Introduction
When stomach cancer spreads to the peritoneum, the emotional impact is usually great. It is normal to think that options are limited or that surgery is no longer possible.
Even so, in carefully selected patients there may be treatment strategies that combine chemotherapy and surgery with the aim of controlling the disease and improving prognosis.
What is peritoneal carcinomatosis of gastric origin?
The stomach is covered by the peritoneum. In some patients with gastric cancer, tumor cells can break away and spread across this membrane, causing peritoneal carcinomatosis.
In many cases, this disease can be extensive and aggressive. For this reason, not all patients benefit from surgery, and each case has to be evaluated carefully before making decisions.
What symptoms can it cause?
Symptoms can vary greatly. Some patients have:
- Abdominal pain or discomfort
- Abdominal swelling or distension
- Loss of appetite
- Weight loss
- Fatigue
- Nausea or digestive changes
In early stages, the disease may cause few symptoms.
What does my treatment involve?
Treatment of peritoneal carcinomatosis of gastric origin must always be individualized. There is no single strategy that works for all patients.
In most cases, the first step is intravenous systemic chemotherapy, with the aim of:
- Controlling the disease
- Reducing its extent
- Evaluating how the tumor responds to treatment
The response to this chemotherapy helps decide the next steps.
Neoadjuvant therapy: intravenous chemotherapy and lapHIPEC
In selected patients, especially when the disease responds well to intravenous chemotherapy, a treatment strategy before surgery (neoadjuvant therapy) may be considered.
Intravenous chemotherapy
It is given into a vein and acts throughout the body. It treats both visible disease and possible microscopic cells.
Laparoscopic intraperitoneal chemotherapy (lapHIPEC)
In some cases, a treatment called lapHIPEC is added, which consists of:
- Administering chemotherapy directly inside the abdomen
- Through minimally invasive surgery (laparoscopy)
- With chemotherapy at a slightly elevated temperature
Objective: To act directly on the peritoneum and assess disease response, without yet performing aggressive surgery.
Why is proper patient selection so important?
Surgery for gastric peritoneal carcinomatosis is very aggressive and not without risks. Performing it without proper selection can cause more harm than good.
That is why, before considering extensive surgery, the team carefully evaluates:
- The response to chemotherapy
- The actual extent of the disease
- The patient's general condition
- The absence of disease outside the abdomen
Important
Only when very specific criteria are met is surgery with the intention of removing visible disease considered.
Surgery: when it is considered and what it involves
When the disease is well controlled and the team considers that surgery may be beneficial, an operation is considered with the aim of:
- Removing the gastric tumor
- Removing visible peritoneal implants
- In some cases, adding HIPEC during surgery
This surgery may involve resection of other organs and needs to be performed in experienced centers.
How long will I be in hospital?
Length of stay depends on the treatment performed:
- lapHIPEC: Short stay
- Extensive surgery: 10-15 days (may be longer in complex cases)
What will my follow-up be like?
Follow-up is continuous and personalized:
- Regular check-ups
- Imaging tests
- Nutritional status assessment
- Quality of life evaluation
The goal is to care for both the disease and the person.
A message for you
Peritoneal carcinomatosis of gastric origin is a complex disease. Today we know that not all patients benefit from aggressive treatments, and that the patients offered surgery have to be selected carefully to avoid causing harm. In the right patients, there may be treatment options.
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