of liver and peritoneal metastasis in human gastric cancer. J Surg Res 129 94. 

Kobayashi, H. Y. Fukuda R. Yoshida Y. Kanada S. Nishiyama M. Suzuki N. Kanayama T. Terao. Suppressing effects of dietary supplementation of soybean trypsin inhibitor on spontaneous, experimental and peritoneal disseminated metastasis in mouse model. Int. J. Cancer, 2004a, 112, 519-524. 

Many reports have been published on the quantitative detection of micro-metastasis as determined by real-time RT-PCR in the peripheral blood, bone marrow, lymph nodes, and peritoneal washes, although the reports on its... 

M2. Marutsuka, T., Shimada, S., Shiomori, K., Hayashi, N., Yagi, Y., Yamane, T., et al.. Mechanisms of peritoneal metastasis after operation for non-serosa-invasive gastric carcinoma An ultrarapid detection system for intraperitoneal free cancer cells and a prophylactic strategy for peritoneal metastasis. Clin. Cancer Res. 9, 678-685 (2003). 

Hagiwara A, Sakakura C, Shirasu M, Togawa T, Sonoyama Y, Fujiyama J, Ebihara Y, Itoh T, Yamagishi H. Intraperitoneal injection of dextran sulfate as an anti-adherent drug for the prevention of peritoneal metastasis of cancer shows low toxicity in animals. Anti-Cancer Drugs 2000 11 393-399. 

M.E. Werner, S. Karve, R. Sukumar, N.D. Cummings, J.A. Copp, R.C. Chen, et ah. Folate-targeted nanoparticle delivery of chemo-and radiotherapeutics for the treatment of ovarian cancer peritoneal metastasis. Biomaterials 32 (2011) 8548—8554. 

Presence of ascites, omental involvement, serosal implants, mesenteric involvement, peritoneal implants, and interruption of the anterior peritoneal line are the most frequently described ultrasonographic findings in patients with peritoneal metastasis. Accessory findings are represented by liver metastasis, lymphadenopathies, and gallbladder... 

Table 18.2 summarizes differential ultrasonographic characteristics between benign and malignant ascites however, significant ascites is present in about 50% of patients with peritoneal metastasis (Rioux and Michaud 1995). 

Stein (1977) clearly described the omental band as a new sign of peritoneal metastasis. Neoplastic infiltration of the great omentum is visualized by... 

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... 

Acid inhibits Peritoneal Metastasis in Human Gastrointestinal Cancer Cells,... 

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