Introduction
When stomach cancer spreads to the peritoneum, the emotional impact is usually significant. It is normal to think that options are limited or that surgery is no longer possible.
However, today we know that, in carefully selected patients, there may be treatment strategies that combine chemotherapy and surgery with the aim of controlling the disease and improving prognosis.
What is gastric peritoneal carcinomatosis?
The stomach is covered by the peritoneum. In some patients with gastric cancer, tumor cells can detach and spread throughout this membrane, producing peritoneal carcinomatosis.
In many cases, this disease can be extensive and aggressive. Therefore, not all patients benefit from surgery, and it is essential to carefully evaluate each case before making decisions.
What symptoms can it cause?
Symptoms can vary greatly. Some patients present:
- Abdominal pain or discomfort
- Abdominal swelling or distension
- Loss of appetite
- Weight loss
- Fatigue
- Nausea or digestive changes
In early stages, the disease may cause few symptoms.
What does my treatment involve?
Treatment of gastric peritoneal carcinomatosis must always be individualized. There is no single strategy valid for all patients.
In most cases, the first step is intravenous systemic chemotherapy, with the aim of:
- Controlling the disease
- Reducing its extent
- Evaluating how the tumor responds to treatment
The response to this chemotherapy is key information for deciding the next steps.
Neoadjuvant therapy: intravenous chemotherapy and lapHIPEC
In selected patients, especially when the disease responds well to intravenous chemotherapy, a pre-surgery treatment strategy (neoadjuvant) may be considered.
Intravenous chemotherapy
Administered through a vein and acts throughout the body. It treats both visible disease and possible microscopic cells.
Laparoscopic intraperitoneal chemotherapy (lapHIPEC)
In some cases, a treatment called lapHIPEC is added, which consists of:
- Administering chemotherapy directly inside the abdomen
- Through minimally invasive surgery (laparoscopy)
- With chemotherapy at a slightly elevated temperature
Objective: To act directly on the peritoneum and assess disease response, without yet performing aggressive surgery.
Why is proper patient selection so important?
Surgery for gastric peritoneal carcinomatosis is very aggressive and not without risks. Performing it without adequate selection can cause more harm than benefit.
Therefore, before considering extensive surgery, the team carefully evaluates:
- Response to chemotherapy
- Actual extent of disease
- Patient's general condition
- Absence of disease outside the abdomen
Fundamental principle
Only when very specific criteria are met is surgery with the intention of removing visible disease considered.
Surgery: when it is considered and what it involves
When the disease is well controlled and the team considers that surgery may be beneficial, an intervention is planned with the aim of:
- Removing the gastric tumor
- Removing visible peritoneal implants
- In some cases, associating HIPEC during surgery
This surgery may involve resection of other organs and must be performed in experienced centers.
How long will I be hospitalized?
Length of stay depends on the treatment performed:
- lapHIPEC: Short stay
- Extensive surgery: 10-15 days (may be longer in complex cases)
What will my follow-up be like?
Follow-up is continuous and personalized:
- Periodic reviews
- Imaging tests
- Nutritional status assessment
- Quality of life evaluation
The goal is to care for both the disease and the person.
A message for you
Gastric peritoneal carcinomatosis is a complex disease. Today we know that not all patients benefit from aggressive treatments, and that properly selecting who to offer surgery to is key to not causing harm. When one acts with caution, experience, and a personalized approach, real and safe treatment options can open up.
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