The peritoneum is a surface lining inside the abdominal cavity. That same surface covers the ovaries. Primary peritoneal cancer has the same appearance as of ovarian cancer under the microscope. The exact cause is not known. Genetics may influence the occurrence of this cancer. Women with inherited mutations that predisposed ovarian cancer also have an increased rate of primary peritoneal cancer. Primary peritoneal cancer is uncommon compared to ovarian cancer. Primary peritoneal cancer is treated the same as ovarian cancer. This disease is easy is to confirm if ovaries have previously been removed prior to a patient developing this cancer. If ovaries have not been removed it is hard to tell if the cancer started with the fallopian tubes, the ovaries, or the peritoneum.
It seems that most often cancer starts on the fallopian tube or ovary and travels to the peritoneum rather than starting on the peritoneum. Symptoms of primary peritoneal cancer are identical to those for ovary cancer. Symptoms are rare prior to the presence of advanced disease. Most of the symptoms are related to cancer irritating the bowels or causing obstruction. The symptoms that develop are abdominal bloating, nausea, loss of appetite, constipation, or pain in the abdomen. If fluid develops in the abdomen and the abdomen may become very distended and the waist line may rapidly increase. A careful office exam may reveal abnormalities in the pelvis and of the abdomen. Blood work may show an elevated CA 125 or other tumor markers. A careful evaluation will help make sure other common causes of her pelvic or abdominal mass are not present. Other things to consider include infection, common uterine tumors, endometriosis, or even pregnancy. Further evaluation would often include CT scan of the abdomen and ultrasound of the pelvis. The diagnosis is confirmed at surgery.
Treatment success is based on surgery to remove all visible disease. Dr. Martin would commonly use a variety of surgical techniques to remove all visible cancer, possible bowel surgery, as well as removal of uterus or ovaries if they are present. The goal is to leave no visible disease at the end of surgery. Chemotherapy is usually required because this disease almost always presents as stage III or greater disease. Treatment is ultimately the same as the treatment recommended for ovarian cancer.