Primary peritoneal cancer (PPC) is rare cancer. It can occur anywhere in the abdominal space. It affects the surface of organs contained inside the peritoneum, says Sanjoy Mandal, the gastro surgeon in Kolkata.
The doctor makes treatment recommendations based on the patient’s needs and collaborates with them to develop a treatment plan. At the time of diagnosis, most cases are in stage 3 or 4. Primary peritoneal carcinoma is treated similarly as epithelial ovarian cancer of a similar grade and stage.
Surgery
Surgery is the foremost treatment for primary peritoneal carcinoma. The following are the various types of surgery performed to treat it:
• With a total hysterectomy and bilateral salpingo-oophorectomy, the uterus plus one (unilateral) ovary and fallopian tube are removed; or the uterus plus both (bilateral) ovaries and fallopian tubes are removed.
• An omentectomy involves surgically removing all or part of the omentum. Within the abdomen, the omentum is a fold of fat that covers the stomach, large intestine and other abdominal organs.
• Getting rid of as much cancer as possible (surgical debulking).
According to the gastrointestinal surgeon in Kolkata, the surgeon also extracts abnormal-looking tissue samples from various parts of the pelvis, abdomen and lymph nodes during surgery. These samples are then analyzed in the lab to determine whether or not cancer has spread. This procedure is known as surgical staging.
Surgical procedures for symptom relief and pain relief in stage 4 cancer include:
• Paracentesis is a procedure used to extract fluid from the abdomen.
• Thoracentesis is a procedure that removes fluid from the area around the lungs.
• Inserting a feeding tube into a patient’s stomach or intestines.
• Inserting a tube (stent) into the large or small intestine or ureter to relieve a tumor-caused blockage.
Chemotherapy
Chemotherapy is used to treat primary peritoneal carcinoma. After surgery, it is administered in conjunction with carboplatin or cisplatin and paclitaxel or docetaxel, says the best gastroenterology surgeon in Kolkata.
When cancer recurs, other chemotherapy drugs that can be used include:
- Etoposide (Vepesid, VP-16)
- Gemcitabine (gemcitabine) (Gemzar)
- Vinorelbine (Navelbine)
Instead of intravenous chemotherapy, intraperitoneal chemotherapy can be used for women with small residual tumours (less than 1 cm) after surgical debulking.
Chemotherapy is sometimes administered prior to debulking surgery. If cancer shrinks due to chemotherapy, surgery can be performed to extract as much cancer as possible. Following the surgery, more chemotherapy is administered. This is referred to as interval debulking surgery.
Personalized medicine
According to the best gastroenterologist in Kolkata, some advanced primary peritoneal carcinoma can be treated with targeted therapy. A targeted therapy drug is sometimes combined with a chemotherapy drug. Among the drugs used in targeted therapy are:
• Bevacizumab (bevacizumab) (Avastin)
• Olaparib (Lynparza) is a drug used to treat women who have a BRCA1 or BRCA2 gene mutation
• Niraparib (Zejula)
Women with recurrent primary peritoneal carcinoma who have responded to chemotherapy with a platinum drug, such as carboplatin or cisplatin, can be given olaparib or niraparib as maintenance therapy.
Hormone replacement therapy
Hormonal therapy can be given in addition to chemotherapy to treat advanced primary peritoneal carcinoma.
Radiation treatment
Advanced primary peritoneal carcinoma is sometimes treated with radiation therapy.
For more details, consult Dr Sanjoy Mondal, a gastrointestinal surgeon in Kolkata.