Therapy

This is only general information! A therapy and all possible therapy options should be discussed with the responsible doctor! Not all patients are suitable for every therapy, which is why every treatment is a decision made on a case-by-case basis, which can be further supported by the methods mentioned below.

An operation or direct chemotherapy of the peritoneum is only used if the benefits of the operation or chemotherapy outweigh the risks and consequences of the method. With regard to the water in the abdomen, there are some drugs that can reduce the pressure in the body and act against increased formation of abdominal fluid. Furthermore, draining the abdominal fluid through a puncture (ascites puncture) can also reduce the pressure in the abdomen and thus improve the quality of life.

As a rule, however, after draining the abdominal fluid, which occurs as a result of peritoneal cancer, new abdominal fluid usually reappears. The actual cause is not eliminated. It is possible that the abdomen swells again immediately after the puncture of abdominal fluid.

A change in diet can also help. Intraperitoneal chemotherapy means that the chemotherapy is administered directly into the (=intra) peritoneum and not, as known from other tumour therapies, via the blood vessels throughout the body in order to reach the tumour. The advantage here is the protection of the rest of the body, which is inevitably affected by chemotherapy via the blood vessels, and the increased concentration at the desired site of action, the peritoneum.

The chemotherapy is started during the operation and then continued in an intensive care unit over several days. The reason for this is that although visible tumour parts in the peritoneum can be removed, individual, invisible tumour cells are always left behind, which can then grow into new cancerous tumours. The subsequent chemotherapy attempts to prevent this process by destroying these cells with the chemotherapeutic drugs.

Another unusual feature of this type of chemotherapy is that it is carried out with warm medication at approx. 42°C (=hyperthermic chemotherapy). On the one hand, this has the advantage that tumour cells react very sensitively to heat and, on the other hand, the additional effect that some of the chemotherapeutic drugs used have a better effect when used warmed.

Even though this therapy seems to be very effective, it is by far not suitable for all patients. Apart from criteria that make treatment impracticable only to a high degree, there are also criteria that speak absolutely against treatment. Criteria that rule out the implementation of the treatment from the outset are tumours that have already formed daughter tumours outside the abdominal cavity (=distant metastases), as well as a very poor general condition of the patient due to, for example, pronounced cardiovascular disease or the ingrowth of tumour cells into the abdominal aorta.

Here, the risks and consequences of the treatment outweigh the benefits it could have for the patient. In case of relative contraindications, treatment should only be carried out after very intensive consideration: Such situations are, for example, very large amounts of abdominal fluid (= ascites) or intestinal obstruction caused by the tumour or its daughter tumours. In these cases it is often questionable whether chemotherapy really brings benefits for the patient.

Before the decision for or against a therapy is made, detailed discussions with each patient are the first priority. A patient should only make a decision when he or she knows all the arguments for and against the therapy and has weighed these against each other with medical support. Radiation therapy is very difficult in the abdomen.

Radiotherapy and chemotherapy attack all cells in the body, which divide and multiply very quickly. Although tumour cells possess this property to a particularly pronounced degree, all cells of the mucous membranes in the mouth and gastrointestinal tract as well as hair also possess this property. Radiation and chemotherapeutic agents cannot distinguish whether cells are tumour cells or not, so they act on all these cells unfiltered.

In order for radiotherapy to cause as little damage as possible to tumour-free organs, it must be possible to delimit the area very precisely. In the abdominal cavity, however, this is difficult to impossible, since both the intestine and the peritoneum are constantly in motion due to the movements of the intestine. It is therefore not possible to specifically target the peritoneum, which then increasingly affects the very sensitive intestinal cells and damages them irrevocably.

In principle, an operation to treat peritoneal cancer is also possible. In this case, however, the extent of the infestation must be taken into account. If it is a metastasis of another tumour and other organs besides the peritoneum are affected, surgery is generally not necessary and the focus is on drug-based chemotherapy.

If metastases are only found on the peritoneum, surgical removal of the peritoneum may be considered. This is a major operation that must be performed openly. It is not uncommon for the organs connected to the peritoneum to be removed during the operation.

Spleen, gallbladder, diaphragm or even parts of the intestine cannot always be preserved in this way. The latter often results in the patient being left with only an artificial bowel outlet so that all affected bowel sections can be removed. If a decision is made in favour of surgical treatment, chemotherapy can be started at the same time.

Long-term, accompanying chemotherapy is also important after the operation. It should ensure that any degenerated cells still remaining in the body are successfully destroyed. The operation of the peritoneum is performed in specialised centres for oncological abdominal surgery. Before deciding to undergo this serious procedure, the patient’s age, concomitant diseases and prognostic chances of recovery should be taken into account. If it is a purely palliative treatment concept, i.e. the aim is not a cure but rather the greatest possible freedom from symptoms and the best possible quality of life, surgical treatment is generally not required.