Carcinomatosis: General Information and Treatment

Introduction

Carcinomatosis is a condition in which multiple carcinomas develop simultaneously, usually after dissemination from a primary source. It implies more than spread to regional nodes and even more than just metastatic disease. The term is usually taken to mean that there are multiple secondaries on multiple sites. Carcinomatosis is often restricted to tumors of epithelial origin and adenocarcinomas, while sarcomatosis describes the dissemination of tumors of mesenchymal origin, sarcomas.

The U.S. Social Security Administration (SSA) has included Peritoneal Mucinous Carcinomatosis and Leptomeningeal Carcinomatosis as Compassionate Allowances to expedite a disability claim.

Main Digest

Strictly, it should be used only for epithelial cancers or carcinomas and not sarcomas or lymphomas, yet it has been extended to include all types of cancer which have spread. The word is now used to describe conditions with a more limited spread, such as the following.

• Pulmonary Lymphatic Carcinomatosis: Pulmonary lymphatic carcinomatosis involves diffuse infiltration of the person's lungs with obstruction of their lymphatic channels. The condition may occur with various cancers, including breast, lung, large intestine, and stomach.
• Peritoneal Carcinomatosis: Peritoneal carcinomatosis involves the spread of metastases into the peritoneum, often from colorectal and ovarian cancers. Peritoneal carcinomatosis has significantly decreased overall survival in people with liver and extraperitoneal metastases from gastrointestinal cancer.
• Leptomeningeal Carcinomatosis: Leptomeningeal carcinomatosis includes the involvement of 'leptomeninges' through seeding via the person's cerebrospinal fluid, which happens either by direct spread or through the person's bloodstream. Any cancer may cause this, yet adenocarcinomas are most commonly involved. The condition classically presents multifocal neurological signs and symptoms. A diagnosis is based on the evaluation of clinical presentation, cerebrospinal fluid cytology, and neuroimaging. The condition is uncommon and usually a late complication of cancer.

Carcinomatosis may be a progression of a known disease. It might be the presentation of recurrence, or it may be the main presenting feature. The presentation will depend on where it is affected. For example, in

• The liver often presents as jaundice
• Bones there might be a pain, or pathological fracture
• The lungs may present as shortness of breath and hemoptysis
• The brain there may be vomiting, headaches, and neurological features

Differential Diagnosis

When these features are present, the question is whether this is part of the known disease or something else. For example, whether jaundice is due to metastatic carcinoma in the liver or gallstones. When carcinomatosis is the presenting feature, it is usual to seek a primary tumor. Histology might be anaplastic and give no help, although improvements in investigative technology are helping to narrow the differential diagnosis.

Investigations

The purpose of investigations is to confirm the nature of the disease and assess its severity and extent. In the unknown primary, FBC might show iron deficiency suggestive of gastrointestinal malignancy, microscopic haematuria may reveal occult genitourinary malignancy, and occult blood might point to a colorectal cause. In instances where the primary is unknown, FBC, U&E, LFT's and creatinine may indicate severity.

Imaging techniques such as CT, ultrasound, and MRI scanning, as well as older investigations such as CXR, provide good information, and an exploratory laparotomy is rarely required. It might be desirable to obtain tissue for histology. Techniques now employed to assist with differential diagnosis include the following:

• Light microscopy
• Electron microscopy
• Chromosome studies
• Tumor markers for leptomeningeal metastases

Management

Often, there is no realistic hope of curative therapy, although radiotherapy and chemotherapy might have a soothing effect.

Surgery may be palliative, and 'debulking' of the tumor before chemotherapy may be helpful.

Resection of liver metastases secondary to colorectal cancer has had some success in limited disease.

Some subgroups of people do fairly well with treatment.

Multi-modality treatment; intrathecal chemotherapy, intravenous chemotherapy, whole brain radiotherapy, and radiotherapy to spinal leptomeninges - has been found to improve survival rates in people with leptomeningeal metastases secondary to breast cancer.

Chemotherapy

Lymphatic carcinomatosis may sometimes be stabilized, or at least the progression reduced, through chemotherapy.

Chemotherapy may be systemic or through infusion into the person's cerebrospinal fluid. Radiotherapy might be required if the tumor tissue is bulky or causing symptoms.

Peritoneal carcinomatosis can occasionally be treated with intraperitoneal and intravenous chemotherapy.

Treatment may be started postoperatively, or chemotherapy drugs may even be instilled in the person's abdominal cavity during surgery. The approaches have resulted in demonstrable improvements in survival rates.

Intrathecal trastuzumab appears to represent a safe - and, in some instances, effective option for treating HER2-positive breast cancer patients with leptomeningeal involvement.

Embolization

Transcatheter arterial chemoembolization (TACE) has resulted in a successful outcome, especially in people with neuroendocrine tumors and colorectal metastases.

A micro-catheter is inserted into the hepatic blood supply, and a combination of chemotherapeutic agents and embolic agents is injected.

Radio-embolisation promises to serve an increasing role in the treatments available for treating and managing the metastatic disease.

Radiotherapy

Palliative radiotherapy can often reduce or eliminate pain from bone metastases or palliate brain metastases. It can relieve spinal cord compression or compressive symptoms from visceral metastases.

Palliative radiotherapy can be used to control bleeding. Various ablative techniques have been used to destroy liver metastases, including microwaves, freezing, lasers, and alternating currents within the radiofrequency range.

Surgery

While palliative surgery for malignant bowel obstruction from carcinomatosis may benefit a person, it does come at the cost of high mortality and morbidity relative to the person's remaining survival time.

Current evidence on the efficacy of cytoreduction surgery (CRS) followed by hyperthermic intraoperative peritoneal chemotherapy (HIPEC) for peritoneal carcinomatosis reveals some improvement in survival for selected people with colorectal metastases. Yet, evidence is limited for other types of cancer.

The surgical treatment of bone metastases may improve life expectancy and quality of life.

For people who are incurable, a plain and honest discussion must occur. The discussion might require more than one session, and the skills for breaking bad news are required.

Additional considerations may be dying at home and dyspnea in palliative care.

Pain control in terminal care and nausea and vomiting in palliative care might also be worthy of attention.

Palliative care should not be perceived as a failure; it is highly demanding and rewarding.

Author Credentials:

Thomas C. Weiss is a researcher and editor for Disabled World. Thomas attended college and university courses earning a Masters, Bachelors and two Associate degrees, as well as pursing Disability Studies. As a Nursing Assistant Thomas has assisted people from a variety of racial, religious, gender, class, and age groups by providing care for people with all forms of disabilities from Multiple Sclerosis to Parkinson's; para and quadriplegia to Spina Bifida. Explore Thomas' complete biography for comprehensive insights into his background, expertise, and accomplishments.

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Cite This Page (APA): Weiss, T. C. (2015, November 29 - Last revised: 2023, February 1). Carcinomatosis: General Information and Treatment. Disabled World. Retrieved September 15, 2024 from www.disabled-world.com/health/cancer/carcinomatosis.php

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