What Is Peritoneal Carcinomatosis?

Primary peritoneal carcinoma (PPC) refers to a malignant tumor that originates in the peritoneal mesothelium. It has multifocal growth and is rare in the clinic. The histological characteristics are consistent with the same type of tumors with the same degree of differentiation in the ovaries, and the ovaries themselves are normal or only superficially affected.

Peritoneal cancer

Peritoneal cancer (external ovarian papillary carcinoma)

It refers to a type of cancer that originates in the peritoneum and whose tissue morphology is like a serous papillary carcinoma of the ovary under the light microscope. Because of its unknown source and nature, clinical and pathologists often misdiagnosed as "extensive peritoneal metastasis of ovarian cancer". This disease has been in the literature for almost 40 years. In 1959, Swerdlow was first named "Pelvic peritoneal mesothelioma resembles papillary cystadenocarcinoma, but it has not received much attention. By 1977, Kannerstein reported 15 cases and named it" primary Peritoneal papillary serous carcinoma ". In 1992, our hospital reported 6 cases of" outer ovarian peritoneal papillary carcinoma ". In 1998, 18 cases were reported under the name" peritoneal carcinoma "(including the first 6 cases). Scholars have reported one after another, and about 300 cases have been reported in domestic and foreign literature so far.

Peritoneal cancer

Peritoneal Cancer Condition

Incidence of peritoneal cancer

In the past, due to a lack of understanding of the disease, most cases were missed for diagnosis based on "extensive metastasis of ovarian cancer in the abdominal cavity". In the past 10 years, there has been some knowledge. The incidence is not as rare as previously thought. A total of 18 cases have been treated since 1996, accounting for 12.8% of ovarian serous cystadenocarcinoma during the same period. From domestic and foreign reports, peritoneal cancer accounts for 7-14% of ovarian serous cystadenocarcinoma.

Age of peritoneal cancer

It is a senile disease. The average age of 18 patients in our hospital is 51.4 years (23-72 years). The youngest patient in the literature is 11 years old.

Peritoneal cancer signs and symptoms

Abdominal distension, abdominal pain, and increase in abdominal circumference are the three most common symptoms, which are insidious progress. The early symptoms are very unclear or almost sensation-free. Swelling or discomfort, and finally signs of advanced ovarian cancer: massive ascites, intra-abdominal mass. The 18 cases in our hospital are all advanced, of which 66.6% have abdominal pain or abdominal discomfort, 61% bloating, 50% ascites, 33.3% intra-abdominal mass, and 16.7% difficulty in defecation.

Peritoneal cancer examination

Preoperative B-ultrasound, CT, MRI, and abdominal puncture can help diagnosis, and serum CA125 are all positive expressions.

Peritoneal cancer pathology

(1) Visual observation

There is a large amount of ascites in the abdominal cavity. The peritoneal surface and visceral surface are covered with multiple nodules, which are granular, nodular, miliary, etc. The miliary nodules are also associated with the liver and plantar surfaces. Membrane can be contracted into cakes.

(II) Histology

At present, they are all serous papillary cystadenocarcinomas. As from ovarian epithelial cancers, they contain a large number of grit bodies. Only Lee (1991) reported a case of clear cell carcinoma.

(Three) diagnostic criteria

Due to lack of understanding of the disease, they were all misdiagnosed before surgery, often ovarian cancer and abdominal tuberculosis, until extensive peritoneal nodules were seen during the operation, and the ovaries were normal or superficially invaded before diagnosis. Recently, the US Gynaecological Oncology (GOG) has established pathological diagnostic criteria.

1. The ovaries on both sides must be of normal physiological size or enlarged due to benign lesions.

2. The volume of the lesion outside the ovary must be larger than that of bilateral ovarian involvement.

3. Microscopic ovarian lesions must have one of the following:

(1) There are no lesions in the ovaries.

(2) The tumor is limited to the surface of the ovary and there is no interstitial infiltration.

(3) For ovarian surface involvement and interstitial involvement, interstitial involvement must be within 5mm × 6mm.

(4) The histological and cytological characteristics of the tumor must be mainly serous, which is the same as or similar to the serous papillary cystadenocarcinoma of the ovary, but with different degrees of differentiation.

Peritoneal cancer tissue source

It is still controversial that it is an independent disease that has nothing to do with ovarian tissue and has been reported in the literature. Peritoneal cancer develops after the ovary is removed for some reason (or a benign tumor). There are currently two theories:

1. Malignant transformation of ovarian tissue derived from embryonic gonad migration pathway;

2. The abdominal epithelium and ovarian epithelium originate from the same mesoderm, and both are derived from the embryonic body cavity epithelium. They have the potential for Mullerian tube differentiation and are called the second Mullerian system (SMS). SMS becomes cancerous in the future by some kind of stimulation. So how similar is peritoneal cancer to epithelial ovarian cancer:

3. The age of onset is all elderly women;

4. Symptoms such as epithelial ovarian cancer stage III-IV;

5. Tumor dissemination sites: abdominal and pelvic peritoneum, greater omentum, palatal surface and visceral surface;

6. Histological type, currently reported material is serous papillary cystadenocarcinoma, which contains a large amount of grit.

7. Patients with peritoneal cancer, like ovarian cancer, have positive CA125 expression in serum;

8. CEA immunopositive staining is more positive, keratin positive, Vimentin negative or weak positive, confirmed as cancer and does not support mesothelial tumors;

9. Moderate sensitivity to DDP-based chemotherapy;

10. There may be a series of tumors from SMS. At present, the literature reports are all serous papillary carcinomas. In addition, Lee reported a case of clear cell carcinoma. It is believed that SMS cancers other than serous papillary carcinoma will also be seen.

Peritoneal Cancer Treatment

Those who can undergo surgery should be completely resected, and those who cannot be thoroughly resected should be reduced. Strive for residual tumors within 2 cm in diameter. Both sides of the ovaries must be emphasized to observe the ovarian lesions. Chemotherapy drugs are not yet standardized, and ovarian cancer programs, that is, DDP-based comprehensive treatments, such as CAP or CP or CFP programs, are still used.

Whether men have peritoneal cancer is currently female in the current literature reports. Recently, Shah et al. Reported a case of serous papillary carcinoma in men.

Causes of peritoneal cancer

What causes primary peritoneal cancer?

Causes of peritoneal cancer

The origin of the unknown tissue is still controversial. At present, there are two theories: from the malignant transformation of ovarian tissue remaining on the embryonic migration path; peritoneal epithelium and ovarian epithelium originate from the same mesoderm. Both are derived from the embryonic body cavity epithelium (Embryonal Coelomic Epithelium). The potential of the susceptibility to retinal duct differentiation is called the Second Müllerian system, which will become cancerous in the future by some carcinogenic stimulation

Pathogenesis of peritoneal cancer

Because the peritoneum and Müllerian tube have a common embryonic source and the female reproductive system is derived from the Müllerian tube during the embryonic period, when a certain factor causes a primary peritoneal tumor, its tissue structure is the same as that of the Müllerian tuberculosis tumor but the surface of the ovary There is no infiltration or only slight infiltration on the surface, so some people think that this type of tumor that is primary in the peritoneum of women is a tumor that originated in the "second Mullerian duct system" is an independent disease different from ovarian cancer because peritoneal serous adenocarcinoma accounts for the primary peritoneum Most of the tumors, so-called female Mullerian tumors, mainly refer to serous adenocarcinoma that occurs in the peritoneum, that is, extraovarian peritoneal serous papillary carcinoma.

Peritoneal cancer diet

should

(1) Eat more foods that can reduce tumors: jellyfish, oysters, hippocampus, crabs, white snakes, clams, cormorants, kiwis, figs, walnuts, hawthorn, papaya, ume, sugar cane, almonds, diamond, white fungus, melon, gourd , Shiitake mushrooms, mushrooms, lentils.

(2) It is advisable to eat coriander, shark, celery, pumpkin, leek, hawthorn, orange cake, tempeh and loofah for abdominal pain.

(3) It is advisable to eat light onion, golden needles, field snails, snails, earthworms, almonds, crabs, kelp, clams, wakame, catfish, adzuki bean, catfish, lettuce, coconut pulp, and lice.

(4) It is advisable to eat figs, oatmeal, hawthorn, shark, catfish, and rabbit meat for abnormal stool.

avoid

(1) Avoid tobacco, alcohol and spicy food.

(2) Avoid mildew, pollution, hard, rough, multi-fiber, greasy, sticky and indigestible food.

(3) Avoid fried, smoked, pickled, and raw mixed foods.

(4) Avoid flatulent foods such as soybeans, peas, and potato.

(5) Avoid overeating and stiffening.