Leading expert in peritoneal surface malignancies, Dr. Paul Sugarbaker, MD, explains the key symptoms of metastatic peritoneal cancer. He details how cancer spreads silently in the abdomen. The top sign is an expanding abdominal girth despite weight loss. Other critical symptoms include a new hernia or a bowel perforation. Dr. Paul Sugarbaker, MD, emphasizes that these signs often indicate a late diagnosis. Early detection is challenging but crucial for effective treatment.
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Recognizing the Symptoms of Peritoneal Metastases from Abdominal Cancers
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- Expanding Abdomen as a Primary Symptom
- New Hernia Onset and Perforation
- Cancer Types That Spread to the Peritoneum
- Challenges in Diagnosing Peritoneal Cancer
- Importance of a Medical Second Opinion
- Full Transcript
Expanding Abdomen as a Primary Symptom
An expanding abdomen is the most common and telling symptom of metastatic peritoneal cancer. Dr. Paul Sugarbaker, MD, notes that patients often misinterpret this sign. They frequently believe they are simply gaining weight or getting fat. This symptom becomes more significant when the abdominal girth increases even as the patient loses weight from dieting. This paradox is a major red flag for a significant cancer burden within the large peritoneal space.
New Hernia Onset and Perforation
Beyond abdominal expansion, two other critical symptoms signal advanced peritoneal disease. The first is the new onset of a hernia, which can develop due to increased intra-abdominal pressure from tumor growth. The second, and more acute, symptom is a perforation of the bowel. Dr. Paul Sugarbaker, MD, explains that this often involves the appendix or colon. A perforation leads to infection, which then becomes the emergency event that finally reveals the underlying advanced cancer that has seeded throughout the peritoneal cavity.
Cancer Types That Spread to the Peritoneum
Several gastrointestinal and gynecological cancers are known to metastasize to the peritoneal lining. Dr. Paul Sugarbaker, MD, specifically highlights appendiceal cancer, colorectal cancer, gastric (stomach) cancer, and ovarian cancer. Peritoneal mesothelioma, a cancer originating from the peritoneum itself, also presents with these symptoms. These cancers can disseminate cells within the abdominal cavity long before any noticeable symptoms appear, making early detection difficult.
Challenges in Diagnosing Peritoneal Cancer
Diagnosing peritoneal metastases remains a significant challenge in oncology. Dr. Paul Sugarbaker, MD, identifies this as the greatest problem for successful treatment. The peritoneal space is vast, allowing a substantial tumor burden to develop silently. Diagnosis is frequently delayed until the disease is extensive. A CT scan is often the first imaging study that reveals the extensive intra-abdominal cancer, but it is typically ordered only after symptoms like an expanding abdomen become pronounced.
Importance of a Medical Second Opinion
Seeking a medical second opinion is crucial for patients presenting with these symptoms. Dr. Anton Titov, MD, discusses how a second opinion can confirm a diagnosis of peritoneal metastases from cancers like stage 4 ovarian cancer or stage 4 colon cancer. This step is vital for clarifying the diagnosis and exploring all treatment options. Specialized treatments, such as cytoreductive surgery combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), require expert evaluation. A second opinion ensures patients are directed toward the most advanced and appropriate care plans.
Full Transcript
Dr. Paul Sugarbaker, MD: Symptoms and signs of cancer spread in the abdomen and peritoneal cavity include ovarian cancer, colorectal cancer, gastric cancer, and appendiceal cancer. They can spread in the peritoneum before any symptoms appear. Expanding abdominal girth is often the first symptom of metastatic cancer spread in the peritoneum.
Dr. Anton Titov, MD: What are other common symptoms of peritoneal metastases?
Dr. Paul Sugarbaker, MD: Metastatic peritoneal cancer symptoms include an expanding abdomen. People report getting fat and increasing abdominal girth. Patients have a very significant peritoneal cancer burden, and peritoneal cancer is diagnosed late.
Symptoms of abdominal cancer spread to peritoneum are: an expanding abdomen, a new hernia, or perforation of the large bowel or appendix. These are symptoms of colon cancer, gastric cancer, and ovarian cancer spread in the peritoneal cavity.
Peritoneal metastases occur in advanced cancer spread. A medical second opinion clarifies colon cancer or ovarian cancer diagnosis and confirms peritoneal cancer metastases.
Intraperitoneal chemotherapy treatment is used for advanced stage 4 cancer with metastatic lesions in the abdomen. A medical second opinion helps to clarify symptoms of stage 4 ovarian cancer, stage 4 colon cancer, or metastatic stage 4 gastric cancer.
It is important to get a medical second opinion on advanced cancer with peritoneal metastases. The best peritoneal metastatic advanced cancer treatment involves surgical operation and regional chemotherapy.
Dr. Anton Titov, MD: How is peritoneal spread of cancer usually diagnosed? Is peritoneal cancer diagnosed after the symptoms appear? Does a vigilant oncologist pick up peritoneal cancer spread? Or is a particular CT scan or technological method used to diagnose cancer spread in the abdomen? How do you identify patients with peritoneal cancer spread?
Dr. Paul Sugarbaker, MD: I would say that the greatest problem with success in treating peritoneal cancer spread is that patients very often come with extensive cancer dissemination. For example, with peritoneal mesothelioma or with appendiceal cancer, the most common symptom is an expanding abdomen.
Patients say, "I thought I was getting fat. I went on a diet, but my belly got bigger even though I lost weight." Then they have a CT scan and find out that they have extensive intra-abdominal cancer.
Because the peritoneal space is very large, patients can develop a very significant peritoneal cancer burden. But there is no correct diagnosis of peritoneal cancer until very late in cancer growth.
The most common presenting features of peritoneal cancer metastases are an expanding abdomen, a new onset of hernia, or perforation of the organ that is involved. It could be the appendix or the colon.
Bowel perforation leads to infection, and this infection becomes the signal that the patient has an advanced cancer. Cancer has now seeded itself around the peritoneal space. Gastrointestinal cancer includes colon cancer, rectal cancer, and gastric cancer.
Metastatic peritoneal cancer symptoms include expanding abdomen, new onset of hernia, and perforation of large bowel.