obsolete metastasis to the peritoneum

Obsolete Metastasis to the Peritoneum

Metastasis limited to a single distant organ, except for the peritoneum, was previously classified as M1a (see [7]). However, this classification is no longer used in modern cancer staging systems.

In the past, metastases to the peritoneum were considered a distinct entity from other types of metastatic disease. The peritoneum is a membrane that lines the abdominal and pelvic cavities, and metastasis to this area was often associated with a poorer prognosis compared to other sites of metastasis (see [1], [2]).

However, with advancements in cancer treatment and a better understanding of tumor biology, the classification and staging of cancer have evolved. The current system focuses on the extent of disease spread rather than specific sites of metastasis.

Key Points:

• Metastasis to the peritoneum was previously classified as M1a
• This classification is no longer used in modern cancer staging systems
• Peritoneal metastases are associated with a poorer prognosis compared to other sites of metastasis (see [1], [2])
• The current system focuses on the extent of disease spread rather than specific sites of metastasis

References:

[7] - OBSOLETE DATA ... [1] - by YJ Kim · 2021 · Cited by 32 — Peritoneal metastasis (PM) is found in approximately 8% to 15% of patients with CRC, with a poorer prognosis than that associated with other sites of metastases ... [2] - by YJ Kim · 2021 · Cited by 32 — Peritoneal metastasis (PM) is found in approximately 8% to 15% of patients with CRC, with a poorer prognosis than that associated with other ...

Common Signs and Symptoms of Peritoneal Metastases

Peritoneal metastases, also known as peritoneal cancer, can cause a range of symptoms that may be vague and nonspecific. These symptoms can vary depending on the individual and the stage of the disease.

• Abdominal Pain: A feeling of pressure or pain in the abdomen or pelvis is one of the most common symptoms of peritoneal metastases [3].
• Ascites: Fluid accumulation in the abdominal cavity, leading to swelling and discomfort.
• Weight Gain or Loss: Unexplained weight gain or loss can be a symptom of peritoneal cancer [13].
• Fatigue: Feeling extremely tired or weak due to the disease's progression.
• Urinary Frequency or Urgency: Difficulty controlling urination or feeling an urgent need to urinate.

Other Possible Symptoms

In more advanced stages, symptoms may include:

• Bowel Obstruction: Blockage of the intestines, leading to constipation, nausea, and vomiting.
• Loss of Appetite: Decreased interest in food due to discomfort or pain.
• Abdominal Swelling: Enlargement of the abdomen due to fluid accumulation or tumor growth.

Important Note

It's essential to note that these symptoms can be similar to those experienced by people with other conditions, making it crucial for a proper diagnosis and medical evaluation. If you're experiencing any of these symptoms, consult a healthcare professional for an accurate assessment and guidance.

References:

[3] Oct 12, 2023 — When symptoms occur, they are often vague and nonspecific and include fatigue, abdominal swelling, diffuse abdominal pain, urinary frequency, ...

[13] What are the symptoms of peritoneal cancer? Peritoneal cancer symptoms are often non-specific. This means they can also be symptoms of many other conditions. Symptoms may include: Unexplained weight gain or weight loss; ...

Diagnostic Tests for Obsolete Metastasis to the Peritoneum

Obtaining an accurate diagnosis of peritoneal metastasis can be challenging, and various diagnostic tests have been employed over time to aid in this process. While some of these tests may be considered obsolete or less effective than others, they are still worth mentioning as part of medical history.

• Computed Tomography (CT) scans: CT scans were once considered the best imaging procedure for evaluating patients with known or suspected peritoneal metastases [4]. However, their sensitivity and specificity have been found to be limited in detecting peritoneal metastasis, with a high specificity but low sensitivity [3].
• Laparoscopy: Laparoscopy has also been used to diagnose peritoneal metastasis, particularly for staging purposes. It has demonstrated a significant incidence of peritoneal metastases in patients undergoing laparoscopic examination [3]. However, its use is now largely limited due to the availability of more advanced imaging modalities.
• Positron Emission Tomography (PET) and Magnetic Resonance Imaging (MRI): While PET/MRI scans have been shown to be superior to CT scans in detecting peritoneal metastasis [6], their use is still not widespread for this specific indication. However, they may be considered as part of a comprehensive diagnostic workup.

Current Diagnostic Approaches

In contrast to these older methods, current diagnostic approaches for peritoneal metastasis rely heavily on more advanced imaging modalities and a combination of radiological imaging, blood tests, and sometimes biopsy or surgery [8]. These newer approaches aim to provide a more accurate diagnosis and guide treatment decisions.

References:

[3] The CT identification of peritoneal metastases has been correlated with second look laparotomy. The specificity of CT for the diagnosis of peritoneal metastases is high ranging from 85–87%, however its sensitivity is low, ranging from 42–47% [45,46]. Laparoscopy has also demonstrated a significant incidence of peritoneal metastases in ...

[4] by JC Healy · 2001 · Cited by 40 — CT is considered the best imaging procedure for the evaluation of patients with known or suspected peritoneal metastases.

[6] by SYA Ho · 2023 · Cited by 4 — A recent systematic review demonstrated that PET/MRI scans exhibited better sensitivity for detecting peritoneal metastasis in gastric cancer ...

[8] May 24, 2019 — A combination of radiological imaging, blood tests, and in some cases biopsy or surgery is essential for the diagnosis of peritoneal metastasis.

Treatment Options for Peritoneal Metastases

Peritoneal metastases, a condition where cancer cells spread to the lining of the abdominal cavity (peritoneum), can be challenging to treat. While there are no definitive cures, various drug treatments and therapies have shown promise in managing this condition.

Chemotherapy

Systemic chemotherapy is often used as a first-line treatment for peritoneal metastases. Chemotherapy drugs such as carboplatin and pemetrexed work by stopping the growth of cancer cells (4). However, due to the plasma-peritoneal barrier, drug penetration into the peritoneum can be hindered, limiting their effectiveness (3).

Intraperitoneal (IP) Chemotherapy

IP chemotherapy involves delivering drugs directly into the abdominal cavity. This method has shown promise in increasing drug concentration and uptake by small peritoneal metastases (12). IP chemotherapy is often used in combination with other treatments like surgery or systemic chemotherapy.

Regional Perfusion Therapy

For patients with cancer spread to the abdomen, regional perfusion therapy can offer a better outlook than traditional chemotherapy alone (8). This treatment involves delivering high doses of chemotherapy directly to the affected area.

Intraperitoneal Chemotherapy with Pressurized Atomization (PIPAC)

PIPAC is a novel method for intraperitoneal drug delivery. It uses pressurized atomization to spray the drug onto the peritoneal surface, increasing drug uptake by tumor tissue (11). This treatment has shown promise in managing peritoneal metastases.

Other Treatment Options

Cytoreductive surgery and intraperitoneal chemotherapy are considered part of multimodal treatment concepts for selected patients with peritoneal metastatic gastric cancer (13). Additionally, systemic chemotherapy consisting of fluoropyrimidine and oxaliplatin is a common first-line treatment in the metastatic setting (7).

Prognosis

Unfortunately, patients with peritoneal metastases have a poor prognosis, with median survival rates ranging from 3-6 months (5). However, ongoing research and advancements in treatment options offer hope for improved outcomes.

References:

• [1] DeVita V.T. Pharmacokinetic rationale for peritoneal drug administration in the treatment of ...
• [3] Current systemic therapies approved for metastatic GI cancers are less effective for PM...
• [4] The usual treatment consists of surgery or chemotherapy.
• [5] EVOCAPE-1 study reported the poor prognosis of untreated PM across the spectrum of gastrointestinal primary tumors...
• [7] First-line systemic chemotherapy consists of fluoropyrimidine and oxaliplatin in the metastatic setting.
• [8] Regional perfusion therapy can offer a better outlook than traditional chemotherapy alone for patients with cancer spread to the abdomen.
• [11] PIPAC treatment uses pressurized atomization to spray the drug onto the peritoneal surface, increasing drug uptake by tumor tissue.
• [12] IP chemotherapy increases drug concentration and uptake by small peritoneal metastases.
• [13] Cytoreductive surgery and intraperitoneal chemotherapy are considered part of multimodal treatment concepts for selected patients with peritoneal metastatic gastric cancer.

The differential diagnosis for metastases to the peritoneum involves considering various conditions that can mimic primary peritoneal cancer. Some of these include:

• Ovarian cancer, particularly epithelial neoplasms [14]
• Peritoneal carcinomatosis, which is characterized by extensive metastasis inside the peritoneal cavity and often associated with a grim prognosis [15]
• Malignant mesothelioma, especially in female patients where it can be mistaken for papillary serous carcinoma [7]
• Lymphoma, tuberculosis, and pseudomyxoma peritonei are also differential diagnoses to consider when evaluating metastases to the peritoneum [2]

It's essential to note that these conditions need to be distinguished from each other as well as from benign metastasizing leiomyoma, which presents with fewer nodules and often involves metastases in the lungs [13].

The presence of multiple peritoneal nodules can also raise suspicion for peritoneal carcinomatosis, peritoneal leiomyosarcomatosis, mesothelioma, tuberculosis, and lymphoma. A thorough examination and diagnostic workup are necessary to accurately diagnose the underlying condition.

References: [2] Diop AD · 2014 · Cited by 155 [7] [13] [14] [15]