The most common treatment options for peritoneal cancer include surgery, chemotherapy, radiation therapy and targeted therapies. The type of treatment you receive will depend on several different considerations, such as the type of peritoneal cancer you have, its stage, your overall health and your treatment preferences. This page aims to give you a comprehensive overview of how peritoneal cancer treatment works in the private health system.
Surgery for peritoneal cancerSurgery
Surgery for peritoneal cancer is performed to remove cancerous tissue, relieve symptoms and improve the chance of long-term remission. The focus is on removing any cancer from within the abdominal (peritoneal) cavity – the space between your abdomen wall and organs in the abdomen, such as the intestines, stomach and liver.
A peritonectomy, also known as cytoreductive or debulking surgery, is a procedure which focuses on removing as much visible disease as possible from within the abdomen. This includes the removal of peritoneal tumours and the partial or complete removal of any affected organs, such as the small or large bowel, omentum, spleen, stomach, gallbladder, bladder and female reproductive organs.
A peritonectomy is an open surgery which requires a long incision in the middle of the abdomen. The extent of surgery required will vary depending on the stage of the cancer.
Chemotherapy for peritoneal cancerChemotherapy for peritoneal cancer
Chemotherapy uses a range of drugs to kill and slow the growth of peritoneal cancer cells. It takes place over several sessions, which is known as a cycle. Your care team will walk you through how many cycles you may need for your course of treatment.
If you have primary peritoneal cancer, peritoneal mesothelioma or peritoneal metastases, you may have chemotherapy inserted directly into the abdominal cavity through a tube (known as intraperitoneal chemotherapy). This treatment can be delivered at the end of surgery before your wound is closed to destroy any remaining cancer cells.
Intraperitoneal chemotherapy methods for peritoneal cancer include:
Hyperthermic intraperitoneal chemotherapy (HIPEC)
Chemotherapy drugs are warmed to approximately 40°C and inserted into the abdominal cavity for 60 to 90 minutes. This can be done at the end of surgery and is the most common method of intraperitoneal chemotherapy.
Early post-operative intraperitoneal chemotherapy (EPIC)
This involves the delivery of intraperitoneal chemotherapy a few days after surgery, typically after HIPEC.
Normothermic intraperitoneal chemotherapy (NIPEC)
This involves the delivery of intraperitoneal chemotherapy which is a normal temperature rather than warmed.
Pressurised Intra-Peritoneal Aerosol Chemotherapy (PIPAC)
Less commonly, chemotherapy drugs may be delivered to the abdomen cavity using pressured gas.
Systemic chemotherapy often combines two or more drugs based on the type and stage of your peritoneal cancer. This is delivered through the vein.
There are several chemotherapy drugs that are used to treat peritoneal cancer, including:
- Carboplatin and cisplatin – These chemotherapy drugs are classified as platinum compounds. They work by stopping the cancer cells from being able to divide and grow
- Docetaxel and paclitaxel – These work by targeting and disrupting certain structures within cancer cells that they need to grow and multiply, causing the cells to stop growing and die
A combination of two different chemotherapy drugs is usually given, with carboplatin or cisplatin given together with either docetaxel or paclitaxel. A combination of paclitaxel and carboplatin is often used.
This is given by intravenous infusion every 21 days, with each intravenous infusion taking around 60 minutes, or by intraperitoneal infusion, with each intraperitoneal infusion usually taking around three hours. The treatment is usually continued for up to six cycles.
Targeted therapies for peritoneal cancerTargeted therapies
Targeted therapies use specialised drugs to destroy specific proteins in primary peritoneal cancer cells that help your cancer grow and spread. They are mainly given to stop your peritoneal cancer from returning after treatment.
Common targeted therapy medicines
Common targeted therapy drugs which are used to treat peritoneal cancer include:
This is a monoclonal antibody that binds to and blocks the protein known as vascular endothelial growth factor (VEGF), which promotes the growth of blood vessels that supply essential nutrients to cancer cells. When VEGF is blocked, cancer cells no longer receive the essential nutrients and oxygen that they need to grow and survive. Bevacizumab is given by intravenous infusion, usually in combination with other chemotherapy drugs.
PARP inhibitors (olaparib, niraparib)
These targeted therapy drugs work by blocking an enzyme called PARP (poly ADP ribose polymerase) which cancer cells need to repair damaged DNA. When PARP is blocked, the cancer cells are unable to repair their DNA and are unable to divide and grow. They are used to treat peritoneal cancer when there is a BRCA1 or BRCA2 mutation and are only given after chemotherapy treatment has first been tried. They are taken orally as a tablet once or twice daily.
Radiation therapy for peritoneal cancer Radiation therapy
Radiation therapy is rarely used for peritoneal cancer. In some cases, radiation therapy may be used to treat primary peritoneal cancer that has returned following initial treatment, alongside symptom management.
External beam radiation therapy (EBRT) is the most common radiation therapy treatment for peritoneal cancer.
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When you are diagnosed with peritoneal cancer, your oncologist will develop your treatment plan as part of a multidisciplinary team based on the stage of your cancer.
Peritoneal cancer is often found at an advanced stage. Common treatment options include:
Advanced primary peritoneal cancer
Surgery with HIPEC is the most common treatment for primary peritoneal cancer. This may be followed by systemic chemotherapy and/or EPIC. In some cases, you may receive targeted therapies to prevent primary peritoneal cancer from returning after treatment.
Advanced metastatic peritoneal cancer
Like primary peritoneal cancer, advanced metastatic peritoneal cancer commonly requires surgery and HIPEC. This can be combined with other treatments depending on your primary cancer.
Recurrent primary peritoneal cancer
For primary peritoneal cancer that returns, you may have a combination of chemotherapy treatment and targeted therapies. Radiation therapy may also be an option to treat small, localised cancers.
- Bowel Cancer Australia. (2020). Metastatic Bowel Cancer Treatment. Retrieved on 22 December 2021 from https://www.bowelcanceraustralia.org/treatment-metastatic-bowel-cancer
- Bowel Cancer UK. (2021). Bowel cancer that has spread to the peritoneum. Retrieved on 22 December 2021 from https://www.bowelcanceruk.org.uk/about-bowel-cancer/advanced-bowel-cancer/treating-advanced-bowel-cancer/spread-to-the-peritoneum/
- Cancer Council. (2019). Understanding Mesothelioma: A guide for people with cancer, their families and friends. Retrieved 13 December 2021 from https://www.cancer.org.au/assets/pdf/understanding-mesothelioma-cancer-booklet
- net. (2020). Ovarian, Fallopian Tube, and Peritoneal Cancer: Types of Treatment. Retrieved on 22 December 2021 from https://www.cancer.net/cancer-types/ovarian-fallopian-tube-and-peritoneal-cancer/types-treatment
- Cancer Research UK. (2019). Primary peritoneal cancer. Retrieved 22 December 2021 from https://www.cancerresearchuk.org/about-cancer/ovarian-cancer/types/epithelial-ovarian-cancers/primary-peritoneal
- Foundation for Women’s Cancer. (2021). Primary Peritoneal Cancer (PPC). Retrieved 22 December 2021 from https://www.foundationforwomenscancer.org/gynecologic-cancers/cancer-types/primary-peritoneal/
- MacMillan Cancer Support (2018). Primary peritoneal cancer. Retrieved 22 December 2021 from https://www.macmillan.org.uk/cancer-information-and-support/ovarian-cancer/primary-peritoneal-cancer
- National Cancer Institute. (2021). Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ®)–Patient Version. Retrieved on 22 December 2021 from https://www.cancer.gov/types/ovarian/patient/ovarian-epithelial-treatment-pdq
- National University Cancer Institute Singapore. (2021). Peritoneal Metastases (Peritoneal Cancer). Retrieved on 22 December 2021 from https://www.ncis.com.sg/Cancer-Information/About-Cancer/Pages/Peritoneal-Metastases.aspx
- (2021). Peritoneal Cancer. Retrieved on 22 December 2021 from https://www.webmd.com/cancer/peritoneal-cancer-prognosis-symptoms-treatments
- Niraparib for ovarian cancer. Aust Prescr 2021;44:208-9. First published 27 October 2021. https://doi.org/10.1877
- Cancer Institute NSW. eviQ. Medical Oncology. Ovarian advanced combined intravenous and intraperitoneal ciSplatin and PACLitaxel. Retrieved on 3 February 2022 from https://www.eviq.org.au/medical-oncology/gynaecological/ovarian/265-ovarian-advanced-combined-intravenous-and-intr
- Niraparib Approved for Women With Recurrent Ovarian Cancer, Oncology Times: May 10, 2017 – Volume 39 – Issue 9 – p 37. doi: 10.1097/01.COT.0000516764.50556.e
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