Peritoneum Cancer
Peritoneum cancer, also referred to as primary peritoneal carcinoma (PPC), is a rare and aggressive malignancy originating from the peritoneal lining, the serous membrane that forms the lining of the abdominal cavity and covers most of the intra-abdominal organs. The peritoneum shares embryological origin and histological characteristics with the ovarian surface epithelium, which is why peritoneum cancer closely resembles epithelial ovarian carcinoma in its biological behavior and clinical presentation. The pathogenesis is thought to involve genetic and environmental factors leading to malignant transformation of mesothelial or submesothelial cells, often associated with mutations in tumor suppressor genes such as BRCA1 and BRCA2. The disease frequently presents as diffuse peritoneal involvement, with tumor implants across the peritoneal surfaces, leading to ascites, abdominal distension, pain, and impaired gastrointestinal function. Health impacts are profound, as the disease is commonly diagnosed at an advanced stage due to non-specific symptoms, resulting in significant morbidity and high mortality rates.
Primary peritoneal carcinoma is a malignancy that arises de novo from the peritoneal lining, without direct involvement of the ovaries or other intra-abdominal organs at the time of diagnosis. It is histologically and clinically similar to high-grade serous ovarian carcinoma, often presenting with diffuse peritoneal carcinomatosis, ascites, and elevated CA-125 levels. The diagnosis is established when extraovarian peritoneal involvement is predominant and the ovaries are either normal in size or only minimally involved.
Secondary peritoneal carcinomatosis refers to the metastatic spread of malignant cells from a primary tumor located elsewhere, most commonly from the ovaries, gastrointestinal tract (such as colorectal or gastric cancer), or pancreas, to the peritoneal surfaces. These metastatic implants result in widespread peritoneal involvement, ascites, and symptoms similar to those of primary peritoneal carcinoma. The underlying primary malignancy dictates the overall prognosis and therapeutic approach.
Peritoneal mesothelioma is a distinct and rare neoplasm arising from the mesothelial cells of the peritoneum, most often associated with prior asbestos exposure. Unlike epithelial peritoneal cancers, mesothelioma demonstrates a unique histopathological profile and clinical course, frequently presenting with diffuse peritoneal thickening, abdominal pain, and ascites. The disease is typically aggressive and has a poor prognosis.
Peritoneum cancer is an uncommon malignancy, with primary peritoneal carcinoma accounting for a small proportion of intra-abdominal cancers. The incidence of primary peritoneal carcinoma is estimated at 6 to 7 cases per million women annually, with a higher prevalence among postmenopausal women, particularly those aged 60 years and older. The disease shares many epidemiological features with epithelial ovarian cancer, including risk factors such as inherited BRCA1/2 mutations and family history of breast or ovarian cancer. Peritoneal mesothelioma is even rarer, representing approximately 10-20% of all mesothelioma cases, and is more frequently observed in individuals with a history of asbestos exposure. Secondary peritoneal carcinomatosis is more common, reflecting the metastatic spread of advanced intra-abdominal malignancies. Overall, peritoneum cancer is associated with late-stage diagnosis and poor long-term survival, with five-year survival rates for primary peritoneal carcinoma ranging from 15% to 30%, depending on stage at diagnosis and response to therapy.
The diagnosis of peritoneum cancer is challenging due to its non-specific clinical presentation and overlap with other intra-abdominal diseases. The diagnostic process begins with a thorough clinical assessment, including evaluation of symptoms such as abdominal distension, pain, early satiety, and ascites. Laboratory investigations often reveal elevated tumor markers, particularly cancer antigen 125 (CA-125), although this is not specific. Imaging studies, including transvaginal and transabdominal ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), are essential for assessing the extent of peritoneal involvement, identifying masses, and detecting ascites. Definitive diagnosis requires histopathological confirmation, typically obtained via image-guided peritoneal or omental biopsy, or during diagnostic laparoscopy. Immunohistochemical staining and molecular testing may be employed to distinguish primary peritoneal carcinoma from ovarian or metastatic tumors and to identify actionable genetic mutations. Diagnostic criteria for primary peritoneal carcinoma include: (1) predominantly extraovarian peritoneal involvement; (2) ovaries either normal or only minimally involved by tumor; (3) histopathology consistent with serous carcinoma; and (4) exclusion of other primary sites. Staging is performed according to the FIGO (International Federation of Gynecology and Obstetrics) system, which parallels ovarian cancer staging.
Pamiparib is an orally administered poly (ADP-ribose) polymerase (PARP) inhibitor that targets DNA damage repair pathways, providing a therapeutic option for patients with peritoneum cancer, particularly those harboring BRCA mutations or exhibiting homologous recombination deficiency. It is indicated as a targeted therapy to induce synthetic lethality in tumor cells with impaired DNA repair mechanisms, thereby inhibiting cancer cell proliferation and survival. Bevacizumab is a recombinant humanized monoclonal antibody that binds to vascular endothelial growth factor (VEGF), inhibiting angiogenesis and thereby reducing tumor vascularization and growth. It is utilized in the management of peritoneum cancer as part of combination therapy or as maintenance treatment, contributing to improved progression-free survival by limiting the tumor's blood supply and metastatic potential.
| Structure | Generic Name | CAS Registry Number | Molecular Formula | Molecular Weight |
|---|---|---|---|---|
 | pamiparib (Rec INN; USAN) | 1446261-44-4 | C16 H15 F N4 O | 298.315 |
| bevacizumab (Rec INN) | 216974-75-3 |
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Peritoneum Cancer
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