Origin of peritoneal cancer

Peritoneal cancer from pancreatic origin

The incidence of pancreatic cancer is increasing in western countries, and pancreatic cancer is becoming one of the leading causes of cancer-related death. At least one in every eight patients diagnosed with pancreatic cancer already has peritoneal cancer at the time of diagnosis. The prognosis for these patients is usually very bad as a large study in the Netherlands has shown the median survival is only six weeks after diagnosis. This relatively small amount of time provides a very small therapeutic window, if any.

For patients in a good clinical condition, palliative systemic chemotherapy may be advised, but there are virtually no studies that have investigated the efficacy of this treatment in this particular patient population. There are few data on the use of HIPEC for treating pancreatic peritoneal cancer patients. Given the aggressiveness of pancreatic cancer, and the high rate of complications after pancreatic surgery, HIPEC is currently not considered for treating these patients.

The observation that a relatively large proportion of patients with pancreatic cancer develop peritoneal cancer after curative surgery has inspired some surgeons to perform “prophylactic HIPEC” during the initial surgery. This approach may prevent subsequent peritoneal cancer. Some encouraging results have been obtained, but this approach is not considered the standard of care for pancreatic cancer patients.

In conclusion, pancreatic peritoneal cancer is relatively frequent and has a bad prognosis. HIPEC currently has no role in the treatment of patients with established peritoneal cancer from pancreatic origin but HIPEC as a preventive measure is currently under investigation by some hospitals.