Carcinomatous peritonitis

Japanese: 癌性腹膜炎

(3) Cancerous peritonitis (peritonitis carcinomatosa, diffuse peritoneal carcinomatosis)
Concept: A condition in which cancer cells metastasize to the peritoneum via the bloodstream, lymph nodes, and dissemination, causing peritonitis symptoms. Most cases originate from abdominal organs such as stomach, colon, pancreas, and ovarian cancer, but it can also be distant metastasis from lung or breast cancer. Ovarian metastasis from gastric cancer is called Kruckenberg tumor, and metastasis to the rectal-uterine pouch is called Schnitzler metastasis, both of which are named after specific localized metastases.
Clinical symptoms include diuretic-resistant ascites, abdominal pain due to ileus, nausea, vomiting, and abdominal distension. In the early stages, neither ascites nor abdominal masses are palpable, but in later stages, extreme ascites accumulation leads to cachexia, impairing quality of life. Pleural effusion and edema of the lower limbs often occur concomitantly.
A definitive diagnosis is made by identifying the primary lesion and by cytological examination of ascites fluid, but ascites fluid cytology may be negative. Imaging findings such as CT scans may reveal accumulated ascites, as well as peritoneal masses or thickening, and intestinal edema.
Treatment Treatment for cancer varies depending on the primary tumor. Anticancer drugs are mainly used for chemotherapy, but localized peritoneal metastasis may be removed by surgery. If anticancer treatment is ineffective, treatment is switched to one aimed at alleviating symptoms. Ascites is often resistant to fluid restriction and diuretics, and is removed by abdominal paracentesis. If the ascites contains a large amount of albumin, cell-free and concentrated ascites reinfusion therapy (CART) may be performed, which removes endotoxins and cancer cells from the ascites and returns only the necessary fluids to the blood. Opioids such as morphine are used for pain, and continuous injections of octreotide are used for ileus. For organic gastrointestinal stenosis, bypass surgery may be performed after considering the prognosis. If the patient is completely unable to take in food, parenteral nutrition via the central vein may be considered.
Prognosis varies depending on the primary tumor, but if surgery and anticancer drug treatment are ineffective, it will be about 2 to 6 months. [Satoshi Fujisawa and Nobuyuki Matsuhashi]
■ References
Debrock G, Vanhentenrijk V, et al: A phase II trial with rosiglitazone in liposarcoma patients. Br J Cancer, 89: 1409-1412, 2003.
Saab S, Hernandez JC, et al: Oral antibiotic prophylaxis reduces spontaneous bacterial peritonitis occurrence and improves short-term survival in cirrhosis: a meta-analysis. Am J Gastroenterol, 104: 993, 2009.

Source : Internal Medicine, 10th Edition About Internal Medicine, 10th Edition Information

Japanese:

（3）癌性腹膜炎（peritonitis carcinomatosa，diffuse peritoneal carcinomatosis）
概念
　腹膜に癌細胞が血行性，リンパ行性，播種性に転移し腹膜炎症状を引き起こした状態．胃，大腸，膵，卵巣癌などの腹部臓器を原発とするものが多いが，肺や乳癌などの遠隔転移でもありうる．胃癌の卵巣転移をKruckenberg腫瘍，直腸子宮窩への転移をSchnitzler転移と特有の限局性の転移に対し名前がつけられている．
臨床症状
　利尿薬抵抗性の腹水，イレウスによる腹痛，悪心，嘔吐，腹部膨満感などがみられる．初期では腹水，腹部腫瘤ともに触知しないが後期では極度の腹水貯留で悪液質となり生活の質が障害される．しばしば胸水，下肢の浮腫を併発する．
診断
　確定診断は原発巣の確定と腹水の細胞診によってなされるが腹水の細胞診は陰性のこともある．CTなどの画像所見において貯留した腹水のほか，腹膜腫瘤や肥厚，腸管の浮腫が認められる．
治療
　癌に対する治療は原発巣によって異なる．おもに抗癌薬による化学療法が行われるが，限局性の腹膜転移に対しては手術で切除することもある．癌に対する治療が無効な場合は症状緩和を目的とした治療に切り替える．腹水に対しては水分制限，利尿薬に抵抗性のことが多く，腹腔穿刺にて腹水を除去する．腹水にアルブミンが多く含まれている場合，腹水中からエンドトキシン，癌細胞などを取り除き必要なものだけを血中に戻す，腹水濾過濃縮再静注法（cell-free and concentrated ascites reinfusion therapy：CART）が行われることがある．痛みに対してはモルヒネなどのオピオイドの使用，イレウスに対してはオクトレオチドの持続注射を行う．器質的な消化管狭窄に対しては予後を考慮したうえでバイパス手術を行うこともある．食事がまったく摂取できないときは中心静脈からの経静脈栄養も考慮される．
予後
　原発巣によって変わるが手術，抗癌薬による治療が無効な場合2～6カ月程度．［藤沢聡郎・松橋信行］
■文献
Debrock G, Vanhentenrijk V, et al: A phase II trial with rosiglitazone in liposarcoma patients. Br J Cancer, 89: 1409-1412, 2003.
Saab S, Hernandez JC, et al: Oral antibiotic prophylaxis reduces spontaneous bacterial peritonitis occurrence and improves short-term survival in cirrhosis: a meta-analysis. Am J Gastroenterol, 104: 993, 2009.

出典　内科学第10版内科学第10版について　情報

<<: Customs Law - Kanzeiho

>>: Kansei Rebellion