Peritoneal carcinomatosis of colorectal origin: Incidence, prognosis and treatment options

Abstract

Peritoneal carcinomatosis (PC) is one manifestation of metastatic colorectal cancer (CRC). Tumor growth on intestinal surfaces and associated fluid accumulation eventually result in bowel obstruction and incapacitating levels of ascites, which profoundly affect the quality of life for affected patients. PC appears resistant to traditional 5-fluorouracil-based chemotherapy, and surgery was formerly reserved for palliative purposes only. In the absence of effective treatment, the historical prognosis for these patients was extremely poor, with an invariably fatal outcome. These poor outcomes likely explain why PC secondary to CRC has received little attention from oncologic researchers. Thus, data are lacking regarding incidence, clinical disease course, and accurate treatment evaluation for patients with PC. Recently, population-based studies have revealed that PC occurs relatively frequently among patients with CRC. Risk factors for developing PC have been identified: right-sided tumor, advanced T-stage, advanced N-stage, poor differentiation grade, and younger age at diagnosis. During the past decade, both chemotherapeutical and surgical treatments have achieved promising results in these patients. A chance for long-term survival or even cure may now be offered to selected patients by combining radical surgical resection with intraperitoneal instillation of heated chemotherapy. This combined procedure has become known as hyperthermic intraperitoneal chemotherapy. This editorial outlines recent advancements in the medical and surgical treatment of PC and reviews the most recent information on incidence and prognosis of this disease. Given recent progress, treatment should now be considered in every patient presenting with PC.

An evaluation of treatment results of emergency versus elective surgery in colorectal cancer patients

“…Peritoneal carcinomatosis is detected more in emergency cases, and the associated risk factors for its development include right colon cancer, advanced T and N stage, and poor differentiation (49). Considering these risk factors, the high rate of peritoneal carcinomatosis in our emergent cases is reasonable.…”

Colloidal stability of nano-sized particles in the peritoneal fluid: Towards optimizing drug delivery systems for intraperitoneal therapy

“…Also in colorectal cancer, cancer cells often migrate to the abdomen where they spread and form peritoneal carcinomatosis [2]. The often late stage of discovery of peritoneal metastases, which can spread over the entire surface of the peritoneum (~2 m²), make the treatment very difficult.…”

Lymph node-independent liver metastasis in a model of metastatic colorectal cancer

“…Importantly, we never observed peritoneal carcinomatosis in any of our transplanted NOD/SCID or NSG host mice-a feature that is widespread in the previously reported CRC models to date [14][15][16][17] . Given that peritoneal carcinomatosis is not a common manifestation in human CRC 18 , our findings further highlight the relevance and advantage of our metastatic CRC model over those that have been reported in the literature.…”

“…It is thus highly plausible that tumour formation in these secondary sites may not be true metastases, but rather a result of peritoneal seeding. The fact that peritoneal carcinomatosis is not a prominent feature of human metastatic CRC 18 further suggests a limited utility of these models for investigating routes of metastatic dissemination.…”