Primary peritoneal cancer at a glance

• Primary peritoneal cancer (PPC) is abnormal growth of cells that form in the peritoneum, a tissue layer lining the abdomen and covering the rectum, bladder and uterus.
• Primary means the cancer originated in the peritoneum and is not a cancer that has spread (metastasized) to the peritoneum from somewhere else, such as breast cancer.
• PPC can occur anywhere in the abdomen and affects the organs in that area.
• Symptoms of PPC are rarely present until the cancer has progressed to a later stage and can include abdominal discomfort, nausea, frequent urination and appetite loss.
• Treatment for PPC may include surgery or chemotherapy, depending on the cancer stage and health of the patient.

What is primary peritoneal cancer?

Primary peritoneal cancer (PPC) is a rare cancer originating in the membrane that lines the inside of the abdomen (the peritoneum). Functioning as a shield, the peritoneum protects the abdomen and produces a lubricant that maintains smooth organ movement when the body is active.

The “primary” in PPC means the cancer originated in the peritoneum. Secondary peritoneum is PPC that has metastasized (spread) to the peritoneum from other areas of the body. Similarly, other primary cancers, such as ovarian cancer, may spread to the peritoneum.

Both men and women can get PPC, but women more commonly get PPC because of its connection and resemblance to ovarian cancer. The surfaces of both the peritoneum and ovaries are comprised of epithelial cells. PPC and common forms of ovarian cancer have similar symptoms and act in nearly identical behaviors. Ovarian cancer commonly spreads into the peritoneum, and women who have had their ovaries removed may still get PPC.

PPC may be diagnosed during a pelvic exam. If a doctor suspects abnormalities, he or she may perform an ultrasound and order a blood test or CT scan to confirm a PPC diagnosis.

Symptoms of primary peritoneal cancer

PPC can be challenging to detect until later stages. Symptoms, which can often be seemingly innocuous, include:

• Constipation
• Feeling overly full after eating small meals
• Complete loss of appetite
• Frequent urination
• Nausea
• General discomfort in the abdomen

PPC is not diagnosed until an ovarian cancer diagnosis is ruled out.

Causes and risk factors of primary peritoneal cancer

PPC triggers and causes are largely unidentified. But there are certain risk factors that correlate with PPC. However, just because an individual has a risk factor does not mean this will cause PPC or any other cancer. Factors that increase the risk of developing PPC include:

• Age is the primary accelerator and risk factor of PPC.
• Women are more likely to contract PPC and women with ovarian cancer are more likely to be diagnosed with PPC.
• Women with BRCA1 and BRCA2 genetic mutations are at a higher risk of PPC.

Treatment of primary peritoneal cancer

There are numerous treatment paths for PPC. Types of treatment will depend on the stage and severity of the cancer, the location and size, and the patient’s overall health. Treatment options include:

• The surgeon removes all visible portions of the cancer from the abdomen and pelvic area. This may include removing the ovaries, uterus and Fallopian tubes, depending on where the cancer has spread.
• Powerful drugs may be injected or inserted directly into the abdomen with a catheter.
• Palliative care. When PPC is found in advanced stages, treatment will attempt to relieve symptoms and pain, instead of removing the cancer.

When found early and treated by a gynecologic oncologist, PPC cancer can generally be removed in its entirety. Patients will continue to be monitored after treatment, as PPC can spread rapidly.

At CU Anschutz Gynecologic Oncology, experts provide advanced diagnosis and care, from surgery to radiation and chemotherapy.