Peritoneal Carcinomatosis.pptx

Metastatic carcinoma to peritoneal membrane of abdomen.

1. Peritoneal Carcinomatosis Dr. Aditi Sarker Resident (Phase-B) Gastroenterology BSMMU

2. Peritoneum Thin serous membrane Lining the wall of the abdominal and pelvic cavities(the parietal peritoneum) Covering the existing organs(visceral peritoneum) Peritoneal cavity : Space between 2 layers

3. Peritoneal carcinomatosis and metastasis Peritoneal carcinomatosis is the malignant tumor of peritoneum Often secondary May be primary Often develops when other abdominal tumors spread to the peritoneum Leading to multiple new tumors on the surface of the membrane

4. Mechanism Detachment of cells from the primary tumor Peritoneal transport Mesothelial adhesion Invasion of the submesothelial tissue Systemic metastasis

5. Metastatic spread to the peritoneum

6. Why Omentum Fatty acid in omental adipocyte: Stimulates cancer growth Pro-angiogenic environment of omental milkyspot Contains immune aggregate Dense capillary network

7. Risk Factors Age Family history of ovarian or peritoneal cancer BRCA genetic mutations Hormone replacement therapy Obesity

8. Presentation Abdominal pain Distension Obstruction: GIT & Urinary tract Symptoms of primary malignancy

9. Sign General: Anaemia Low BMI Lymphadenopathy Abdomen: Diffuse tenderness Visible veins Umbillical nodule Ascites

10. Investigations Routine tests Imaging Paracentesis & Study: Appearance Cell count SAAG Biochemistry: Protein, Glucose, LDH Culture Cytology

11. Tumor markers Endoscopy & colonoscopy Laparoscopy: To take biopsy of peritoneal implants To take Omental biopsy Sensitivity approaches 100%

12. Newer modalities for diagnosis Liquid biopsy: Molecular diagnostic studies that are performed on blood or body fluid as opposed to cancerous tissue itself Utilizes circulating biomarkers in the serum of patients May be used to tailoring treatment plan and early intervention Exosomes: Stable patient-derived nanovesicles present in blood, urine, and many other bodily fluids Promising tool for the evaluation of labile biomarkers

13. Treatment Depending on particular case Usually palliative: Ease pain Paracentesis, diuretics, shunt Analgesia Nutrition Improvement quality of life

14. Therapeutic options Cytoreductive surgery Surgical removal of tumors on peritoneum in some cases, nearby abdominal organs Hyperthermic intraperitoneal chemotherapy Often used right after cytoreductive surgery this method bathes peritoneum with heated chemotherapy drugs to kill any remaining cancer cells Peritonectomy Hormonal therapy SERM, HER-2 receptor blocker, Aromatase inhibitor

15. Intraperitoneal treatment modalities include Hyperthermic intraperitoneal chemotherapy(HIPEC), Pressurized intraperitoneal aerosol chemotherapy (PIPAC), Neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) Early postoperative intraperitoneal chemotherapy (EPIC)

16. HIPEC Applied as single administration after cytoreductive surgery (CRS) By use of a perfusion machine Circulation of the heated chemotherapy solution can be performed using either an open (termed Coliseum) or a close technique duration of 60–120 min temperature of 40–43 °C Indications: Curative. Potential other indications: Palliative, neoadjuvant and adjuvant

17. PIPAC Applied repeatedly by laparoscopy using a two- trochar technique. PIPAC is not combined with CRS. Administration of chemotherapy is achieved via a high-pressure injector. • Indications: Palliative. • Potential other indications: Neoadjuvant , adjuvant.

18. NIPS Long-course combination treatment of intraperitoneal and intravenous chemotherapy using implanted catheter access ports. • Indications: Neoadjuvant

19. EPIC Administered typically after CRS and HIPEC by use of intraoperatively placed intraperitoneal catheters to extend intraperitoneal drug exposure over 5 days postoperatively . Indications: Adjuvant

20. Prognosis For colorectal PC, median survival is approximately five months Palliative systemic therapy is able to extend this to approximately 12 months (CRS/ HIPEC) with a curative intent is possible in some patients with limited tumor burden In well-selected patients undergoing complete cytoreduction, median survival has been reported as high as 63 month

21. Thank You