Peritoneal cancer and its risks

Dr PK Julka

There are around 22.5 lakh estimated cancer patients in India with 11,57,294 lakh new incidences every year. There are 7,84,821 annual deaths by the dreaded disease.

The scary statistics are proof enough that cancer has become quite common and can affect anyone — from common man to film stars. 

In the recent past many Bollywood personalities have been afflicted with various kinds of cancer, including Manisha Koirala, Irrfan Khan, Sonali Bendre, Tahira Kashyap. The latest to fall victim to this problem is veteran actress Nafisa Ali. Ali recently shared that she is suffering from stage-3 peritoneal and ovarian cancer.   

Peritoneal cancer is a rare form of cancer that develops in the peritoneum — a thin, delicate sheet that lines the inside wall of the abdomen. It covers the uterus and extends over the bladder and rectum. The peritoneum is made of epithelial cells (cells that line the surfaces of the body). By producing a lubricating fluid, the peritoneum helps the organs to move smoothly inside the abdomen. It is important to note that peritoneal cancer isn’t the same as intestinal or stomach cancer, nor should it to be mistaken for tumours that spread to the peritoneum. 

This disease begins in the peritoneum, and thus is called primary peritoneal malignancy. This is a rare malignancy, with incidence of 6.74 cases per 1 million new cases diagnosed in US, and is even less in India. 

Primary peritoneal cancer is more common in women than in men. Women at risk for ovarian cancer are also at increased risk for peritoneal cancer.

While there is no particular cause for this, hormones can frequently disrupt the gene pattern, creating the risk for malignancy. Hormone replacement therapy (HRT) has been found to increase the risk for ovarian cancer in few patients. Apart from this, women suffering from endometriosis, a condition where the womb grows outside the sac, and being overweight can also double up the risk of this cancer. 

Diagnosis

The diagnosis of peritoneal cancer can be done using laparoscopy or laparotomy. This gives a direct visualisation of the peritoneal surfaces along with palpation of the abdominal contents. It is by far the most sensitive modality for detecting peritoneal cancer. Laparoscopy is minimally invasive and allows for safe, directed peritoneal lavage. 

Treatment

A patient may have to undergo more than one type of treatment for peritoneal cancer. The type of treatment she/he has to undergo depends upon the stage and grade of the cancer, the size and location of the cancer and the age and overall health of the patient. Treatments for peritoneal cancer includes: 

Surgery: It not only helps with diagnosis. but would help in removal of any tumours. To stage and treat this malignancy, a specialist removes all noticeable illness. The specialist can also remove the ovaries, fallopian tubes, and sometimes uterus too. But this depends on what has been discovered at the diagnosis or treatment stage. The specialist may also remove other tissue and organs. It is critical to have this medical procedure performed by a highly trained gynaecologist and oncologist.

Chemotherapy: The drugs for treating peritoneal cancer are similar to those used for ovarian cancer. You may receive these drugs by injection on an outpatient basis every one, two, or three weeks. At times, chemotherapy is delivered directly into the abdomen through a catheter. This is called intraperitoneal chemotherapy. You additionally get it about at regular intervals, yet it is an increasingly complex treatment. 

If the symptoms are far too dangerous for a surgery and the cancer gets diagnosed at a very late stage, the only option is to control the cancer, as surgery might pose a risk to life. Hence, the earlier the cancer gets diagnosed, better it is for the patient. 

Signs and symptoms

Peritoneal cancer can be hard to detect in the early stages. The symptoms are vague and hard to pin-point, but when clear symptoms do occur, the disease has often progressed and moved on to second or third stage. Many of the symptoms are due to build-up of fluid in the abdomen. Peritoneal cancer symptoms may include:

• Abdominal discomfort or severe pain due to gas, indigestion, pressure, swelling, bloating, or cramps
• Feeling of fullness, even after a light meal or loss of appetite
• Nausea or diarrhoea
• Constipation
• Frequent urination
• Unexplained weight gain or loss
• Abnormal vaginal bleeding
• Rectal bleeding
• Shortness of breath

— The writer is senior director, oncology day-care centre, Max Super Speciality Hospital, New Delhi