Abdominal Cancers and Cancer-Related Conditions

There are several cancer and cancer-related conditions that occur in the abdomen that can affect the gastrointestinal system.

Peritoneal Mesothelioma

Peritoneal mesothelioma is a cancer that arises in the peritoneum, which is the thin layer of tissue that lines the abdominal cavity. It is distinct from thoracic mesothelioma, a more common form of this cancer that develops in the lining of the chest cavity. Malignant peritoneal mesothelioma is a rare cancer. Only about 400 people in the U.S. are diagnosed with this condition every year. The most common cause of mesothelioma is asbestos exposure, but this disease is also associated with other carcinogens.

For about one-third of patients, the first symptoms of peritoneal mesothelioma are abdominal pain and/or abdominal swelling. Other possible symptoms are loss of appetite, weight gain and the buildup of fluid within the abdomen (known as ascites).

Initial tests for peritoneal mesothelioma may include computed tomography (CT) and positron emission tomography (PET) scans. These imaging tests can help physicians detect the cancer and determine whether or not it has spread. A definitive diagnosis of peritoneal mesothelioma requires the examination of biopsy samples.

The Froedtert & MCW Clinical Cancer Center at Froedtert Hospital campus is one of the nation’s leading centers for the treatment of peritoneal mesothelioma. Our experience with this rare disease allows us to provide patients with an accurate diagnosis and the most effective therapy possible.

The most effective treatment for peritoneal mesothelioma is HIPEC. During a single procedure, surgeons remove as much cancerous tissue as possible from the abdominal cavity and then bathe the area with a heated chemotherapy solution. HIPEC improves the prognosis for peritoneal mesothelioma and extends life significantly for many patients.

Surgery patients may later receive chemotherapy, sometimes within days following their procedure. Early post-operative drug therapy is typically delivered via infusion directly into the abdominal cavity. Patients who are not eligible for surgery may receive chemotherapy alone.

Pseudomyxoma Peritonei (PMP)

Pseudomyxoma peritonei (PMP) is a condition in which the abdominal cavity becomes filled with a jelly-like fluid. It is a syndrome that is caused by the spread of certain cancers within the abdomen.

PMP develops when cancer cells from one part of the body spread to the peritoneum. The peritoneum is the thin layer of tissue that lines the abdominal cavity. These tumor cells produce mucus, which accumulates within the peritoneal cavity. The most common cause of PMP is appendix cancer. Other cancers that can lead to PMP are gastric (stomach) cancer, pancreatic cancer, ovarian cancer and colon cancer.

The accumulation of mucinous fluid within the peritoneum is also called ascites. This buildup of fluid can lead to abdominal distension and eventually bowel obstruction. Impairment of gastrointestinal function can lead to serious malnutrition. In many cases, PMP develops very slowly.

PMP often has no clear symptoms in the early stage. As the condition advances, patients may experience increasing waist size, unexplained weight gain, changes in bowel habits and loss of appetite. Patients may also feel abdominal pain or discomfort, and many cases of PMP are initially diagnosed as appendicitis, hernia or an ovarian cyst or tumor. In many cases, PMP is first discovered incidentally during surgery for an unrelated condition. Diagnosis may be confirmed by computed tomography (CT) scans or magnetic resonance imaging (MRI) of the abdomen and by direct inspection of the abdominal cavity using a laparoscopic camera.

The most effective treatment for PMP is HIPEC. This innovative therapy can allow many PMP patients to live for decades with their condition. The treatment can be repeated several times during a patient’s lifetime.

Depending on disease stage and other factors, some patients may benefit from conventional chemotherapy provided in addition to HIPEC. This could be traditional intravenous (IV) chemotherapy delivered during the months before or after HIPEC. It could also consist of intraperitoneal (IP) chemotherapy delivered within one week following the HIPEC procedure. IP chemotherapy is an outpatient therapy in which medications are infused directly into the abdominal cavity.

Peritoneal Carcinomatosis

Peritoneal carcinomatosis is a cancer condition, not a separate cancer disease. It refers to cancer that has spread to the peritoneum from another part of the body. The peritoneum is the thin layer of tissue that lines the abdominal cavity. Cancers that can spread to the peritoneum include colorectal cancer (including appendix), ovarian cancer, gastric (stomach) cancer, pancreatic cancer and gallbladder cancer. 

Many patients with peritoneal carcinomatosis eventually develop pseudomyxoma peritonei (PMP). This syndrome is characterized by the accumulation of jelly-like fluid within the abdomen and pelvis.

Early peritoneal carcinomatosis is difficult to detect. Disease that is more widespread can be diagnosed using imaging studies such as computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound. Tissue biopsy is also an important element of a complete diagnosis. Occasionally, peritoneal carcinomatosis is discovered incidentally during surgery for another condition.

Peritoneal carcinomatosis is metastatic cancer. In previous years, there were few treatment options for patients with cancers that have spread to the peritoneum. Today, however, many patients with peritoneal carcinomatosis can be treated with HIPEC. This innovative therapy can improve outcomes and extend survival for many patients with metastatic disease to the abdomen. For some patients with peritoneal carcinomatosis, this treatment approach can even achieve a cure. Specific treatment plans, including the use of additional therapeutic options, can vary widely depending on the origin of the cancer and other factors.