Metastatic spread of malignant tumors into the peritoneum, a two-layered (parietal and visceral) mesothelial lining, is almost universally fatal within a short period of time, as only palliative therapeutic measures may be implemented at this stage of progression [1] [2] [3] [4] [5]. Neoplasms of the gastrointestinal system (particularly colorectal cancer) and the genitourinary tract, as well as hepatic, pancreatic, and primary peritoneal tumors (mesothelioma), are known for their propensity to metastasize into this anatomical landmark, and they are able to do so in several ways [1] [2] [4] [6]. Proximal masses (eg. gastrointestinal or ovarian cancers) are able to directly penetrate into the peritoneum, whereas spread via the lymphatic or hematogenous routes (typical for more distant primary malignancies, such as melanoma, lung cancer, or breast cancer), as well as intraperitoneal dissemination of the tumor through ascitic fluid (a potential complication during surgical procedures), are other possible routes [1] [2] [6]. The clinical presentation of peritoneal metastasis is quite variable, and often depends on the location and the severity of tumor invasion, but in most cases, the initial course is asymptomatic [2]. The majority of patients, however, develop symptoms of abdominal pain, distension, and discomfort (developing as a result of bowel obstruction), followed by weight loss, nausea, vomiting, and severe fatigue with cachexia [1] [2] [4].

• Ascites

  Readers recorded the presence or absence of ascites, increased peritoneal fat density, peritoneal thickening or enhancement, and peritoneal nodule or mass. [ncbi.nlm.nih.gov]

• Surgical Procedure

  Even though central nervous tumors rarely metastasize spontaneously, the literature indicates that systemic metastases are related to previous surgical procedures and especially shunt surgery. [ncbi.nlm.nih.gov]

  procedures), are other possible routes. [symptoma.com]

  Despite initial chemosensitivity and improved surgical procedures, abdominal recurrence remains an issue and results in patients' poor prognosis. [vivo.med.cornell.edu]

  Often surgical management includes two components: Removal of the visible tumor through a procedure called surgical cytoreduction (CRS), also called tumor debulking. [nebraskamed.com]

  It is a day care procedure and patient can be discharged the same night or next day morning. The 2 disadvantages are: 1. It is a surgical procedure done laparoscopically and under general anaesthesia & 2. It is slightly costly. [health.economictimes.indiatimes.com]

• Weight Loss

  The clinical presentation is initially asymptomatic, but at some point, complaints of abdominal pain, weight loss, and ascites appear. [symptoma.com]

  We report an unusual presentation of chronic appendicitis with a synchronous peritoneal nodule on CT in a 76-year-old woman who presented with poor appetite, weight loss and a mass in the right iliac fossa. [ncbi.nlm.nih.gov]

  Symptoms and Diagnosis The symptoms of local spread of bowel cancer can be vague, but are likely to include unexplained pain, tenderness over the area, or unusual discharges, changed appetite or unexpected weight loss. [bowelcanceraustralia.org]

  Presents with abdominal pain and distension, fever, night sweats, weight loss, and altered bowel habits. Ascites is present in about half of cases. Abdominal mass may be felt in a third of cases. [wikidoc.org]

• Fever

  During CCRT, she suffered from acute lower abdominal pain, high fever, and leukocytosis. [ncbi.nlm.nih.gov]

  Fever and leukocytosis are common. Colchicine prevents but does not treat acute attacks. [wikidoc.org]

  During these therapies, the patient developed a fever and mild abdominal pain, which was associated with an increased C-reactive protein level. [wjso.biomedcentral.com]

• Swelling

  However, 6 months after nivolumab administration, ureteral stenosis and swelling of the para-aortic lymph nodes occurred again. Nivolumab administration was replaced with SOX. [karger.com]

  The beginning symptoms of peritoneal mesothelioma include abdominal distension, abdominal pain, swelling or tenderness around the abdomen and constipation or diarrhea. [asbestos.com]

  Case presentation In 2014, a 75-year-old man was referred to our department with bilateral swelling of the cervical lymph nodes. There was moderately differentiated SCC in the posterior wall of the hypopharynx. [wjso.biomedcentral.com]

  Physical examination may be remarkable for: [4] Inspection Enlarged abdomen Abdominal distension Palpation Bulging of the flanks or shifting dullness Fluid thrill or fluid wave Other physical examination findings may include: Leg swelling Bruising Gynecomastia [wikidoc.org]

• Abdominal Pain

  The most frequent grade 3/4 adverse events were neutropenia (38.6%) and abdominal pain (30.8%). The incidence of abdominal pain cumulatively increased in the later treatment cycles. [ncbi.nlm.nih.gov]

  The clinical presentation is initially asymptomatic, but at some point, complaints of abdominal pain, weight loss, and ascites appear. [symptoma.com]

  Symptoms include ascites, abdominal pain, nausea, vomiting. [wikidoc.org]

• Peritoneal Disease

  In patients with EGFR mutations who developed peritoneal disease, we documented the presence of known resistance mechanisms. Median time to peritoneal metastasis, time from peritoneal disease to death, and overall survival were collected. [ncbi.nlm.nih.gov]

  Key Findings Seven of the trial patients (37%) achieved resolution of their peritoneal disease, and five (26%) opted to undergo gastrectomy. [ascopost.com]

  A retrospective study among women with peritoneal metastasis from breast cancer observed a prevalence of peritoneal disease from ovarian cancer or primary peritoneal malignancy of even 74.7 %, while just the remaining 25.3 % of carcinomatosis resulted [springerplus.springeropen.com]

• Nausea

  Gastrointestinal symptoms (nausea/vomiting, constipation, diarrhoea, anorexia) remained stable under PIPAC therapy. [ncbi.nlm.nih.gov]

  The majority of patients, however, develop symptoms of abdominal pain, distension, and discomfort (developing as a result of bowel obstruction), followed by weight loss, nausea, vomiting, and severe fatigue with cachexia. [symptoma.com]

  Symptoms include ascites, abdominal pain, nausea, vomiting. [wikidoc.org]

  A 67-year-old man in relatively good health presented to the ED with abdominal pain, nausea and vomiting. [healio.com]

• Vomiting

  Two months after initiation of chemotherapy, he complained of vomiting and abdominal pain. A computed tomography scan revealed marked thickening of the sigmoid colon wall adjacent to the catheter of the i.p. access port system. [ncbi.nlm.nih.gov]

  The majority of patients, however, develop symptoms of abdominal pain, distension, and discomfort (developing as a result of bowel obstruction), followed by weight loss, nausea, vomiting, and severe fatigue with cachexia. [symptoma.com]

  In the brain there may be headaches, vomiting and neurological features. [ 6 ] In bones there may be pain or pathological fracture. [patient.info]

  A 67-year-old man in relatively good health presented to the ED with abdominal pain, nausea and vomiting. [healio.com]

• Abdominal Mass

  The abdominal mass was 26 x 17 x 12 cm in size, as determined by magnetic resonance imaging, and was diagnosed as a peritoneal relapse of GIST. Treatment with 400 mg of imatinib daily was started. [ncbi.nlm.nih.gov]

  On the left a 33-year-old man who complains of an increasing abdominal girth, abdominal fullness, and a palpable abdominal mass. First study the images on the left and continue with the MR. [radiologyassistant.nl]

  Presents with abdominal pain and distension, fever, night sweats, weight loss, and altered bowel habits. Ascites is present in about half of cases. Abdominal mass may be felt in a third of cases. [wikidoc.org]

• Aggressive Behavior

  This case confirms the aggressive behavior of PMA and makes clinicians aware of the possibility of extraneural, peritoneal metastasis through a VP shunt. [ncbi.nlm.nih.gov]

• Confusion

  However, ascites caused by malignancies not associated with increase serum CA 19-9 concentrations, including lymphoma, mesothelioma, leukemia, and melanoma, routinely had CA 19-9 concentrations Cautions Discusses conditions that may cause diagnostic confusion [mayomedicallaboratories.com]

  CASE SUMMARY A 50-year-old male with history of cirrhosis secondary to Hepatitis B and C and treated multiple myeloma presented to the emergency department with abdominal distension, confusion, and lethargy. [appliedradiology.com]

  This name is very confusing since there is no relation with the malignant mesothelioma. It is seen in women with prior gynaecological surgery or infection. [radiologyassistant.nl]

  Unfortunately, the end result has been a variety of different proposed classifications that has led to confusion within the literature and among treating clinicians. [wjgnet.com]

The clinical manifestation of peritoneal metastasis is nonspecific, but the observation of a newly formed ascites must raise suspicion toward a malignant etiology [2]. For this reason, the physician must obtain a detailed patient history that will assess the duration of symptoms, their onset, as well as progression, whereas anamnestic data of malignant diseases is crucial for making a presumptive diagnosis. In fact, up to 50% of gastric cancers and 10-35% of colorectal cancers recur as peritoneal metastasis [3]. After a thorough physical examination, imaging studies need to be employed. Abdominal ultrasonography, a common first-line procedure, provides little benefit when it comes to visualizing the metastatic deposits, but its use as a guide to obtain a viable sample of the ascitic fluid or of superficial tumors for histopathological testing is invaluable [6]. Instead, more advanced methods - computed tomography and magnetic resonance imaging are the cornerstones for identifying peritoneal metastasis and tumor spread [2] [3] [6] [7]. Typical findings range from multifocal nodules to aggressive infiltrating masses, whereas stellate lesions and calcifications might also be encountered [2] [7]. MRI is particularly effective if used with gadolinium as a contrast, and images should be obtained 5-10 minutes after the agent is administered [2]. The diagnosis can be further solidified through the use of fluorodeoxyglucose (FDG)-PET [2].

CRS and HIPEC for PM were compared in others trials with different intraperitoneal treatments without hyperthermia or with no intraperitoneal treatment or with intravenous chemotherapy. Inclusions were closed for the French study - PRODIGE 7. [ncbi.nlm.nih.gov]

BACKGROUND/AIMS: Peritoneal metastasis (PM) is a well-known predictor of poor prognosis. This study aims at identifying factors affecting recurrence and prognosis after R0 resection for colorectal cancer (CRC) with synchronous PM. [ncbi.nlm.nih.gov]

The clinical manifestation of peritoneal metastasis is nonspecific, but the observation of a newly formed ascites must raise suspicion toward a malignant etiology. [symptoma.com]

Sari R, Yildirim B, Sevinc A, et al: The importance of serum and ascites fluid alpha-fetoprotein, carcinoembryonic antigen, CA 19-9, and CA 15-3 levels in differential diagnosis of ascites etiology. [mayomedicallaboratories.com]

Pathologically it is a chronic inflammation of unknown etiology. This entity is more common than previously thought. The signs and symptoms are variable. [radiologyassistant.nl]

Intraperitoneal abscesses Most common etiologies being Gastrointestinal perforations, postoperative complications, and penetrating injuries. [wikidoc.org]

The epidemiology of patients with peritoneal metastases mirrors that of affected patients. [radiopaedia.org]

Epidemiology and risk factors of urothelial bladder cancer. Eur Urol 2013 Feb;63(2):234–41. [ CrossRef ] [ Pubmed ] Quinn DI. Nonurothelial bladder cancer. UptoDate. 2014. Pevarski DJ, Mergo PJ, Ros PR. [ijcasereportsandimages.com]

Epidemiology and Demographics The prevalence of peritoneal carcinomatosis is approximately 0.03 per 100,000 individuals worldwide. [5] Age Peritoneal carcinomatosis is more commonly observed among patients aged 50 - 70 years. [6] Peritoneal carcinomatosis [wikidoc.org]

Asbestos: Risk Assessment, Epidemiology, and Health Effects, Second Edition. Taylor & Francis: Boca Raton, 2012. Bridda, A. et al. (2007). Peritoneal mesothelioma: A review. Med Gen Med., 9(2), 32. [asbestos.com]

Useful For Suggests clinical disorders or settings where the test may be helpful An adjunct to cytology to differentiate between malignancy-related ascites and benign causes of ascites formation Clinical Information Discusses physiology, pathophysiology [mayomedicallaboratories.com]

"Pathophysiology and biology of peritoneal carcinomatosis". World J Gastrointest Oncol. 2 (1): 12–8. doi : 10.4251/wjgo.v2.i1.12. PMC 2999153. PMID 21160812. ↑ Thomassen I, van Gestel YR, Lemmens VE, de Hingh IH (2013). [wikidoc.org]

RESULTS: Four trials (Dutch, French, Italian and Spanish) focussed on a preventive strategy to decrease the rate of CRC-PM. Inclusions were closed for the French study - ProphyloCHIP. [ncbi.nlm.nih.gov]

The present report suggests the importance of paying close attention to procedures during laparoscopic colorectal resection to prevent peritoneal seeding. J. Med. Invest. 64: 288-290, August, 2017 [jstage.jst.go.jp]

1. Bellavance EC, Alexander HR Jr. Palliative interventions in patients with peritoneal metastases and malignant bowel obstruction. J Clin Oncol. 2012;30(35):4290-4201.
2. Levy AD, Shaw JC, Sobin LH. Secondary tumors and tumorlike lesions of the peritoneal cavity: imaging features with pathologic correlation. Radiographics. 2009;29(2):347-373.
3. Coccolini F, Gheza F, Lotti M, et al. Peritoneal carcinomatosis. World J Gastroenterol. 2013;19(41):6979-6994.
4. Klaver YL, Lemmens VE, Nienhuijs SW, Luyer MD, de Hingh IH. Peritoneal carcinomatosis of colorectal origin: Incidence, prognosis and treatment options. World J Gastroenterol. 2012;18(39):5489-5494.
5. Raptopoulos V, Gourtsoyiannis N. Peritoneal carcinomatosis. Eur Radiol. 2001;11(11):2195-206.
6. Healy JC. Detection of peritoneal metastases. Cancer Imaging. 2001;1(2):4-12.
7. Agarwal A, Yeh BM, Breiman RS, Qayyum A, Coakley FV. Peritoneal calcification: causes and distinguishing features on CT. AJR Am J Roentgenol. 2004;182(2):441-445.