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>> Peritoneal surface malignancy is the medical term
for tumors that have spread from the primary organ
to the abdomen.
The peritoneum itself is the lining of the abdominal cavity,
so outside of the organs.
There are a number of tumors that can spread here
from the colon, appendix, ovaries, or other sites.
And then there are some tumors,
such as primary peritoneal mesothelioma,
that come directly from the peritoneal lining itself.
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There are some patients that present with symptoms,
such as abdominal fullness or bloating,
decreased appetite, weight loss, or abdominal pain.
But there are many patients who have no symptoms,
and these tumors are found on work-up for other conditions.
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Patients that have tumors that have spread to the abdomen,
and cause a peritoneal surface malignancy,
it is often diagnosed with either a CT or CAT scan,
which is often done for other purposes
particularly in a patient that is completely asymptomatic.
They maybe got a CT scan
to look at their gallbladder or something.
For other patients that are symptomatic,
oftentimes they're brought to surgery,
and at the time of surgery, these tumors are found.
If the tumors are found on imagining,
we'll often proceed to a biopsy,
often done by the radiologist.
But in cases where we don't have a tissue diagnosis,
then we'll proceed to a minimally invasive surgery
to obtain a piece of tissue for formal diagnosis.
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The treatment options for peritoneal surface malignancy
depend greatly on the tumor type.
For example, primary peritoneal mesothelioma
is treated mainly through cytoreductive surgery and hipec.
That means cytoreductive surgery,
an operation where we go in and remove all evidence
of tumor inside the abdomen
and any organs that may be involved.
And we follow this at the same time with heated chemotherapy
that we our pour directly into the abdomen.
We may also use intravenous chemotherapy
or other newer techniques such as immunotherapy,
but the mainstay is surgical treatment.
In the case of something like
low-grade appendicle mucinous neoplasm,
there is no role for intravenous chemotherapy, and surgery,
meaning cytoreductive surgery and hipec,
is the only treatment that is effective for this condition.
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The recovery from cytoreductive surgery and hipec
is somewhat variable,
depending on the patient's preoperative condition, age,
and comorbidities, meaning other medical conditions,
such as heart disease, diabetes.
In general though, we tell patients that it's roughly
a six week period of time, from the date of surgery
until a point where they'll have more good days than bad.
In the interim time, patients are at home,
they're hopefully eating normal food,
getting around the house okay,
but they will require some assistance
from friends and family members during this time.
In the six week to three months period, again,
I would describe more good days than bad,
but it generally takes three to six months
before the patient's quality of life
returns to preoperative levels.
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