Treatments for primary peritoneal carcinoma
The following are treatment options for the stages of primary peritoneal carcinoma. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.
Most cases are stage 3 or 4 at the time of diagnosis. Treatment for primary peritoneal carcinoma is the same as for epithelial ovarian cancer of a similar grade and stage.
Surgery is the first treatment for primary peritoneal carcinoma. The types of surgery are:
removing the uterus, both ovaries and both fallopian tubes (total hysterectomy and bilateral salpingo-oophorectomy)
removing as much of the cancer as possible (surgical debulking)
During surgery, the surgeon also removes abnormal-looking tissue samples from different parts of the pelvis, abdomen and lymph nodes. These samples are then analyzed in the lab to find out if the cancer has spread. This part of surgery is called surgical staging.
Surgical procedures to reduce symptoms and relieve pain for stage 4 cancer include:
paracentesisto remove fluid from the abdomen thoracentesisto remove fluid from around the lungs
placing a feeding tube into the stomach or intestines
placing a tube (stent) in the large or small intestine or ureter to relieve a blockage caused by a tumour
Chemotherapy is a treatment for primary peritoneal carcinoma. It is given after surgery with carboplatin (Paraplatin, Paraplatin AQ) or cisplatin along with paclitaxel (Taxol) or docetaxel (Taxotere). Carboplatin and paclitaxel given by IV is the chemotherapy that is most often used.
Other chemotherapy drugs that may be used when the cancer recurs include:
etoposide (Vepesid, VP-16)
pegylated liposomal doxorubicin (Caelyx)
Intraperitoneal chemotherapy may be given instead of intravenous chemotherapy. It may be offered to women who still have small residual tumours (less than 1 cm) after surgical debulking.
Sometimes chemotherapy is given before debulking surgery. If the cancer shrinks from the chemotherapy, surgery can be done to remove as much cancer as possible. More chemotherapy is given after the surgery. This is called interval debulking surgery.
Targeted therapy @(Model.HeadingTag)>
Targeted therapy may be used to treat some advanced primary peritoneal carcinoma. Sometimes a targeted therapy drug is combined with a chemotherapy drug. Targeted therapy drugs used include:
olaparib (Lynparza) for women with a BRCA1 or BRCA2 gene mutation
Olaparib or niraparib may be given as
Hormonal therapy @(Model.HeadingTag)>
Hormonal therapy may be given in addition to chemotherapy to treat advanced primary peritoneal carcinoma. Hormonal therapy includes drugs such as:
tamoxifen (Nolvadex, Tamofen)
Radiation therapy @(Model.HeadingTag)>
Radiation therapy is sometimes used to treat advanced primary peritoneal carcinoma.
If you can't have or don't want cancer treatment @(Model.HeadingTag)>
You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don't work anymore, they're not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can't have or don't want cancer treatment.
Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.
Clinical trials @(Model.HeadingTag)>
Tien Le, MD, FRCSC, DABOG
Saul Offman, MD
Cannistra SA, Gershenson DM, Recht A . Ovarian cancer, fallopian tube carcinoma, and peritoneal carcinoma. DeVita VT Jr, Lawrence TS, Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015: 76: 1075-1099.
Fleming GF, Ronnett BM, Seidman J, Zaino RJ, Rubin SC . Epithelial ovarian cancer. Barakat RR, Markman M & Randall ME. Principles and Practice of Gynecologic Oncology. 5th ed. Philadelphia: Wolters Kluwer Health / Lippincott Williams & Wilkins; 2009: 25: 763-835.
Health Canada. Regulatory Decision Summary Avastin. 2015: http://www.hc-sc.gc.ca/dhp-mps/prodpharma/rds-sdr/drug-med/rds_sdr_avastin_171255-eng.php.
Health Canada. Regulatory Decision Summary: Lynparza. 2016: http://www.hc-sc.gc.ca/dhp-mps/prodpharma/rds-sdr/drug-med/rds-sdr-lynparza-182283-eng.php.
Health Canada. Lynparza - Notice of Compliance with Conditions - Qualifying Notice. Ottawa, ON: Health Canada; 2018.
Selman AE, Copeland LJ . Extraovarian primary peritoneal carcinomas. Raghavan D, Blanke CD, Honson DH, et al (eds.). Textbook of Uncommon Cancer. 4th ed. Wiley Blackwell; 2012: 34: 485-495.