What are the treatment options for peritoneal cancer?
The most common treatment options for peritoneal cancer include surgery, chemotherapy, radiotherapy and targeted therapies. The type of treatment you receive will depend on several different considerations, such as the type of peritoneal cancer you have, its stage, your overall health and your treatment preferences. This page aims to give you a comprehensive overview of how peritoneal cancer treatment works.
Types of peritoneal cancer treatment
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Surgery
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Chemotherapy
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Targeted therapies
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Radiotherapy
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Surgery for peritoneal cancer
Surgery for peritoneal cancer is performed to remove cancerous tissue, relieve symptoms and improve the chance of long-term remission. The focus is on removing any cancer from within the abdominal (peritoneal) cavity – the space between your abdomen wall and organs in the abdomen, such as the intestines, stomach and liver.
Peritonectomy
A peritonectomy, also known as cytoreductive or debulking surgery, is a procedure which focuses on removing as much visible disease as possible from within the abdomen. This includes the removal of peritoneal tumours and the partial or complete removal of any affected organs, such as the small or large bowel, omentum, spleen, stomach, gallbladder, bladder and female reproductive organs.
A peritonectomy is an open surgery which requires a long incision in the middle of the abdomen. The extent of surgery required will vary depending on the stage of the cancer.
Chemotherapy for peritoneal cancer
Chemotherapy uses a range of drugs to kill and slow the growth of peritoneal cancer cells. It takes place over several sessions, which is known as a cycle. Your care team will walk you through how many cycles you may need for your course of treatment.
Intraperitoneal chemotherapy
If you have primary peritoneal cancer, peritoneal mesothelioma or peritoneal metastases, you may have chemotherapy inserted directly into the abdominal cavity through a tube (known as intraperitoneal chemotherapy). This treatment can be delivered at the end of surgery before your wound is closed to destroy any remaining cancer cells.
Intraperitoneal chemotherapy methods for peritoneal cancer include:
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Hyperthermic intraperitoneal chemotherapy (HIPEC)
Chemotherapy drugs are warmed to approximately 40°C and inserted into the abdominal cavity for 60 to 90 minutes. This can be done at the end of surgery and is the most common method of intraperitoneal chemotherapy.
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Early post-operative intraperitoneal chemotherapy (EPIC)
This involves the delivery of intraperitoneal chemotherapy a few days after surgery, typically after HIPEC.
Targeted therapies for peritoneal cancer
Targeted therapies use specialised drugs to destroy specific proteins in primary peritoneal cancer cells that help your cancer grow and spread. They are mainly given to stop your peritoneal cancer from returning after treatment.
Radiotherapy for peritoneal cancer
Radiotherapy is rarely used for peritoneal cancer. In some cases, radiotherapy may be used to treat primary peritoneal cancer that has returned following initial treatment, alongside symptom management.
External beam radiotherapy (EBRT) is the most common technique for peritoneal cancer.
Treatment by stage of peritoneal cancer
When you are diagnosed with peritoneal cancer, your oncologist will develop your treatment plan as part of a multidisciplinary team based on the stage of your cancer.
Peritoneal cancer is often found at an advanced stage. Common treatment options include:
Advanced primary peritoneal cancer
Surgery with HIPEC is the most common treatment for primary peritoneal cancer. This may be followed by systemic chemotherapy and/or EPIC. In some cases, you may receive targeted therapies to prevent primary peritoneal cancer from returning after treatment.
Advanced metastatic peritoneal cancer
Like primary peritoneal cancer, advanced metastatic peritoneal cancer commonly requires surgery and HIPEC. This can be combined with other treatments depending on your primary cancer.
Recurrent primary peritoneal cancer
For primary peritoneal cancer that returns, you may have a combination of chemotherapy treatment and targeted therapies. Radiotherapy may also be an option to treat small, localised cancers.
References
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