Introduction
When colon or rectal cancer spreads to the peritoneum, it is called peritoneal carcinomatosis. Although this diagnosis may seem serious, today we have treatments that, in selected patients, can offer the possibility of disease control and, in some cases, cure.
What is colorectal peritoneal carcinomatosis?
The peritoneum is a thin membrane that lines the inside of the abdomen. When colorectal cancer cells spread to this surface, we speak of peritoneal carcinomatosis.
This can occur:
- At the time of diagnosis of the primary tumor
- As a recurrence after initial treatment
- Associated with liver metastases in some cases
Symptoms
The most common symptoms include:
- Abdominal distension or swelling
- Abdominal pain or discomfort
- Changes in bowel habits
- Loss of appetite
- Weight loss
- Fatigue
In some cases, the disease may cause few symptoms in its early stages.
Treatment options
Treatment of colorectal peritoneal carcinomatosis has evolved significantly in recent years.
Cytoreductive surgery + HIPEC
In carefully selected patients, the combination of:
- Cytoreductive surgery: Removal of all visible tumors
- HIPEC: Heated intraperitoneal chemotherapy
This combination can offer the possibility of long-term disease control in some patients.
Systemic chemotherapy
- Can be used before surgery (neoadjuvant) to assess response
- Or after surgery (adjuvant) to consolidate results
- Or as the main treatment when surgery is not possible
Patient selection: why is it important?
Not all patients with colorectal peritoneal carcinomatosis are candidates for cytoreductive surgery. Careful selection is essential to:
- Offer the best possible outcome
- Avoid unnecessary surgery
- Ensure that the benefit outweighs the risks
Favorable factors
- Limited extent of peritoneal disease
- Good response to chemotherapy
- Good general condition
- Absence of unresectable liver metastases
- Favorable tumor biology
What does surgery involve?
Cytoreductive surgery is extensive and may include:
- Removal of affected peritoneal areas
- Resection of the primary tumor if not yet removed
- Removal of liver metastases if limited
- Resection of other involved structures
The goal is to leave no visible disease.
Duration and hospitalization
- Surgery duration: 6-10 hours
- Hospitalization: 10-15 days on average
- Full recovery: 2-3 months
Possible complications
As with any major surgery, complications may occur:
- Infections
- Anastomotic leak
- Bleeding
- Need for temporary stoma
- Delayed recovery
These surgeries are performed in specialized centers with experience in managing these complications.
Results and prognosis
In well-selected patients:
- Significant improvement in survival compared to chemotherapy alone
- Possibility of long-term disease control in some cases
- Good quality of life after recovery
Important: Results depend greatly on proper patient selection and completeness of cytoreduction.
Follow-up
After treatment, regular follow-up includes:
- Periodic consultations
- Tumor markers (CEA)
- Imaging tests (CT scans)
- Assessment of quality of life
A message of hope
The treatment of colorectal peritoneal carcinomatosis has advanced significantly. What was once considered an incurable disease can now, in selected patients, be treated with the intention of long-term control. If you have been told that your disease is inoperable, it is worth seeking a second opinion at a specialized center.
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