Treatment

Patients with a lesser extent of carcinomatosis may be treated with cytoreductive surgery for complete removal of the disease.  

There are some contraindications, however, for cytoreductive surgery:  

• Extensive carcinomatosis
• Massive involvement of the small intestine, affectation of structures (e.g., certain vascular structures) or organs that cannot be removed.
• Multiple lung metastases, bone metastases or retroperitoneal involvement.  
• Appearance of early carcinomatosis after surgery of the primary tumour.  

Patients who are candidates for cytoreductive surgery undergo an intervention to remove the viscera affected by the tumour.

Hyperthermic intraoperative chemotherapy (HIPEC), as well as surgery, is usually used during the intervention itself.  

It consists of applying the chemotherapy drug directly to the peritoneum at a temperature higher than body temperature. This elevated temperature helps the drug penetrate the peritoneum and remove tumour cells.  

The chemotherapy drug used depends on the tumour. The most used are mitomycin-C, oxaliplatin, irinotecan and cisplatin. It is administered at 41-43ºC for between 30 minutes and 2 hours.

Systemic chemotherapy is the most common treatment for patients with carcinomatosis who cannot be operated on. In some cases, it is administered prior to surgical treatment to reduce tumour volume. It can also be administered after the intervention for greater control of the tumour.

There is currently a wide field of global research for the treatment of carcinomatosis. Improving the quality of life of patients is one of the main objectives, as well as the treatment of inoperable carcinomatosis.  

Pressurised intraperitoneal aerosol chemotherapy (PIPAC) is a method that has recently appeared in clinical practice for the treatment of inoperable carcinomatosis. It is based on administering chemotherapy in the form of an aerosol in the peritoneal cavity and is applied by laparoscopy.

The main advantage is that it is less toxic than systemic chemotherapy and penetrates better into tumour tissues. This reduces the symptoms caused by peritoneal disease. It has been shown to reduce the volume of the tumour and so could be used as post-surgical treatment.