Peritoneum and peritoneal metastases
The thin membrane lining the abdominal cavity and covering the bowel. Cancers of the ovary, stomach, colon, appendix and pancreas often seed it with many small deposits, which is hard to treat with drugs alone.
Peritoneal metastases (carcinomatosis) cause ascites, bowel obstruction and cachexia, are under-detected by CT, and respond poorly to systemic therapy because deposits are small, poorly vascularised and bathed in a protective fluid space. Treatments include cytoreductive surgery with HIPEC (standard in appendiceal and selected ovarian cancers), intraperitoneal chemotherapy and PIPAC, and in gastric cancer the extent of peritoneal disease (P score, cytology) determines resectability. Mesothelioma can also arise from the peritoneum.
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