Forecast

Peritoneal metastases are usually an expression of the final stage of cancer or its return (recurrence), so the prognosis is generally poor. In the presence of peritoneal metastases there are often metastases from other parts of the body, which further reduce the chances of recovery. Furthermore, various circumstances make a curative therapy more difficult.

Some hospitals promise a 25% chance of recovery when using HIPEC. Individual chances of success of such a therapy depend on many factors, such as age, general condition and existing secondary diseases. In many cases, both the primary tumour and the peritoneal metastases are already well developed.

Rarely are curative approaches available that have a realistic chance of cure. Always present even after a curative intervention is the risk that the tumour returns or new metastases occur (recurrence). In the case of peritoneal metastases, however, there are some approaches that can alleviate the suffering of the disease and improve the patient’s quality of life and sometimes even lead to a cure.

The individual prognosis depends on the underlying disease and stage and can only be estimated by the treating physicians. Firstly, the peritoneum with the metastases can be surgically removed. If neighbouring abdominal organs are affected, parts of them can also be removed completely or partially.

On the other hand, chemotherapy can be infused directly into the peritoneal cavity with the aim of locally fighting the metastases there. Such chemotherapy can shrink the peritoneal metastases or limit their growth and spread. Regular chemotherapy is often not optimally effective for peritoneal metastases because the drugs are transported to the site of action via the blood and the peritoneum is not very well supplied with blood.

Another approach that is currently being tested is an immunotherapy in the peritoneal cavity, which is intended to fight the metastases by means of defence cells against the tumour. In each stage, the symptoms caused by the peritoneal metastases (abdominal fluid, pain, feeling of pressure) should be relieved. In most cases, the chances of recovery from peritoneal metastases are low.

In some cases, depending on the type and stage of the primary tumour, the presence of additional metastases elsewhere in the body and the size and extent of the peritoneal metastases themselves, healing can be achieved by interdisciplinary therapy. In most cases, however, infestation of the peritoneum is regarded as the final diagnosis, especially if the metastases are found in the entire abdomen and even surgical intervention cannot safely remove all tumour cells. In the following, we then change from a curative (healing) approach to a so-called palliative (pain-relieving) approach, by which the complaints are to be minimized and the quality of life of the affected persons is to be improved as much as possible.

An important component of palliative therapy is pain therapy, which is tailored to the needs of the patient and should be carried out by an experienced team of oncologists (cancer doctors) and pain therapists. In addition, symptoms of the disease that restrict the patient are relieved as much as possible. This can include drug therapy, but also surgical therapy.

In the case of peritoneal metastases, for example, abdominal fluid can be drained in a small operation, which can mean relief for the patient. Psychological care provided by specially trained psychotherapists can also help to deal with a final diagnosis. The treating clinic can provide the contact here. If the care of a terminally ill patient overtaxes the relatives, there is the possibility of using the offer of care in so-called hospices, which are specialized in the care of terminally ill patients in the last phase of their illness. In palliative therapy, the will of the patient has the highest priority.