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Ovacome is a national charity providing support to anyone affected by ovarian cancer. We give information about symptoms, diagnosis, treatment and research.  Ovacome runs a telephone and email support line and works to raise awareness and give a voice to all those affected by ovarian cancer.

This fact sheet gives information on primary peritoneal cancer, a rare variant of ovarian cancer.

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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.

PPC 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 women 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.

It is most commonly diagnosed in people 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.  There is more information about these stages in Ovacome fact sheets 3c and 3d.

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Signs and 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.

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Diagnosis

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 many other less serious medical conditions.

Normal CA125 levels are below 35, if the level is 35 or more in a person with symptoms of possible PPC she 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 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.

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Treatment – surgery and chemotherapy

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.

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Surgery

Surgery aims to remove as much of the cancer as possible.  This means the surgeon will probably perform an abdominal hysterectomy, bilateral salpingo-oophorectomy, an omentectomy and peritonectomy to remove the  peritoneum, womb, cervix, ovaries, fallopian tubes and a fatty layer in the abdomen called the omentum. 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.

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.

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Follow up care

When your treatment has finished you will have a programme of follow-up appointments to check your health. This may include blood tests and scans. You should contact your doctor or cancer nurse specialist (CNS) if you have any problems or notice new symptoms.

If you would like more information on the sources and references for this fact sheet please call our supportline on 0800 0087 054 Monday to Friday between 10am and 5pm.

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Reviewed by Valerie Ng, Macmillan gynaecology clinical nurse specialist (research nurse), Imperial College Healthcare NHS Trust

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Disclaimer

Ovacome fact sheets provide information and support.  We make every effort to ensure the accuracy and reliability of the information at the time of printing.  The information we give is not a substitute for professional medical care.  If you suspect you have cancer you should consult your doctor as quickly as possible.  Ovacome cannot accept liability for any inaccuracy in linked sources.   

v.2

Date December 2018

Date for review December 2020

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Did you find this fact sheet helpful? We welcome your feedback. If you have any comments or suggestions, please email [email protected] or call 0207 299 6653.

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