Carcinomatosis is a complication of primary cancer

If, with metastases of a primary tumor, cancer cells move into the tissues of other organs, threatening to damage them, then carcinomatosis means the development of malignant formations - metastatic carcinomas or adenocarcinomas - after spreading from the primary focus. Oncologists in most cases use this term for any type of secondary cancerous tumors of any localization.

In ICD-10, this condition is defined as disseminated malignant neoplasm (unspecified) with code C80.0.

Epidemiology

According to some estimates, peritoneal carcinomatosis is detected in 5-8% of cancer patients with colorectal cancer -  rectal adenocarcinoma , which is one of the most common cancers in the world (diagnosed annually in 1.4 million people). At the same time, at the time of diagnosis, peritoneal carcinomatosis is observed in almost 10% of patients with colorectal cancer and in about 70% of patients with ovarian carcinoma.

According to statistics, pulmonary lymphogenous carcinomatosis accounts for 6-8% of cases of secondary (metastatic) lung cancer. [1]

Leptomeningeal carcinomatosis occurs in 1-5% of solid cancers, in 5-15% of hematologic malignancies, and in 1-2% of primary brain cancers.

Causes carcinomatosis

The development of carcinomatosis has no other reason than the presence of a primary malignant tumor and its metastasis. That is, such a condition is possible only in cancer patients and represents the dissemination of cancer and its progression. [2]

Distinguishing the types of carcinomatosis by the way tumor cells spread, experts note lymphogenous carcinomatosis (through the lymphatic vessels and lymphatic drainage system), which develops with  metastases in the lymph nodes , non-Hodgkin's lymphoma, ovarian cancer or neuroendocrine tumors.

In patients with leukemia, as well as with  malignant tumors of the mammary gland  and lungs, hematogenous spread of metastases may occur - with damage, respectively, to the brain and abdominal organs.

And with implantation spread - direct invasion of cancer cells from tumors of the intestine, stomach, pancreas, uterus or ovaries - carcinomatosis can develop in the lungs, peritoneum and liver.

Secondary malignant tumors are also classified according to localization. Lung carcinomatosis occurs when tumors of the breast, uterus or ovaries metastasize; cancer of the kidney, pancreas or thyroid gland,  prostate cancer .

With malignant neoplasms of the lungs, breast, stomach, as well as with any tumor capable of  metastasizing to the lungs  and the mediastinal region, carcinomatosis of the pleura and pleural cavity may develop. [3]

Carcinomatosis of the abdominal cavity (cavum peritonei) is the result of  metastases in the abdominal cavity . And the spread of cancer of the gastrointestinal tract or the female reproductive system is caused by carcinomatosis of the peritoneum (peritoneum). According to experts, peritoneal carcinomatosis is most often caused by metastasis of malignant neoplasms of the stomach, pancreas, ovaries and colorectal carcinoma, as well as primary extra-abdominal tumors - mammary glands, lungs,  malignant skin melanoma , high-grade lymphomas.

With an oncological disease of any organ of the abdominal and abdominal cavity, omentum carcinomatosis can be detected, the development of which occurs by the lymphogenous pathway - through the lymphatic system of the greater omentum - and leads to infiltration of soft tissues into the fatty tissue.

Primary gastric cancer is diagnosed very often, but gastric carcinomatosis - with metastases to this organ of squamous cell carcinoma of the esophagus, renal cell carcinoma, lobular carcinoma of the breast, or ovarian cancer - is a rare condition.

When  metastasis in the intestine that can be distributed to the majority of tumors of the abdominal cavity, there is a bowel carcinomatosis, and cancer of the colon or rectum - colon carcinomatosis (colon department).

Etiologically associated with melanoma, tumors of the lungs, ovaries, stomach and intestines, pancreas and prostate, liver carcinomatosis.

In most cases, ovarian carcinomatosis is a consequence of metastasis of tumors of the uterus, breast, gastrointestinal tract and bladder.

A late and rare complication of malignant tumors of the breast, lungs and melanoma, which  metastases to the brain  through the blood or cerebrospinal (cerebrospinal) fluid, is carcinomatosis of the meninges or leptomeningeal carcinomatosis (leptomeninges - arachnoid and soft membranes of the brain).

Risk factors

Indisputable risk factors for the development of carcinomatosis are: the presence of a primary tumor with a high degree of malignancy, late stages of the primary tumor (TK and T4), metastases to the lymph nodes and visceral metastases.

Thus, the risk of developing disseminated malignant neoplasms in the abdominal cavity or abdominal wall in colon cancer at stage T3 does not exceed 10%, and at stage T4 it is 50%.

The threat of carcinomatosis is also increased in cases of non-radical resection of the primary tumor, and leptomeningeal carcinomatosis - with surgical removal of the neoplasm without radiotherapy of the whole brain.

Pathogenesis

Pathologically altered  tumor cells  are characterized by a violation of the internal structure and metabolic processes (with a predominance of anabolism), as well as suppression of cellular immunity with the transformation of T-lymphocytes, which begin to act as toxins in the tissues surrounding cancer cells. In addition, under the influence of cancer cells, the growth of fibroblasts, adipocytes, endothelial, mesothelial and stem cells is activated - with the loss of their normal properties and functions. [4]

Particularly important in the mechanism of the oncological process is the disruption of the physiological cell cycle in the tumor tissue, leading to uncontrolled proliferation of mutant cells both in the primary focus and when they spread beyond it.

The pathogenesis of secondary malignant neoplasms of various localization in carcinomatosis is due to desquamation - the ability of cells of primary tumors to exfoliate, their spread through lymphatic vessels, blood, peritoneal and cerebrospinal fluid and direct invasion, as well as adhesion (intermolecular connection) of healthy cells to cancerous cells, which rapidly multiply to nodular damage to the surface tissues of organs.

Symptoms carcinomatosis

From where carcinomatosis develops and how extensive the organ damage is, its main symptoms depend.

So, the first signs of pulmonary carcinomatosis can be manifested by shortness of breath and hemoptysis; carcinomatosis of the peritoneum - its abnormal enlargement and bloating of the upper abdomen; disseminated malignant neoplasm of the stomach is often manifested by periodic abdominal pain, and the liver - by jaundice.

The most common symptoms of peritoneal carcinomatosis are ascites (which develops due to a malignant neoplasm blocking the outflow of lymph or secretion of fluid into the abdominal cavity), nausea, cachexia (general exhaustion with a significant decrease in body weight) and intestinal obstruction (due to thickening of the intestinal wall and compression of the rectum). With nodular formations on the intestinal walls (sometimes up to several centimeters in size), sharp or pulling pains are possible. [5]

Affecting the ovaries, carcinomatosis can cause discomfort in patients, pain, shortness of breath, bloating, anorexia.

In carcinomatosis of the meninges of the brain, symptoms are observed caused by damage to the nerves crossing the subarachnoid space, direct tumor invasion into the brain or spinal cord, cerebral circulation disorders, and obstruction of the outflow of cerebrospinal fluid. The clinical picture is quite variable and may include headaches, vomiting, impaired swallowing, confusion, and progressive neurological dysfunction.

Complications and consequences

The key consequences of carcinomatosis of any location are reduced patient survival. So, in more than half of patients with stomach cancer, the progression of the disease leads to peritoneal carcinomatosis, in the absence of treatment, the average survival rate does not exceed three months, and after chemotherapy, ten months.

Without proper treatment, leptomeningeal carcinomatosis is fatal in a month to one and a half months, but chemotherapy can extend life to three to six months.

The most frequent complications of peritoneal carcinomatosis: impaired gastrointestinal motility,  portal hypertension , small bowel obstruction,  splenomegaly ,  hepatic encephalopathy , intestinal obstruction, intestinal fistula formation, peritonitis. [6]

In all cancer patients, the risk of thromboembolism in carcinomatosis increases several times, since the formation of blood clots in the veins in cancer is caused by the influence of tumors on the homeostasis system and blood coagulation.

Diagnostics carcinomatosis

In the case of carcinomatosis, the diagnosis is intended to verify the nature of the disease and assess its severity.

Blood tests for tumor markers  and serum creatinine levels are required ; analysis of intra-abdominal fluid (with ascites) - for the number of neutrophils; analysis of cerebrospinal fluid - for the presence of malignant cells and the level of protein and glucose; general urine analysis. A biopsy and histological analysis of the tissue sample is needed to select a treatment method.

Visualization of the pathological state of the affected organs is provided by instrumental diagnostics: X-ray, ultrasound, CT, MRI (in case of suspicion of damage to the meninges - MRI with contrast enhancement). [7]

Differential diagnosis

Differential diagnosis is carried out with primary multiple malignant neoplasms; peritoneal carcinomatosis - with mimicking tuberculosis, as well as lymphomatosis, pseudomyxoma and primary peritoneal mesothelioma. Pulmonary carcinomatosis should be differentiated from viral and lymphocytic interstitial pneumonia, radiation pneumonitis, and pulmonary sarcoidosis.

Read more in publications:

• Cancer diagnostics
• Screening for cancer

Treatment carcinomatosis

The treatment of disseminated malignant neoplasms is carried out using the same methods as the treatment of primary malignant tumors, but in many cases it is, in fact, palliative.

Surgical treatment consists in the most complete  removal of the cancer tumor  - complete cytoreductive surgery. [8]

After it, radiation therapy is prescribed (with a significant volume of tumor tissue) and a  course of chemotherapy : this is either intravenous chemotherapy, or intrathecal (with the introduction of drugs into the cerebrospinal fluid by epidural injections). And hyperthermic intraoperative peritoneal (intraperitoneal) chemotherapy (HIPEC) can be performed in patients with peritoneal carcinomatosis. What medicines can be used in this case, read in detail in the materials:

• Cancer medications
• Chemotherapy drugs

It is also possible to prescribe drugs of the antimetabolite group, for example, Methotrexate, which suppresses the proliferation of cancer cells. And targeted drug therapy uses such anticancer drugs of the monoclonal antibody group as Ipilimumab, Pembrolizumab, Bevacizumab (Avastin), Trastuzumab (Gerticad), Rituximab (Rituxan), etc.

Prevention

Oncologists believe that the main prevention of the formation of secondary cancerous tumors is the early detection of primary malignant tumors and their immediate treatment. As a sign, the situation with the diagnosis of one of the most deadly types of oncology in women - ovarian cancer, which in more than 70% of cases is detected only at III-IV stages, is given.

Forecast

Analyzing the survival time of patients with carcinomatosis, experts say that the prognosis is poor. [9]Because there is no real hope for a cure in many cases.