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This information is about a rare type of cancer called primary peritoneal cancer. It should be read alongside our information about ovarian cancer, which gives more information and puts this into context.
Primary peritoneal cancer (PPC) is a rare cancer that starts in the peritoneum. This is the membrane which lines the inside of the abdomen (tummy), clinging to and covering all the organs in the abdomen (for example the intestines, the liver, and the stomach). This membrane helps to protect the contents of the abdomen. It also produces a lubricating fluid, which helps the organs to move smoothly inside the abdomen as we move around. A primary peritoneal cancer can start in any part of this membrane, usually in the lower part of the abdomen (pelvis).
The peritoneum is made up of cells called epithelial cells. These cells also line the ovaries. Although the lining tissue in the ovaries forms only a small part of the ovaries themselves, this is where most ovarian cancers start. Ovarian cancers commonly spread from the ovaries to the peritoneum. For this reason, primary peritoneal cancer can only be diagnosed in women once ovarian cancer has been excluded.
Primary peritoneal cancer and epithelial ovarian cancer (the commonest type of ovarian cancer) behave very similarly, and are treated in the same way.
Another rare type of cancer that can affect the lining of the abdomen is called peritoneal mesothelioma. This mainly occurs in people who have been exposed to asbestos. Peritoneal mesothelioma is not discussed here, but we have information on mesothelioma.
The causes of primary peritoneal cancer (PPC) are unknown. Like most types of cancer, it is more common in older people. It very rarely occurs in men. A small number of PPCs are associated with an inherited faulty gene linked to breast cancer in the family. People who are worried about cancer because of their family history can be referred to specialist clinics, where their risk will be carefully assessed. Because PPC mainly affects women, this information is written for them. If you are a man with PPC, please contact our cancer support service, which can provide you with more specific information.
Most women don't have any symptoms for a long time. When symptoms occur, they may include any of the following:
The above symptoms may be caused by a number of conditions other than primary peritoneal cancer. However, if you have any symptoms that get worse or that last for a few weeks, it is important to have them checked by your doctor.
Usually you begin by seeing your GP, who will examine you and arrange for you to have any tests that may be necessary, such as ultrasound scans and blood tests. Your GP may need to refer you to a specialist in conditions of the female reproductive system (a gynaecologist) at the hospital for the tests, and for specialist advice and treatment.
At the hospital, the gynaecologist will ask you about your medical history before doing a physical examination. This will include an internal (vaginal) examination to check for any lumps or swellings. Sometimes, you may also have an examination of your back passage (rectum). You can ask to be seen by a female doctor if you would prefer this.
Your doctor may arrange for you to have a blood test and chest x-ray to check your general health. You may have a specific blood test to check the levels of a protein called CA125. Levels of this can be higher than normal when a PPC or ovarian cancer is present.
The following tests are commonly used, and you can read about these in more detail in our information about ovarian cancer:
Ultrasound scan This test uses sound waves to build up a picture of the inside of the abdomen, the liver and the pelvis. It will usually be done in the hospital scanning department.
Pelvic ultrasound You will be asked to drink plenty of fluids so that your bladder is full, which will help in providing a clearer picture. Once you are lying comfortably on your back, a gel is spread onto your abdomen. A small device, like a microphone, which produces sound waves, is then rubbed over the area. The sound waves are converted into a picture by a computer.
Vaginal ultrasound A small device (about the size of a tampon) is put into your vagina. As before, the device produces sound waves which are then converted into a picture by a computer. Although this type of ultrasound scan may sound uncomfortable, many women find it more comfortable than having a pelvic ultrasound, as it is not necessary to have a full bladder.
CT (computerised tomography) scan This is a series of x-rays which builds up a three-dimensional picture of the inside of the body. The scan is painless but takes about 10–30 minutes. It may be used to find the exact site of the tumour, or to check for any spread of the cancer.
Most people who have a CT scan are given a special drink, or injection into a vein, of a liquid that allows particular parts of the body to be seen more clearly. For a few minutes, this may make you feel hot all over. It is important to tell your doctor and the person doing this test, if you are allergic to iodine or have asthma, before having the injection or drink. It is usually still possible to have the injection, as long as you have steroid treatment to prevent an allergic reaction, on the day before and the day of the injection.
Just before the scan begins, a tampon may be put into your vagina and the nurse may pass a liquid into your back passage (rectum). These preparations ensure that the best possible picture is produced from the scan. Once you are lying in a comfortable position, the scan will be taken.
You will probably be able to go home as soon as the scan is over.
MRI (magnetic resonance imaging) scan This test is similar to a CT scan, but uses magnetism instead of x-rays to build up cross-sectional pictures of your body. During the test, you will be asked to lie very still on a couch inside a large metal cylinder which is open at both ends. The whole test may take up to an hour and is completely painless.
If you don't like enclosed spaces, you may find the machine claustrophobic. The machine is also quite noisy, but you will be given earplugs or headphones to wear.
Abdominal fluid aspiration Sometimes with PPC, there is a build up of fluid in the abdomen. If this happens, a sample of the fluid can be taken to check for any cancer cells. The doctor will use a local anaesthetic to numb the area before passing a small needle through the skin. Some fluid is drawn into a syringe and examined under a microscope.
Laparoscopy This is a small operation which allows the doctor to look at the ovaries and the surrounding area. It is done under a general anaesthetic and will mean a short stay in hospital.
While you are under anaesthetic, the doctor makes a small cut (approximately 1cm in length) in the skin and muscle of the lower abdomen and carefully inserts a thin mini-telescope (laparoscope). By looking through the laparoscope the doctor can look at the ovaries and take a small sample of tissue (biopsy) for examination under a microscope.
During the operation, carbon dioxide (CO2) gas is passed into the abdominal cavity and this can cause uncomfortable wind and/or shoulder pains for several days afterwards. The pain is often eased by walking about or by taking sips of peppermint water.
After a laparoscopy, you will have one or two stitches in your lower abdomen. You should be able to get up as soon as the effects of the anaesthetic have worn off.
Laparotomy Sometimes it is necessary for a full operation (laparotomy) to be carried out, in order to make a definite diagnosis of primary peritoneal cancer.
The stage of a cancer is a term used to describe its size and whether or not it has spread beyond its original site. Knowing the extent of the cancer helps the doctors to decide on the most appropriate treatment for you. Because ovarian and primary peritoneal cancers are so alike, the same staging system is used. PPCs are either stage 3 or stage 4.
A number of different types of treatment are used to treat primary peritoneal cancer.
You may be offered surgery to remove as much of the cancer as possible. This usually involves removing the womb, ovaries, the sheet of fatty tissue inside the abdomen (omentum), and as much of the tumour elsewhere as possible.
Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. They work by destroying the growth and division of cancer cells. Chemotherapy is often given after surgery if it was not possible to remove all of the tumour, or if there is a risk that some cancer may have been left behind.
If the surgeon feels that the cancer may be difficult to remove, chemotherapy may be given first and surgery carried out afterwards. This is to make the tumour smaller and easier to remove.
Radiotherapy treats cancer by using high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells. Radiotherapy is occasionally used to treat individual areas of PPC if it comes back after surgery and chemotherapy.
Research into new ways of treating primary peritoneal cancer is ongoing. Doctors are continually looking for improved ways of treating the disease and they do this by using clinical trials. Many hospitals now take part in these trials. Before any trial is allowed to take place it must have been approved by an ethics committee, which checks that the trial is in the interest of patients.
You may be asked to take part in a clinical trial. Your doctor must discuss the treatment with you so that you have a full understanding of the trial and what it involves. You may decide not to take part, or to withdraw from a trial, at any stage. You will then receive the best standard treatment available.
After treatment you will have regular follow-up appointments with your specialist to monitor how you are recovering after treatment. They can also pick up whether or not you have any new symptoms or difficulties. Follow-up will usually include a physical examination. It may also involve taking blood samples.
You are likely to experience a number of different emotions during your experience of cancer. These can include shock, disbelief, fear and anger. At times, these emotions can be overwhelming and hard to control. It is quite natural, and important, to be able to express them. Everyone has their own way of coping with difficult situations; some people find it helpful to talk to friends or family, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is available if you need it. You may wish to contact our cancer support service for information about counselling in your area.
This section has been compiled using information from a number of reliable sources including:
For further references, please see the general bibliography.
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