Advanced Abdominal Cancer is an unusual term we use for cancers that have spread extensively inside the abdomen. Traditionally these types of tumors are considered inoperable and are only offered palliative chemotherapy or only supportive care.
However, with improved understanding of these cancers it has become clear to us that several surgical treatment options are available in these situations. A surgeon experienced in treating such cancers uses one or more of these treatment options to achieve cure, improved survival and better quality of life in these patients who are usually not considered for any type of surgical intervention.
What is advanced abdominal cancer?
An abdominal cancer is considered to be advanced when it spreads to
- Surrounding organs
- Engulfs major blood vessels in the abdomen
- Peritoneal lining of the abdomen
Most of these cancers are considered to be stage 4.
What types of cancers reach such stages?
Several varieties of cancer can reach advanced stages.
- Stomach cancer
- Colon cancer
- Rectal cancers
- Cancers of the appendix
- Ovarian cancers
- Endometrial cancers
- Few other rarer cancers
Signs & symptoms of advanced abdominal cancer
- Unexplained weight loss
- Nausea and vomiting
- Diarrhea or constipation
- An unexplained lump in your abdomen
- Fluid accumulation in the abdomen
- Other symptoms directly related to primary tumour.
If you experience any of these symptoms, it is crucial to see a doctor as soon as possible. Early detection and treatment of abdominal cancer can help improve your treatment outcomes.
Treatment for advanced abdominal cancers
Advanced abdominal cancers are generally more difficult to treat than early-stage cancers. Treatment options depend on various factors, such as the specific type of tumor, how far it has spread, and the individual’s general health condition.
Several tests and interventions are needed to deicide the best course of action in these cancers. These tests include –
- CT/MRI/PET scans
- Repeat biopsies or reassessment of prior biopsies with advanced molecular analysis.
- Laparoscopic evaluation of the spread of the disease- as CT/PET and MRI can miss tumor nodules less than 5mm, sometimes it is necessary to directly visualize the inside of the abdomen to assess the disease burden. This is done in cancers that have spread to the peritoneum. Depending on the extent of the spread, intent of treatment and outcomes vary.
Goal of the treatment:
At the end of a comprehensive evaluation it is essential to decide the goal of treatment.
The goal can be (1) Curative (2) non curative
The type of cancer, extent of its spread, site of spread , response to prior treatments and patients overall health are a few of the important deciding factors.
E.g. A colonic cancer that has spread to the liver with 3 small nodules in the liver is treated with a curative intent. However if the same colonic tumor has spread to the peritoneal lining so extensively that no lining is without the tumor, then the goal of treatment is essentially non curative.
Surgery and chemotherapy are used in both creative and non curative settings.
- For cancers that have spread to the peritoneum – For several varieties of cancers, cytoreductive surgery with or without HIPEC has shown remarkable improvement in outcomes and survival.
- For cancers that have spread to the liver- Image guided liver resections give an innovative way of removing all the tumor nodules , whilst maintaining as much of the normal liver parenchyma as possible. In these types of surgeries, we use ultrasonography machine to identify and map the tumor nodules in the liver, during surgery. We also study how close these tumor nodules are to blood vessels and bile ducts and remove them under sono guidance.
- For cancers that have spread to the adjacent organs – Multivisceral resections – tumors that spread to multiple adjacent organs require en bloc resection of these organs to remove the cancer fully. These surgeries are complex and hence experience is required to perform these challenging surgeries.
- For tumor engulfing major blood vessels- In some situations major blood vessels of the abdomen are engulfed or invaded by the tumor. Re lomoving a part or whole of a length of blood vessel is necessary to remove the tumour completely. After a successful removal the continuity of the vessel has to be established either by native blood vessel or a graft.
Role of chemotherapy
Depending on the type of cancer and its spread, chemotherapy is used in several scenarios before considering surgery.
The purpose of chemotherapy in these situations can be
- Downsizing the tumor so that the surgical complexity reduces
- Attacking micrometastasis (cancer cells circulating in lymphatics and blood vessels that can lodge in distant organs like liver, lungs, bone and brain).
- Understanding the nature of the tumor to decide whether aggressive forms of surgical treatment benefit the patient.
NON CURATIVE TREATMENT:
This is an innovative technology in the treatment of peritoneal cancers. Some of the Cancers that have spread extensively in the peritoneum are not candidates for aggressive treatments like HIPEC and cytoreductive surgery. Most of these patients have to receive chemotherapy for disease control. Some of these patients have progressive disease that is not responding to varieties of chemotherapy. Some patients may not be fit at all to receive any treatment due to poor health. Fluid accumulation, pain, poor nutrition are some of the conditions that decrease the quality of life in these patients.
PIPAC offers a palliative treatment to control disease progression and thus improve quality of life. In PIPAC, chemotherapeutic drugs are sprayed inside the abdomen in nano aerosol form under direct vision. These chemo-aerosoles directly penetrate the tumor nodule and induce cell kill, thus achieving disease control. The dose of the chemotherapy drug used is far lesser compared to systemic chemotherapy. Hence the side effects of PIPAC are minimal.
2. IP Port:
Just like a chemo port, a similar kind of a port can be installed in the abdomen to deliver chemotherapy directly into the abdomen. Similar to PIPAC , IP PORT based chemotherapy is another novel way of delivering chemotherapy directly to the tumor nodules in the abdomen while avoiding the toxicity of systemic chemotherapy. In some cases IP port chemotherapy is combined with IV chemotherapy as well.
3. Palliative procedures :
Due to the shear volume and extent of spread inside the abdomen, cancer can cause obstruction in the bowel loops that may not be relieved by non surgical methods. A surgical bypass is a procedure where the intestine beyond the obstruction is connected surgically to the intestine before the obstruction to allow smooth passage of food.
4. Evacuation of ascites/ mucin :
Accumulation of cancerous fluid ( ascites) can be burdening in some patients. The presence of a large volume of fluid will hamper mobility, breathing and food intake. Simple evacuation of such fluid in combination with other measures to reduce or prevent reaccumulation (like PIPAC , IP Port etc) improve the patients’ general condition dramatically.
Role of chemotherapy:
Chemotherapy plays a central part in management of non curative advanced cancers. New drugs are discovered and approved constantly that help us fight these cancers better. Cancer surgeons play an important part in keeping the patient fit enough to receive ultramodern chemotherapy options to control disease progression.
Advanced abdominal cancers are difficult to treat. However several surgical options are available to the patients. WIth right patient selection and aggressive treatment, cure is possible in some of these patients. An experienced surgeon can help you decide what kind of treatment suits you the best.
To get more details on advanced abdominal cancer, get in touch with our experts now!
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