Symptoms of peritoneal carcinomatosis

In most cases, peritoneal cancer does not initially cause any symptoms. The further the disease progresses, the stronger the symptoms become. The first complaints can be the so-called general symptoms such as weakness, night sweat and unspecific exhaustion.

There can also be a progressive loss of performance and most patients often complain of unintentional weight loss. The disease usually progresses rapidly and subsequent symptoms are usually more severe. One of the typical symptoms of peritoneal involvement in tumor diseases is ascites, which is almost always present in peritoneal cancer.

This is an accumulation of water in the abdomen between the viscera and in the flank area. It is caused by the fact that the pressure conditions in the abdominal cavity are changed by the peritoneal carcinoma and both inflammatory fluid and fluid from the blood stream are pressed out into the free tissue. This fluid rapidly increases in volume and also presses on surrounding organs such as the intestine, stomach, lungs and heart, so that further complaints can result.

In a lying patient, abdominal fluid can be detected by a wave on the abdominal surface when the examiner taps one side of the abdomen. Abdominal fluid can be proved by an ultrasound examination. At first, cancer of the peritoneum does not cause any discomfort, but since numerous nerve fibres run above and below the peritoneum, pain can occur as the disease progresses and these nerve fibres are affected.

The pain caused by peritoneal cancer is usually dull in character and is sometimes described as drilling. The pain is either localised in the area of the abdomen or can be transmitted to the back or flanks. The pain triggered by peritoneal cancer is usually permanent and increases in intensity as it progresses.

In addition to a basic pain, there are still so-called pain attacks, which are then stronger than the basic pain. A short time later the pain level decreases again, but never becomes less than the basic pain. Patients with advanced stomach cancer are rarely completely pain-free.

The more a peritoneum is affected by cancer, the stronger the pain and the greater the suffering. In this situation, good pain therapy with well effective, strong painkillers is especially important. The many small tumours on the peritoneum make the treatment very complex and require several specialist disciplines to work very closely together to combat the tumours. If the tumours are not treated, sooner or later there is a risk of complications such as a narrowing of the intestine with intestinal obstruction or of the ureter with urinary retention.

Diagnosis of peritoneal carcinoma

The daughter tumors are usually not single, large, solid tumors, but grow as many small tumor nests, often not even visible to the eye. Some grow only in one part of the peritoneum, others spread all over the organs surrounding the peritoneum. Unfortunately, the involvement of the peritoneum is still associated with a worsening of the prognosis of the affected person, as it always means advanced tumour growth.

In order to assess the extent of the affection, a computer tomogram (=CT) or an MRI of the abdomen is usually made before each treatment. In addition, there is an assessment sheet, in which points are determined, from the values of which the extent of the disease as well as a statement about the prognosis can then be made, the so-called PCI, the Peritoneal Carcinoma Index. This index divides the abdominal cavity and the organs into different sections for which point values are then distributed for the infestation. Depending on the findings and value in the PCI, there are then recommendations for different combinations of different forms of therapy that promise success.