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Removing peritoneum?

AussieMaddie's picture
AussieMaddie
Posts: 345
Joined: May 2011

Hi,

having seen this question elsewhere on this board, I'd like to know too if it is possible for a cancerous peritoneum to be removed entirely. I would have thought that it wasn't because it's so thin and so *large* (especially if, like me, your body is all abodmen and grossly overweight)

So there are two of us wanting to know.

Let us know if you have had the experience.

Thanks

AussieMaddie

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi AussieMaddie: Yes, as far as I know that is what the stripping (not debulking) surgery does. The peritoneum is very thin and it is removed with cancerous nodules in its entirety but the surgery can take up to 17 hours. That is the surgery that my oncologist is recommending for me because the seeding from my gallbladder tumour created about 6 nodules on the peritoneum and omentum but microscopic ones can't be seen by scans and so they go for removing the entire peritoneum. There are some discussions on this under colon cancer and ovarian cancer. Look for peritoneum stripping online.
Cheryl

eternaloptimist
Posts: 2
Joined: Aug 2011

Cheryl, I am having my peritoneum stripped this month during HIPEC surgery, which sounds like what they are recommending for you. I have signet ring cell adenocarcimonam of unknown primary with spreading to the peritoneum (peritoneal carcinomitosis). I am a stage IV and first found my cancer 2 years ago. I have had 8 rounds of carbo-taxol and have no symptoms from the cancer or residual side effects from the chemo. In fact, I feel great......but they want to do this surgery because my last scan showed one nodule on my peritoneal wall was bigger. But my oncologist wants to be aggressive and that's why he sent me to gastro/oncologist. They thought my primary site was small bowel. Now they think primary peritoneal.......and maybe appendix since I'm still healthy 2 years later. My oncologist told me (a year later) he didn't have much hope for me when I first came to him, but I continue to prove him wrong. I was intrigued by your story of primary gallbladder cancer. Is that rare? And, how are you doing? I always see you encouraging other people but not how you are doing. I love dogs too......I have a bouvier des flanders. Deb

AussieMaddie's picture
AussieMaddie
Posts: 345
Joined: May 2011

I will look up peritoneal stripping on Google. As I think I've said in the past, if the surgery takes as long as 17 hours I cannot imagine them doing it to me as I'm so big. Besides, so far, they've haven't seen any cancerous tumours at all, not even on the peritoneum. No seeding. Nothing. The onc. is still going by the signs of my having a build-up of fluid in the abdomen. At present, I'm off chemo (the carbo/taxol having started to lose effectiveness). The CA125 has started to go up. We watch and wait.

Maybe another scan will show something up. No talk about having one yet.

I'm still following behind others here.

AussieMaddie

eternaloptimist
Posts: 2
Joined: Aug 2011

AussieMaddie, I'm having this done Sept 22, so yes it is possible. And, the peritoneum does grow back. I'll let you know how it goes.......
Deb

Tina Brown's picture
Tina Brown
Posts: 1054
Joined: Nov 2009

I too have seeding all over my peritoneum. I was told they are too tiny for surgery and chemo is my only option. However now there seems to be this other option I am intrigued. I am stage 4 with seeding around my lungs and malignant fluid in my plueral cavity.

I have not had any surgery and find it quite hard to understand why not when I read all these messages on here. I am in the UK and I am guessing they are very conservative and cautious over here?

I would love to know how you get on eternaloptimist

Cheers Tina x

wanttogetwellsoon
Posts: 147
Joined: Apr 2011

Hi Tina...
I have wondered why you didn't have surgery myself ever since I first read your posts in May. I'm basically in the same position as you although so far as I know, there is no seeding around the lungs. At least, I haven't had fluid there. The only reason I didn't have surgery (although I did have a laparoscopy) was that I have had many surgeries in the past including the removal of the ovaries, fallopian tubes, uterus, appendix, some small intestine and the gallbladder - not all in the same operation. I still have the omentum. One of the problems is that my cancer, like yours, is microscopic and the seeding is on the adhesions - of which I have many. There is no blood supply to adhesions so far as I know so IV chemo won't help the situation there. Have you asked your onc why they haven't taken measures to operate. Maybe you're right and the reason they don't operate is because of the microscopic nature of the illness. Surgery is a hard option sometimes especially when it's as radical as debulking. My disease, though advanced, is low grade so there is doubt whether chemo helps in any event. I hope it'll stop the fluid building up and slowing the progress of what I have but I know there is no cure for me. That's what they've said anyway. The onc has said that there may be a slight chance of peritoneal stripping depending on how I get on and I'm hoping they'll make some kind of decision on that issue within the next six weeks. Certain types of microscopic cancer respond very well to chemo. :)

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

HI all: As far as I know, this kind of surgery is not done very many places - only one place in Canada (in Calgary) and not in the UK or Australia but I may be wrong there. There are a few places in the States. I was talking to my gynocologist today (on another issue) and asked her if she knew anyone who had it done and she said yes, she had operated on a woman with appendix cancer that spread to the peritoneum. She went to Calgary to have the stripping and it wasn't a pleasant experience, lots of pain, etc. but she is glad she had it done. It is my understanding the the nodules on the peritoneum are not connected to the blood system and so ordinary IV chemo is not very effective, although I have had some success with the oxaliplatin/irenotecan/5FU chemo - no progression, some shrinkage. But don't think it will get rid of them completely. I was turned down for the surgery after the cisplatin/gemcitibine chemo I had last year. Probably my age (68)but they said they haven't had much success with gallbladder cancer patients. Someone on this discussion thread has had appendix cancer and did have the stripping and the heated chemo treatment. I think the surgery is away more radical than debulking - can take up to 17 hours. With 3 weeks in hospital and a long recovery. So my brochure says anyways.

Gallbladder cancer was my primary cancer (Stage IV) that spread into the liver. It is very rare. My gallbladder and its tumour plus part of the liver were removed last April so its only the nodules on the peritoneum/omentum left. I have no symptoms at all, never have had, so feeling good except for a few days after the 5Fu pump comes off. Thanks for asking!

Keep in touch re the Sept 22 surgery (you won't feel like it for awhile though!).

Cheryl

carolenk's picture
carolenk
Posts: 909
Joined: Feb 2011

Now how does the cancer stay alive if it has no blood supply??? It makes no sense to me. Isn't that the point of Avastin? To cut off the blood supply to the cancer?

There HAS to be some kind of blood supply to the cancer or it would just shrivel up and die.

AussieMaddie's picture
AussieMaddie
Posts: 345
Joined: May 2011

Thanks for all the feedback on this. I also find it hard to imagine that there is no blood supply to the nodules on the peritoneum. How can cancer grow at all without a blood supply? Many people have much more knowledge about such things than I have.

Thanks

AussieMaddie

wanttogetwellsoon
Posts: 147
Joined: Apr 2011

I know what you mean about the blood supply. I was told that there is a blood supply to the peritoneum but not to the adhesions which have grown mainly because of the many abdominal surgeries I have had in the past. Maybe I've misinterpreted what my oncologist said, but I got the impression that microscopic cells were not only on the peritoneum but on the adhesions too and that the chemo wouldn't affect the cells which are growing there. Actually, I have low grade disease which is platinum resistent. There is controversy as to whether taking carboplatin makes any difference at all, but it is being used to slow the progress of the disease and to reduce the build up of ascites. I'm now on the 5th cycle and I seem to be stronger than I was. :)

MarisaUK54's picture
MarisaUK54
Posts: 41
Joined: Aug 2011

Hi Tina

Firstly may I say how knowledgeable all you ladies are! I read all these comments and think blimey, how do they know all that stuff...?
I live in London and I had surgery in February but I get confused. I had a full hysterectomy (overies, tubes, cervix) plus debulking, omentum removal together with a couple of lymph nodes in my groin. There were microscopic cells in the peritonueum after surgery but 2 further chemo's would zap them (HE said!)
I know PPC can develop after the uterus has been removed so is removing it AFTER a PPC diagnosis possibly a bit like "after the horse has bolted" syndrome?? Can it go backwards?? I never quite understood that even from the point of a preventative procedure.

Staging and grading is tricky too. I am "3c" on every letter and document but not sure if that's Grade 3, Stage c?? I hasten to add I'm not of limited intelligence but I guess I just didn't ask enough when I was going through treatment. In a way, now I can cope with the information I don't need it! Daft eh..!

I hope however, you are coping with the chemo ok; I do feel for you...

Marisa

MarisaUK54's picture
MarisaUK54
Posts: 41
Joined: Aug 2011

Hi Tina

Firstly may I say how knowledgeable all you ladies are! I read all these comments and think blimey, how do they know all that stuff...?
I live in London and I had surgery in February but I get confused. I had a full hysterectomy (overies, tubes, cervix) plus debulking, omentum removal together with a couple of lymph nodes in my groin. There were microscopic cells in the peritonueum after surgery but 2 further chemo's would zap them (HE said!)
I know PPC can develop after the uterus has been removed so is removing it AFTER a PPC diagnosis possibly a bit like "after the horse has bolted" syndrome?? Can it go backwards?? I never quite understood that even from the point of a preventative procedure.

Staging and grading is tricky too. I am "3c" on every letter and document but not sure if that's Grade 3, Stage c?? I hasten to add I'm not of limited intelligence but I guess I just didn't ask enough when I was going through treatment. In a way, now I can cope with the information I don't need it! Daft eh..!

I hope however, you are coping with the chemo ok; I do feel for you...

Marisa

AussieMaddie's picture
AussieMaddie
Posts: 345
Joined: May 2011

Hi Deb,

I make one more who will sending lots of thoughts to you on 22nd, and hoping that it goes well. Also very interested to know your experience of it will be. It shocks me that it can totally regrow.

Take good care,

AussieMaddie

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi: It is no blood supply to the peritoneum that I read so thus no blood supply to the nodules either which in my case have seeded there from elsewhere. Don't know, just what I read - I'll try to dig it up. It is also what my oncologist said. That is the purpose of the HIPEC procedure which is the internal chemo - swished around your insides because the IV type doesn't get to them much. All a mystery to me! Seems there is so much we don't know about this cancer. I can say though that the IV chemo regime seems to be helping my "nodules" a little!
Cheryl

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi: There is a lot of information on line about the peritoneum and peritoneum cancer. The peritoneum is the biggest organ in our body - covers about 2 metres square and in most places is only 1 cell layer thick (it is like a glistening bag holding our insides in!). There are many parts to it but one part is the omentum, the fatty layer covering our stomachs. All parts can get cancer seeding (called caking if it is the omentum). It is not well connected to the bodies' blood system, what I read through the abdominal wall. Men's peritoneums are a closed sack while women's open out to the ovarian area. Peritoneum cancer is most common with ovarian cancer, then colon cancer. Primary peritoneum cancer, seeding from a cancerous appendix, and from the stomach (mostly in Japan for the latter) are much less common. The HIPEC procedure was developed by Dr Sugarbaker now at Washington Hospital to direct chemotherapy directly (targetted) into the peritoneum rather than through the regular IV system. It is usually done after debulking and peritoneum stripping. It is either heated (to very high temperatures) or not. Your inside abdominal cavity is basically washed with the chemicals. It is a big surgery with strict criteria about who can take it (at least here in Canada where it is only done in Calgary) (i.e. younger than 70, good physical and psychological state, not too many nodules, not very big nodules, etc.). That's what I understand from it anyways. Lots of good information on line.
Cheryl

AussieMaddie's picture
AussieMaddie
Posts: 345
Joined: May 2011

Thanks Cheryl :)

- AussieMaddie

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