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Peritoneal Cancer Treatment

Understanding treatment for peritoneal cancer and how it is delivered.

What are the treatment options for peritoneal cancer?What are the treatment options for peritoneal cancer?

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. 

Types of peritoneal cancer treatmentTypes of peritoneal cancer treatment

Surgery

Chemotherapy

Radiation therapy

Targeted therapies

Peritonectomy

Surgery for peritoneal cancerSurgery for peritoneal cancer

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.

Peritonectomy
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Peritonectomy

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. 

Intraperitoneal chemotherapy

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) Early post-operative intraperitoneal chemotherapy (EPIC) Normothermic intraperitoneal chemotherapy (NIPEC) Pressurised Intra-Peritoneal Aerosol Chemotherapy (PIPAC)

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

Systemic chemotherapy often combines two or more drugs based on the type and stage of your peritoneal cancer. This is delivered through the vein. 

Learn more about chemotherapy and how it is delivered.

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 for peritoneal cancer

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:

Bevacizumab PARP inhibitors (olaparib, niraparib)

Bevacizumab

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 cancerRadiation therapy for peritoneal cancer

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.

Treatment by stage of peritoneal cancerTreatment by stage of peritoneal cancer

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.

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