By Pat Carragher - August 09, 2021
Over the past four years, Moffitt Cancer Center’s Peritoneal Disease Team has become a national leader in this specialized type of care. Dr. Sean Dineen, an associate member of the Department of Gastrointestinal Oncology, focuses on patients who have developed peritoneal disease and the application of heated intraperitoneal chemotherapy to treat it. He answered some of the most frequently asked questions about peritoneal disease.
Q: What is peritoneal disease?
A: Peritoneal disease describes a pattern of metastatic disease where cancer has spread from where it initially started into the lining of the abdominal cavity. There are some cancers that have a high propensity for this type of spread, including appendix cancers, some types of colon cancers, gastric cancer and ovarian cancer. There are rare cases when cancer starts in the peritoneal lining and these are typically peritoneal mesothelioma cancers. So, when we discuss peritoneal disease, it is important to understand we are talking about several different types of cancers.
Q: What are some of the symptoms of peritoneal disease?
A: One of the problems treating these types of cancer is that the symptoms typically present fairly late. They're usually gastrointestinal-related symptoms like abdominal pain and symptoms of obstruction, which are typically nausea, vomiting or bloating.
Q: How is peritoneal disease diagnosed?
A: Most of the times the symptoms aren’t very specific which would ultimately lead to a CT scan where we’ll see some evidence of this. It’s also occasionally diagnosed incidentally. For example, an appendix cancer could be diagnosed during what would have been a routine appendectomy. Similarly, we may identify peritoneal disease during surgical procedures for colon and gastric cancers. We would be operating under the assumption that the disease is localized but would see that the disease has spread to the lining or the fat surrounding the organs.
Q: Is there any way to screen for peritoneal disease?
A: Appendix cancer is quite rare and there's no real screening process for this type of cancer. In colon cancer, which we treat sometimes, it typically would be standard screening colonoscopy. So, if we were able to identify colon cancers earlier, we would see less of this type of advanced spread.
Q: Who is at risk for this type of cancer?
A: Right now, we don’t have a great profile of who is at risk for this overall, but we do tend to see this in younger patients with colon cancer. For appendiceal cancers we don’t have a great sense for what the predisposing factors are. With peritoneal mesothelioma there are some links to asbestos or smoking, but less than for the lung type.
Q: What treatment options are available?
A: Most times the treatment options will be a combination of chemotherapy and surgery. We would approach a low-grade appendix cancer differently than a gastric cancer depending on the aggressiveness of the cancer. The more aggressive the cancer, the more likely we are to combine systemic therapy with a regular type of IV chemotherapy. For the less aggressive cancers surgery alone may be the approach. When we talk about surgery, we're referring to cytoreductive surgery and heated intraperitoneal chemotherapy. For the surgery, we investigate all the surfaces of the abdomen and perform what can turn out to be an extensive operation. We take out the lining of the abdominal cavity and then any organs that have tumor on the surface of it. Once we're finished with the cytoreduction, we introduce the heated chemotherapy solution into the abdomen. After about 90 minutes, the solution is rinsed out and incisions are closed. The single chemotherapy treatment helps to treat and sterilize microscopic disease.