Origin of peritoneal cancer

PC from Ovarian Cancer

Ovarian cancer is the most frequent cause of death among women with gynecological malignancies. One of the reasons for this high mortality is the notorious tendency of ovarian cancer to metastasize to the peritoneal cavity prior to discovery. This development occurs often and as a result, ovarian cancer is the most common cause of peritoneal cancer in women.

Unfortunately, most patients with ovarian cancer present with advanced and widespread disease. Complaints may include ascites, the inability to eat properly, weight loss, abdominal pain and an abdominal tumor can sometimes be felt during physical examination. Ovarian cancer may occur at any age, but the incidence of ovarian cancer increases with age, especially after menopause.

Various stages exist to describe the severity of ovarian cancer in a particular patient. The FIGO scoring system is one of the most commonly used systems. FIGO stage III indicates the presence of peritoneal cancer deposits outside the pelvis.

Treatment of ovarian cancer is demanding and usually involves an intensive, complex and multidisciplinary effort consisting of systemic chemotherapy and surgical resection. Whether systemic chemotherapy should be administered before or after surgery remains a topic of debate. However, most institutes now start with surgical debulking of the tumor. This procedure typically involves removal of the uterus, both ovaries, the omentum and all visible tumor, including affected organs. Next, patients are treated with systemic chemotherapy.

The results of this treatment are directly correlated with the results of the initial surgery. In patients for whom complete tumor removal can be accomplished, median survival may be as long as 70-80 months. In patients for whom tumor was left behind after surgery, survival may still be 45-50 months if the remaining tumor was smaller than 1 cm in diameter but drops to 30-36 months if larger tumor nodules are left behind. Even after complete removal of the tumor and treatment with systemic chemotherapy, ovarian cancer recurs often in the abdominal cavity. Following recurrence, treatment may consist of surgery, systemic chemotherapy or a combination of both.

The role of intraperitoneal chemotherapy and HIPEC in ovarian cancer

Even in advanced stages, ovarian cancer remains within the abdominal cavity for the vast majority of patients. Additionally, tumor recurrence often occurs exclusively in the abdominal cavity.

The hallmark of ovarian cancer to remain or recur within the abdominal cavity theoretically makes this disease an ideal target for aggressive regional treatment by combining surgery with (heated) intraperitoneal chemotherapy in high doses. Indeed, very promising results using this approach have been published by various Centers of Excellence around the world. However, none of these studies have systematically compared conventional treatments to novel treatments, including HIPEC. Currently, various hospitals are investigating the role of HIPEC in the treatment of ovarian cancer through properly designed clinical trials. The results of these trials will evaluate the promising role of HIPEC in ovarian cancer. Until the results are collected, HIPEC for ovarian cancer should ideally be offered only to patients through clinical trials.