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The peritoneum is the layer of tissue that lines the abdominal cavity and covers the abdominal organs. When cells in the peritoneum grow abnormally, peritoneal cancer may develop.

Cancer that begins in the peritoneal lining is primary peritoneal cancer. When cancer starts elsewhere in the body and spreads to the peritoneum, it’s called peritoneal carcinomatosis. Other terms for this include metastatic peritoneal cancer or secondary peritoneal cancer.

Carcinomatosis in the peritoneum results in many tumors forming throughout the abdominal cavity.

You may face a greater risk of developing peritoneal carcinomatosis if you have cancer in your:

• Appendix.
• Colon.
• Pancreas.
• Stomach (gastric cancer).
• Rectum.
• Ovaries.

Peritoneal carcinomatosis means that your cancer is advanced. If a doctor has diagnosed you with this condition, you likely have many questions about which treatment is right for you. Researchers continue to study new treatment options for this disease.

Cytoreductive Surgery for Peritoneal Carcinomatosis

Cytoreductive surgery (CRS) is one way that experts treat peritoneal carcinomatosis. Doctors sometimes call this a tumor-debulking surgery. Typically, you’ll also receive chemotherapy drugs directly to your abdomen (intraperitoneal chemotherapy) during this surgery.

The entire procedure, including surgery and intraperitoneal chemotherapy, may take up to 10 hours on average. Here’s what to expect when you have CRS for peritoneal cancer:

Surgical consultation

Your surgeon will talk with you about cytoreductive surgery and how it can help you. They’ll tell you what to expect and answer your questions. Your care team will tell you what to do to get ready for surgery and how to prepare before coming to the hospital.

Medication to make you sleep

When it’s time for surgery, an anesthesiologist inserts a flexible tube into your vein (an IV). They give you medication (general anesthesia) through the IV to make you fall asleep. You won’t feel any pain or remember what happens during surgery.

Tumor removal

Your surgeon makes an incision on your abdomen. They examine the peritoneum and remove all the tumors and cancerous tissue they can see.

Chemotherapy for Peritoneal Carcinomatosis

You may receive hyperthermic intraperitoneal chemotherapy (HIPEC) treatment during cytoreductive surgery. This is often abbreviated as CRS/HIPEC. HIPEC is used to destroy microscopic cancer cells that may remain in the abdomen after a tumor debulking surgery.

What is HIPEC?

HIPEC is a special type of administration of chemotherapy. You’ll get this treatment while you’re still asleep during surgery. It is done at the time of your tumor debulking.

How do doctors perform HIPEC?

During HIPEC, doctors:

• Heat chemotherapy drugs to between 106 and 108 F.
• Wash the open abdominal cavity with the heated chemotherapy. They connect you to a special machine (a perfusion machine) that circulates chemotherapy throughout your abdomen.
• Drain the chemotherapy drugs from your abdomen after a certain period of time and rinse your abdomen with saline solution.
• Close the abdominal cavity when HIPEC is complete.

Benefits of HIPEC after cytoreductive surgery for peritoneal cancer

HIPEC provides a higher dose of chemotherapy drugs than you might get during chemotherapy that goes into your bloodstream (systemic chemotherapy). Heating the chemotherapy drugs may make them more effective. HIPEC also comes into direct contact with remaining cancer cells, which helps the drugs destroy them.

Does CRS/HIPEC have side effects?

You may experience some chemotherapy side effects after HIPEC. But you’ll typically experience fewer side effects than you might with systemic chemotherapy.

CRS/HIPEC side effects can include:

• Diarrhea
• Fatigue
• Nausea
• Pain
• Vomiting
• Weight loss

Some people may feel depressed or have trouble sleeping after CRS/HIPEC.

Are there any risks to CRS/HIPEC?

There are some risks to HIPEC. The treatment can sometimes damage healthy abdominal tissue.

HIPEC may cause:

• Bleeding
• Blood clots
• Swelling

Talk to your doctor about the benefits and risks of HIPEC in treating peritoneal carcinomatosis.

Recovery after CRS/HIPEC

The HIPEC procedure delivers a very strong dose of chemotherapy to your abdomen. You’ll need to stay in the hospital for about a week after the procedure. During your stay, your care team checks for side effects and may provide nutrition through a feeding tube or IV line.

Is CRS/HIPEC right for me?

Researchers continue to study the effectiveness of CRS/HIPEC in treating peritoneal cancer. A 2023 journal article in Cancers noted that cytoreductive surgery and HIPEC have helped improve outcomes for some people with peritoneal carcinomatosis.

But CRS/HIPEC isn’t right for everyone.

Talk to your doctor about where the cancer started in your body and your overall health. Your doctor will tell you if you’re a good candidate for cytoreductive surgery and HIPEC for peritoneal carcinomatosis.

Immunotherapy for Peritoneal Carcinomatosis

There are other relatively new treatment options for peritoneal carcinomatosis. Doctors can use newer cancer drugs called immunotherapy to activate the body’s immune cells and help them fight cancer. These are given through an IV.

Doctors may treat you with:

• Immune checkpoint inhibitors — These drugs turn off molecules that stop immune cells from attacking the body, which can help the body fight cancer.
• Monoclonal antibodies — These manufactured antibodies (proteins that help your body fight infection) can mark cancer cells so the immune system can destroy them.

Researchers are also studying other treatments, like cancer vaccines and cell therapies. Ask your doctor if you’re eligible for a research study (clinical trial).

Immunotherapy side effects include:

• Diarrhea.
• Fatigue.
• Headache.
• Inflammation (swelling) in the liver and other organs.
• Nausea and vomiting.

Targeted Therapy for Peritoneal Carcinomatosis

Your doctor may recommend checking your tumor sample to identify certain genetic mutations. This is to learn about the specific genes and proteins in your cancer. Based on these mutations, Doctors can then use targeted therapy drugs to attack your cancer cells.

Targeted therapy drugs may help:

• Change certain chemicals inside the cells and cause the cells to die.
• Make sure cancer cells can’t use your blood to grow.
• Prevent cancer cells from dividing and growing.

Talk to your doctor about whether targeted therapy is right for you.

Understanding Treatment Options for Peritoneal Carcinomatosis

Your cancer care team can provide you with information about the best peritoneal cancer treatment options for you. Regional perfusion therapy and cytoreductive surgery may help improve your quality of life.

Editor's Note: This article was originally published on October 8, 2024, and was last reviewed on February 13, 2025.