Primary peritoneal cancer

What is primary peritoneal cancer?

Primary peritoneal cancer (PPC) is a rare cancer that affects the peritoneum, which is a layer of tissue that lines the abdomen and covers the organs inside it and the pelvis from below the diaphragm.

It is very similar to the most common type of ovarian cancer which is epithelial cancer; this develops in the surface, epithelial, cells of the ovary. The ovaries and the peritoneum both contain epithelial cells and PPC can occasionally spread to the ovaries.

There are no exact figures for how many people in the UK are diagnosed with PPC, but research suggests that between seven and 15 per cent of women with advanced ovarian cancer (cancer which has spread) do in fact have PPC. It is possible for men to get PPC, but this is very rare.

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It is most commonly diagnosed in those aged 60 and above. The causes are unknown, but a very small number of cases may be caused by the BRCA gene mutation which increases the risk of breast and ovarian cancer.

PPC is always at the advanced stages of three or four, meaning it extends into the abdomen and sometimes to other organs. You can find out more about stage 3 here and stage 4 here.

Symptoms

The symptoms of PPC can be hard to detect but they include:

Abdominal bloating
Abdominal pain
Constipation or diarrhoea
Nausea and sickness
Indigestion
Loss of appetite

These symptoms need to be new and unusual for you and experienced frequently and persistently.

How is primary peritoneal cancer diagnosed?

Those with symptoms that may be caused by primary peritoneal cancer should be examined by their GP, who may want to check the abdomen for lumps and changes and may want to do an internal examination to check the womb and ovaries for abnormalities.

The GP may offer a CA125 blood test. This is to test levels of a protein marker, sometimes called a tumour marker, as raised levels can indicate ovarian cancer, PPC or fallopian tube cancer.

However, CA125 levels can be raised by other medical conditions.

If the CA125 level is 35 or more in someone with symptoms of possible PPC they should be referred urgently for an ultrasound scan.

The ultrasound scan will probably take place in hospital on an outpatient basis. It will give a detailed picture of the organs in your pelvis and abdomen. It may be necessary to do a transvaginal ultrasound when the transducer (a small probe containing a microphone) is placed in the vagina to give a clearer picture of the womb and ovaries and other pelvic organs. Most cases of PPC are diagnosed by the detection of fluid in the abdomen.

It may then be necessary to have a CT (computerised tomography) or MRI (magnetic resonance imaging) scan to get more information about what is causing the symptoms and then give a diagnosis.

How is primary peritoneal cancer treated?

The treatment of primary peritoneal cancer is the same as treatment for advanced ovarian cancer. The aim of the treatment is to reduce the cancer as much as possible and to control and manage symptoms to enable the best possible quality of life.

You may have surgery followed by chemotherapy, or a course of chemotherapy first to shrink the cancer before surgery. These options will be discussed with you by the gynaecological oncology team. Sometimes PPC is treated using chemotherapy without surgery.

Surgery

Surgery aims to remove as much of the cancer as possible. This means the surgeon will probably perform an abdominal hysterectomy (to remove the womb and cervix), bilateral salpingo-oophorectomy (to remove the fallopian tubes and ovaries), an omentectomy (a fatty layer in the abdomen called the omentum) and peritonectomy to remove the peritoneum. The surgeon will also remove other areas affected by the cancer, where possible. This operation is called debulking surgery. Surgery for PPC should be performed by a gynaecological oncologist. You can read more about surgery here.

Chemotherapy

When you have recovered from your surgery you will be offered chemotherapy to destroy any remaining cancer cells. The drugs used are carboplatin and paclitaxel (Taxol) which are widely used to treat ovarian cancer. You will probably be offered six cycles of these. You will be given the chemotherapy drugs intravenously through a vein as a hospital outpatient.

Chemotherapy can cause unpleasant side effects but these can usually be controlled with other medicines. Side effects can include nausea, tingling in your hands and feet, a sore mouth and loss of appetite, a lowering of your blood cell count making you vulnerable to infection and hair loss. You can read more about chemotherapy here.

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Ovacome is the UK 's national ovarian cancer support charity. We've been providing emotional support and personalised, expert information since 1996. Contact our support line by phone, email or text if you have questions about a diagnosis, or if you just want to talk things through.

We support anyone affected by ovarian cancer, including family members, carers, those with an inherited risk, and health professionals working in the field.

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