Secondary Peritoneal Cancer : Which Cancers Can Spread to the Peritoneum
The peritoneum is a thin membrane that lines the organs within the abdominal cavity and helps protect them. Certain types of cancer can spread to this area and cause what is known as peritoneal carcinomatosis. This spread does not happen at random: some tumors are more likely to reach the peritoneum because of their location and biological characteristics. Detecting and treating these situations early is essential, and the expertise of specialized centers such as the Peritoneal Cancer Institute (PCI) can make a decisive difference in the patients’ prognosis.
How cancer spreads to the peritoneum
There are several mechanisms by which tumor cells can reach the peritoneum:
- Spread by direct contact: the primary tumor invades nearby organs and infiltrates the peritoneum.
- Spread through peritoneal fluid: some tumor cells break away from the primary tumor and travel in the fluid that bathes the abdominal cavity, implanting on the surface of abdominal organs.
- Lymphatic or hematogenous spread: less common, it occurs through blood vessels or lymphatic channels, allowing cancer cells to settle in areas away from the primary tumor and or within organs.
These mechanisms explain why certain abdominal cancers are more likely to spread to the peritoneum and highlight the importance of early diagnosis.
Cancers with a higher likelihood of peritoneal spread
Ovarian cancer is one the malignancies most commonly associated with peritoneal dissemination. The ovaries sit in the lower part of the abdominal cavity and are largely surrounded by the peritoneum and peritoneal fluid, which makes it easier for tumor cells to detach and implant in other areas of the abdomen. As a result, many patients already show peritoneal involvement at the time of diagnosis.
When colon or appendix tumors become advanced, they can grow through the intestinal wall and release cancer cells into the abdominal cavity. In some cases, mucinous tumors of the appendix can lead to pseudomyxoma peritonei, a distinctive form of peritoneal disease that requires specialized treatment.
Gastric tumors that invade the stomach wall also shed cancer cells into the peritoneum. Peritoneal spread is one of the main complications of advanced gastric cancer and often occurs through metastatic seeding.
Certain cancers of the pancreas or gallbladder, as well as abdominal sarcomas, can also spread to the peritoneum, although less frequently.
Diagnosis and treatment
Detecting peritoneal spread requires advanced imaging techniques and direct assessment:
- CT Scan (computed tomography).
- MRI (magnetic resonance imaging).
- PET CT.
- Diagnostic laparoscopy, which allows clinicians to directly visualize the extent of tumor spread and take samples for targeted pathological analysis.
The type of treatment and the prognosis depend on the primary tumor, the extent of peritoneal disease, tumor biology, and the patient’s individual characteristics. Available options include:
- Cytoreductive surgery to remove all visible tumors.
- HIPEC (hyperthermic intraperitoneal chemotherapy).
- PIPAC (pressurized intraperitoneal aerosol chemotherapy).
- Systemic chemotherapy, tailored to the specific type of cancer.
The experience and specialization of centers such as PCI are essential to improving outcomes, as they enable a multidisciplinary, personalized approach for each patient.
Research and scientific outlook
Research in peritoneal oncology is moving forward rapidly. New surgical technologies, novel systemic treatments, imaging techniques (supported by 3D tools and AI), and carefully designed clinical trials are expanding treatment options and improving prognosis. PCI is actively involved in innovation and European leadership in this field, contributing to the training of specialists and the development of more effective therapies. We are currently working on several publications on pseudomyxoma peritonei and collaborating with reference centers such as those in Manchester and Milan, which specialize in genetic studies and are already delivering promising results.
Conclusion
Peritoneal spread does not occur in all cancers, but certain tumors carry a higher risk of disseminating to the peritoneum. Understanding these risks and achieving an early diagnosis are essential. The expertise and specialization of centers such as the Peritoneal Cancer Institute make it possible to offer precise, multidisciplinary care, combining advanced surgical techniques, intraperitoneal chemotherapy, and the latest scientific research. Thanks to these advances, patients today have more opportunities to improve both their prognosis and quality of life, and in some cases, to be cured.