Current treatment options for colon cancer peritoneal carcinomatosis

Abstract

Peritoneal carcinomatosis (PC), the dissemination of cancer cells throughout the lining of the abdominal cavity, is the second most common presentation of colon cancer distant metastasis. Despite remarkable advances in cytotoxic chemotherapy and targeted therapy for colon cancer over the last 15 years, it has been repeatedly shown that these therapies remain ineffective for colon cancer PC. Recently, there has been a rapid accumulation of reports that cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) prolongs the life of colon cancer PC patients. Here, we will review the clinical presentation, the mechanisms of disease progression, and current treatment options for colon cancer PC, with a focus on the benefits and limitations of CRS-HIPEC.

Keywords: Cancer; Carcinomatosis; Colorectal; Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Intraperitoneal chemotherapy; Mechanism; Peritoneal.

Figure 1

A multistep process is involved in establishment and progression of colon cancer peritoneal carcinomatosis. First, loose cancer cells are released from the primary tumor that has penetrated the colon wall. The free floating cancer cells enter the peritoneal cavity and are transported to the peritoneal surface, where with inflammation playing a major role, the cells become adhesed to the peritoneum. The cancer cells then invade into the submesothelial layers and ultimately are able to access to the systemic circulation. Note that the progression of peritoneal carcinomatosis is not only at the single adhesion site, but its spill over to the neighboring peritoneum.