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Peritoneal cancer

This page was reviewed under our medical and editorial policy by

Ruchi Garg, MD, CTCA National Program Director for Gynecologic Oncology.

This page was updated on May 9, 2022.

The peritoneum is the lining of the abdominal cavity and the organs in the abdomen and pelvis. Peritoneal cancer grows in this lining. It is rare in women and extremely rare in men.

In female patients, this cancer is typically bundled with ovarian cancer and treated in a similar manner because the peritoneal lining has the same embryologic origins as the cells that make up the ovaries. 

There are two main types of peritoneal cancer:

Primary peritoneal cancer develops first in the lining of the abdomen. Sometimes, it can be difficult to differentiate between peritoneal and tubal or ovarian cancers because often the cancerous cells spread over these areas before they’re discovered.

Secondary peritoneal cancer develops first in another part of the body then spreads to the peritoneum. Secondary peritoneal cancers are treated as metastasis from the primary cancer, which commonly involve the ovary, stomach, colon, pancreas, gallbladder, appendix, breast, uterus or lungs.

Peritoneal cancer symptoms

Symptoms of peritoneal cancer are similar to those of ovarian cancer. People with peritoneal cancer may experience:

  • Pain, swelling or pressure in the abdomen
  • Digestive symptoms, including nausea, vomiting, indigestion, changes in bowel movements and bloating
  • Urge to urinate
  • Lump in the pelvic area

Causes and risk factors for peritoneal cancer

Researchers and doctors haven’t yet found specific environmental factors that increase the likelihood of developing primary peritoneal, ovarian or fallopian tube cancers. One type of peritoneal cancer, called mesothelioma, is linked to asbestos exposure. It occurs more often in men older than age 60.

Risk factors for peritoneal cancer include:

  • Family history of ovarian, fallopian tube or peritoneal cancer
  • Genetic mutations or conditions, including inherited breast cancer (BRCA1 and BRCA2 mutations), Li-Fraumeni syndrome and Lynch syndrome 
  • History of endometriosis
  • Obesity in early adulthood 
  • Age: Being older than 50
  • Certain reproductive circumstances, including early periods, unexplained infertility, late menopause, no pregnancies

By contrast, birth control pills may actually lower the risk for ovarian cancer. Undergoing a hysterectomy or tubal ligation has also been associated with lower risk for the disease.

Diagnosis of peritoneal cancer

If peritoneal cancer (or ovarian/fallopian tube cancer) is suspected, your doctor may start with a thorough examination and take a detailed personal and family history.

Your doctor is also likely to perform a pelvic exam searching for any lumps, painful areas or abnormal tissues.  

Doctors may test your blood for the presence of the tumor marker CA-125, which can be a sign of ovarian cancer.

To take a look inside the abdomen, your doctor may order imaging tests, such as an ultrasound, computed tomography (CT) scan, positron emission tomography (PET) scan and magnetic resonance imaging (MRI).

If your care team finds a lump or abnormal tissue, they may conduct a biopsy. If the mass is isolated, a biopsy is typically performed via surgery. On the other hand, if the cancer appears to have spread, a biopsy may be performed either as a surgical procedure or one performed by a radiologist, who then sends the sample to a pathologist for examination under a microscope to determine whether it’s cancerous, and if so, to identify the cancer type. 

Peritoneal cancer treatment options

Treatment options for peritoneal cancer are similar to those of ovarian cancer and include surgery, chemotherapy and targeted treatments. Other treatment approaches, including radiation therapy and immunotherapies, are being investigated in clinical trials.

Surgery

Doctors usually conduct surgery, often called debulking, before going forward with other treatments. This surgery aims to remove as much of the tumor as possible. Surgeons will likely also remove or biopsy lymph nodes in the area of the cancer to check whether cancerous cells have started to spread.

Learn more about surgical options to treat ovarian or peritoneal cancer

Chemotherapy

Chemotherapy for peritoneal cancers is sometimes given directly into your abdomen instead of being injected into a vein or taken as a pill. This approach is called intraperitoneal chemotherapy, and it may limit side effects in other areas of the body. It may be performed during surgery, as a procedure called hyperthermic intraperitoneal chemotherapy (HIPEC) or at regular intervals afterward.

Targeted therapies

Newer drugs called targeted therapies act specifically on certain types of cancers based on their characteristics.

Avastin® (bevacizumab) is one targeted therapy used to treat peritoneal cancer that has come back after other treatments (recurrent). It works by blocking the growth of blood vessels that feed tumors. Another type of targeted treatment, poly (ADP-ribose) polymerase inhibitors (PARP inhibitors), is used to block the repair mechanisms that occur during cell division. This helps slow or stop tumor growth. Currently approved PARP inhibitors include Lynparza® (olaparib), Rubraca® (rucaparib) and Zejula® (niraparib).

Clinical trials

Clinical trials compare new treatments to standard approaches in an aim to improve patient outcomes. Your care team can help you evaluate whether a clinical trial may be appropriate for you.

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