26 Nov, 2025
Feel free to reach out to us.
26 Nov, 2025
This article is medically reviewed by Dr. K. Lakshmi Priyadarshini, Consultant - Medical Oncology, HCG Cancer Centre, Vijayawada.
The peritoneum is the transparent membrane made up of smooth tissues (serous membrane) and lines the abdominal cavity, viscera, and coelom. The infiltration of malignant cells into this serous membrane is referred to as peritoneal cancer.
Cancer of the peritoneum is divided into primary and secondary types based on their origin.
Primary peritoneal carcinoma (PPC) is a rare type of cancer that starts in the peritoneum. PPC cells resemble the most common type of ovarian cancer cells, often making them difficult to diagnose.
This disease progresses rather quickly, and therefore, timely treatment is crucial.
Women are generally more prone to being affected than men, especially those with a family history of ovarian and breast cancer.
Secondary peritoneal carcinomatosis typically arises when malignant cells from tumors in the digestive and reproductive systems spread to the peritoneum.
In patients with secondary peritoneal carcinomatosis, the disease would have advanced significantly, and therefore, the treatment goal is primarily to control cancer growth, prolong survival, and alleviate symptoms.
Secondary peritoneal carcinomatosis affects both men and women, and it is relatively more common than primary peritoneal cancer.
The peritoneum is a membrane that lines the inside wall of the abdomen. It is made up of mesothelial cells, connective tissue, and epithelial cells.
The peritoneum covers the abdominal organs and facilitates the transmission of nerves, blood vessels, and lymphatics. Despite its thinness, the peritoneum comprises two layers with a potential space between them.
The term "gastrointestinal cancer" refers to cancers that arise from the digestive or gastrointestinal tract. It includes cancers of the esophagus, gallbladder, liver, pancreas, stomach, small intestine, bowel (large intestine, colon, and rectum), and anus.
Advanced gastrointestinal cancer can metastasize to the peritoneum and lead to the formation of secondary peritoneal carcinoma.
Gastrointestinal cancer spread to the peritoneum can occur when the disease directly invades the peritoneum. It can also occur when the primary tumors shed cancer cells, which can get implanted into the peritoneal lining or enter the peritoneum fluid and lead to cancer formation.
GI cancers and peritoneal cancers may exhibit similar symptoms, such as abdominal pain, bloating, alterations in bowel movements, and unexplained weight loss.
Colorectal, gastric, pancreatic, and appendix cancers tend to metastasize into the peritoneum.
The peritoneal cavity provides a favorable microenvironment for the survival and growth of these cancer cells. This enables the implantation and development of secondary tumors in the peritoneum.
Colorectal cancer starts as an abnormal growth in the inner lining of the colon or rectum. This growth is called a polyp (a flat bump shaped like a mushroom), and it often starts as a benign or precancerous growth and can become malignant over time.
As the disease progresses, it infiltrates the lining of the colon or rectum and reaches the abdominal cavity. Approximately 15% to 20% of colorectal cancer cases metastasize to develop cancer of the peritoneum.
The abnormal growth and division of cells in any part of the stomach can lead to stomach cancer. Although tumors can erupt anywhere in the stomach, most originate in the glandular tissue of the stomach's inner surface.
The spread of stomach cancer to the peritoneum typically occurs in the advanced stages of the illness.
Cancer cells from the primary stomach tumor may detach and circulate through the bloodstream or lymphatic system, eventually reaching the peritoneum.
Pancreatic cancer refers to an abnormal growth of cells in the pancreas, which in turn is caused by mutations and unregulated cell division.
Due to the delayed onset of clinical symptoms, the disease is often diagnosed in its advanced stages.
A complex interplay of molecular mediators characterizes the progression of pancreatic cancer to peritoneal cancer. These mediators aid tumor invasion and remodeling of the extracellular matrix of healthy cells.
Appendix cancer is a rare type of gastrointestinal cancer. In some cases, appendix cancer can spread to the peritoneum, giving rise to cancer of the peritoneum.
Pseudomyxoma peritonei is a rare type of cancer that arises from the appendix, and it is characterized by the formation of polyps. These polyps are different from those that form in the colon and rectum. The cancer cells from these polyps spread to the peritoneum by following the flow of peritoneal fluid.
Other than this, certain high-grade appendiceal cancers can also spread to the peritoneum to form peritoneum cancer.
Hepatocellular carcinoma is the most common type of liver cancer, and it is often found in individuals with chronic liver diseases.
Liver cancer, especially if it spreads to the peritoneum, may result in the formation of ascites. Ascites refers to the fluid build-up in the peritoneal cavity. Ascites formation is an indicator of the spread of cancer as well as a medium through which cancer cells can disseminate rapidly within the abdominal cavity.
Among the primary tumors that frequently result in carcinomatosis of the peritoneum are gastrointestinal (GI) cancers, including those affecting the stomach, colon, pancreas, and appendix.
Numerous factors contribute to the likelihood of GI cancer spreading to the peritoneum.
The peritoneum is closely wrapped around various sections of the GI tract. That is, the anatomical proximity makes it susceptible to invasion by GI cancers.
Cancer cells can easily invade through the wall of the GI tract and reach the peritoneal cavity.
The term transcoelomic spread refers to a route of tumor metastasis across a body cavity.
Cancer cells associated with GI cancers can detach from the primary tumor, penetrate the outermost layer of the GI tract, and invade the peritoneal cavity. These cells can then bind to and settle on the peritoneal surface, leading to the formation of secondary tumors.
GI cancers also spread to the peritoneum via lymphatic and hematogenous dissemination. The infiltration of cancer cells into lymphatic vessels or blood vessels allows them to travel to the peritoneum.
Once in the peritoneum, they can escape the circulation and establish metastatic growth. Moreover, the peritoneum is equipped with a complex network of lymphatic channels that aids this process.
A small quantity of fluid is present in the peritoneal cavity to help move abdominal organs. The same peritoneal fluid can also disseminate cancer cells within the abdominal cavity.
The unique microenvironment of the peritoneal cavity is conducive to the growth of cancer cells.
Tolerance is meant to reduce increased inflammation in response to foreign materials from the gut. However, it ends up creating a permissive space for the spread of malignant cells.
The direct invasion of cancer cells consists of a complex series of steps:
Direct invasion is a key feature of cancer's aggressive stage, highlighting its capability to grow uncontrollably.
Lymphatic and hematogenous dissemination are the two major ways in which cancer cells can spread from the primary tumor site to other parts of the body.
Lymphatic dissemination refers to the spread of cancer cells via the lymphatic system. The lymphatic system consists of vessels, nodes, and organs that work together to move lymph back into the bloodstream. Thus, it acts as a channel for the cancer cells to travel from the original tumor site to the lymph nodes and other parts of the body.
Within the context of peritoneal cancer, cancer cells can separate from the primary tumor, infiltrate the lymphatic vessels, and then travel to the regional lymph nodes.
As the name suggests, this form of dissemination is characterized by the migration of cancer cells via the bloodstream.
This method offers a quicker spread due to the extensive vascular network and continuous and rapid blood circulation, in contrast to the slower lymphatic pathway. It allows the cancer cells to travel long distances from their primary site and form secondary tumors in remote organs, referred to as metastases.
Ascites is the pathological accumulation of fluid within the peritoneal cavity. About 70% of patients with peritoneal carcinomatosis present with ascites.
Ascites associated with cancer of the peritoneum signal advanced illness. In that stage, the treatment selected focuses on enhancing the quality of life and managing symptoms.
Reasons for ascites formation in the context of peritoneal cancer:
Gynecological cancers, such as ovarian, endometrial, and cervical cancer, have the potential to cause peritoneal metastasis.
Dealing with peritoneal metastases presents a significant difficulty in treating gynecological cancers. It is reported that around 60% of gynecologic tumors already have peritoneal metastases upon diagnosis, adding to the complexity of treatment strategies for these types of cancer.
Ovarian cancer is caused by tumors within the ovary. It can either originate from the ovary or spread from adjacent structures such as the fallopian tubes or the inner lining of the abdomen. Recent research indicates that most ovarian tumors begin in the fallopian tubes. The peritoneum is the most common site of metastasis of ovarian cancer.
Uterine cancer is a general term that refers to any cancer that originates in the uterus. It is primarily divided into two main types based on where it starts:
This type of cancer begins in the endometrium, or the lining of the uterus. It's usually detected early because it often causes abnormal vaginal bleeding, which prompts women to seek medical advice. Endometrial cancer is the second most prevalent gynecological malignancy in women globally, following cervical cancer.
This is a rare form of uterine cancer that starts in the muscles and tissue that support the uterus. Uterine sarcomas are more aggressive and difficult to treat than endometrial cancer.
Cervical cancer is a type of cancer that occurs in the cells of the cervix, the lower part of the uterus that connects to the vagina. It can often be prevented through vaccination and regular screening tests. The primary cause of cervical cancer is a persistent infection with certain types of human papillomavirus (HPV). Peritoneal metastasis from primary cervical cancer is not very common.
The progression of advanced gynecological cancers can result in secondary peritoneal cancer. It occurs when cancer cells originating from the ovaries or other gynecological organs spread to the peritoneum. The dissemination of cancer cells to the peritoneum is commonly observed in cases of advanced or recurrent epithelial ovarian cancers.
Peritoneal cancer management demands a comprehensive approach, which is often multimodal. Depending on the extent of the disease's spread, the treatment goal may vary from one case to another.
Debulking surgery, or cytoreductive surgery, is a surgical intervention that focuses on minimizing the tumor load by removing as much cancerous tissue as possible.
This particular surgical procedure is crucial in the management of advanced cancers that have spread to the peritoneum, where complete elimination of the tumor is not viable due to its widespread nature or its proximity to essential organs.
HIPEC surgery is a multimodal treatment approach that combines surgery with abdominal chemotherapy. HIPEC is performed in two phases: During the first phase, the surgeon removes as much cancer tissue as possible. In the second phase, a heated chemotherapy solution is delivered into the abdominal cavity, where it circulates for about 60-90 minutes.
HIPEC helps kill cancer cells that are left behind after the debulking surgery. The chemotherapy solution is then washed off, and the incision is closed.
Increasing the temperature improves the "cancer-killing" ability of chemotherapy drugs. Also, cancer cells are more susceptible to heat than normal cells. In other words, heating chemotherapy drugs will enhance the overall effectiveness of the treatment.
Chemotherapy is a drug treatment that uses potent chemicals to kill rapidly dividing cells in the body. It can be done before surgery (neoadjuvant chemotherapy) to shrink the tumor size, facilitating its surgical removal.
Additionally, chemotherapy is often administered after surgery (adjuvant chemotherapy) to target any remaining cancer cells to lower the cancer recurrence.
Targeted therapy is the latest treatment option available for peritoneal cancer.
Drugs administered as part of targeted therapy work by targeting specific molecules and pathways that are associated with cancer cells and are responsible for their growth. Targeted therapy uses various mechanisms to kill cancer cells and control their growth.
The biggest advantage of targeted therapy is that it specifically targets the cancer cells while leaving the healthy cells unharmed.
Targeted therapy may be combined with other treatment approaches, namely surgery and chemotherapy, to enhance the overall effectiveness of the treatment.
The cancer specialists at HCG prioritize the overall well-being of their patients. Our medical practitioners are compassionate and competent. We empower patients with the knowledge to make informed choices regarding their health.
As a leading hospital for peritoneal cancer treatment in India, HCG brings forth the most up-to-date advancements in the treatment of cancer of the peritoneum, including cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), and helps patients manage this condition effectively.
Revolutionary treatment modalities have improved outcomes for peritoneal cancer patients. However, timely detection and treatment are crucial for peritoneal cancer to be managed effectively.
To reduce the risk of cancer of the peritoneum, one may follow peritoneal cancer prevention measures, such as adopting a healthy lifestyle and undergoing regular health checkups. With increased awareness and appropriate measures, it is possible to put oneself a step ahead of peritoneal cancer.
Dr. K. Lakshmi Priyadarshini
MBBS, MD (Paediatrics), DM (Medical Oncology)
Consultant – Medical Oncology
Dr. K. Lakshmi Priyadarshini is an experienced medical oncologist and pediatric oncologist who also specializes in hematology and bone marrow transplants (BMT). She is practicing at the HCG Cancer Centre, a top cancer hospital in Vijayawada. With over 7 years of experience, she has a deep understanding of cancer treatments, especially pediatric and adult cancers. She is committed to providing the best possible care to her patients and has a holistic approach to treatment, taking into consideration the emotional and physical needs of her patients and their families.
Appointment Link: Book an Appointment with Dr. K. Lakshmi Priyadarshini.
