People usually don’t experience symptoms in the early stages
of peritoneal cancer. When symptoms do occur, they often resemble those of
other, less serious conditions such as heartburn or indigestion. It’s important
to see experienced specialists with expertise in evaluating symptoms to confirm
an accurate diagnosis.
Diagnosing Peritoneal Cancer
At UT Southwestern Medical Center, our cancer specialists
use the most advanced techniques to diagnose peritoneal cancer. Our physicians
begin with a thorough evaluation that includes a:
- Discussion of symptoms
- Review of personal and family medical history
- Physical exam, often with a pelvic exam to check
the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum for
abnormalities
We sometimes diagnose peritoneal cancer differently,
depending on where it began:
- Primary
peritoneal cancer: This is cancer that begins in the peritoneum, and we
often find this type during abdominal surgery for other reasons.
- Secondary
peritoneal cancer: Cancer can begin in other abdominal organs, such as the appendix,
intestines, or ovaries, and spread (metastasize) to the peritoneum. We use a
variety of imaging tests or procedures to help diagnose secondary peritoneal
cancer.
Tests for Peritoneal Cancer
Tests and procedures that we often use include:
- Computed tomography (CT) scans: Specialized X-ray technology
creates cross-sectional images inside the abdomen. CT scans show details
of the peritoneum and organs to assess for abnormalities.
- Magnetic resonance imaging (MRI) scans: Equipment that uses a powerful magnet and radio waves can
produce images that show the extent of diseased tissue in the abdomen.
- Ultrasound: This imaging uses high-frequency sound waves to create
images of abdominal organs. Ultrasound can show differences between
healthy tissues and cancerous tumors.
- Blood
tests: Certain tests can show increased levels of tumor markers such
as CA125, CA 19-9, CEA, or HE4, which can indicate peritoneal cancer.
However, these tumor marker levels can be high for other reasons.
- Laparoscopy:
This is a minimally invasive
surgical procedure in which our surgeons create tiny incisions to insert
narrow scopes with lens to view the peritoneum (inside of the abdomen).
If we spot any fluid or abnormal tissue, we can take a tiny sample
(biopsy) of the tissue or fluid to evaluate under a microscope for signs
of cancer. The surgeon might also
determine the peritoneal cancer index (PCI) to assess the extent of peritoneal
cancer in the abdominal cavity during this procedure.
Staging Peritoneal Cancer
After we establish a diagnosis of peritoneal cancer, we
stage the cancer based on its size, location, and origin, if it has spread from
another organ. Because peritoneal cancer usually doesn’t produce symptoms in
its early stages, patients are often diagnosed with stage 3 or 4 cancer by the
time it’s found.
Stages of Primary Peritoneal Cancer
Stage 3 of primary peritoneal cancer includes three
substages:
- 3A: The cancer
has spread to lymph nodes outside the peritoneum, or cancer cells have
spread to the surface of the peritoneum, outside the pelvis.
- 3B: The cancer
has spread to the peritoneum outside the pelvis. The cancer in the
peritoneum is 2 cm or smaller. It might have also spread to lymph nodes
outside the peritoneum.
- 3C: The cancer
has spread to the peritoneum outside the pelvis, and the cancer in the
peritoneum is larger than 2 cm. It might have spread to lymph nodes
outside the peritoneum or to the surface of the liver or spleen.
In stage 4,
cancer has spread to other organs and has two substages:
- 4A: Cancer
cells are found in the fluid that builds up around the lungs.
- 4B: The cancer
has spread to organs and tissues outside the abdomen, such as the liver,
lungs, or lymph nodes in the groin.
Staging Secondary Peritoneal Cancer
Our cancer specialists stage secondary peritoneal cancer
based on the primary cancer. Primary cancer that spreads to the peritoneum from
elsewhere in the body is usually considered stage 4.
