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, leading to what is known as peritoneal carcinomatosis. This type of dissemination does not occur at random: some tumors have a greater tendency to reach the peritoneum due to their anatomical location and biological characteristics. Early detention and timely treatment are essential, and the experience of specialized centers such as the Peritoneal Cancer Institute (PCI) can make a significant difference in patient prognosis.
How Cancer Spreads to the Peritoneum
There are several mechanisms by which tumor cells can reach the peritoneum:
- Dissemination by direct contact: the primary tumor invades nearby organs and infiltrates the peritoneum.
- Dissemination via peritoneal fluid: some tumor cells detach from the primary tumor and travel in the fluid that bathes the abdominal cavity, implanting on the peritoneal surface as well as on the surfaces of abdominal and pelvic organs.
- Lymphatic or hematogenous dissemination: this occurs through blood or lymphatic vessels, establishing metastases in areas distant 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 Higher Likelihood of Peritoneal Dissemination
Ovarian cancer is one of the cancers most associated with peritoneal dissemination. The ovary is located in the lower region of the abdominal cavity and is largely surrounded by the peritoneum and peritoneal fluid, which tends to accumulate in the lower areas due to gravity, facilitating the implantation of tumor cells. As a result, many patients already present peritoneal involvement (?) at the time of ovarian cancer diagnosis.
When colon and appendix tumors spread, they can penetrate the intestinal wall and release cells into the abdominal cavity. In some cases, mucinous tumors of the appendix can lead to pseudomyxoma peritonei, which are characteristic tumor manifestations of the peritoneum that require specialized treatment.
Gastric tumors that invade the stomach wall can release tumor cells into the peritoneum. Peritoneal dissemination, one of the main manifestations of advanced gastric cancer, is often the primary pathway of metastasis.
Some tumors of the pancreas, gallbladder, or abdominal sarcomas can also disseminate to the peritoneum, although less frequently.
Diagnosis and Treatment
Detecting peritoneal dissemination requires advanced imaging techniques and direct evaluation:
- CAT (Computed Axial Tomography) (REVISAR SI SE ESCRIBE ASÍ)
- MRI (Magnetic Resonance Imaging).
- PET-TC (Positron Emission Tomography-Computed Tomography).
- Diagnostic laparoscopy, which allows direct observation of tumor spread and the collection of samples for targeted tumor analysis.
- The experience of the oncologists, surgeons, and the entire multidisciplinary PCI team, who have treated over 2,000 patients, is essential for analyzing the results of these tests.
The type of treatment and its prognosis depend on the primary tumor, the extent of peritoneal disease, tumor biology, and patient characteristics. Treatment options include:
- Cytoreductive surgery, to remove the visible tumor.
- HIPEC (Hyperthermic Intraperitoneal Chemotherapy).
- PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy).
- Systemic chemotherapy, according to the type of cancer.
The experience and specialization of the experts at Peritoneal Cancer Institute, surgeons Domenico Sabia and Lana Bijelic, as well as Dr. Jaume Capdevila, are key to improving outcomes, as they enable a multidisciplinary and personalized approach for each patient.
Research and Scientific Perspective
Research in peritoneal oncology is constantly progressing. New surgical technologies, new systemic treatments, imaging techniques (with 3D and AI support), and clinical trials are expanding treatment possibilities and improving patient prognosis. PCI actively participates in European innovation and leadership, contributing to the training of specialists and the development of more effective treatments. We are currently working on several publications on pseudomyxoma peritonei and collaborating with several international reference centers, such as in Manchester or Milan.
Conclusion
Peritoneal dissemination does not occur in all cancers, but certain tumors have a higher risk of spreading to the peritoneum. Knowing these risks and having an early diagnosis is essential. The experience and specialization of centers like the Peritoneal Cancer Institute allow us to offer precise and multidisciplinary treatment, combining advanced surgical techniques, intraperitoneal chemotherapy, and the latest scientific research. Thanks to these advances, patients now have more opportunities to improve their prognosis and quality of life.