Peritoneal disease (carcinomatosis) is the spread of cancer to the peritoneum, the membrane lining the abdomen. Once considered untreatable, in selected patients it can now be treated with curative intent through the combination of cytoreductive surgery (CRS) — removing all visible disease — and HIPEC, that is heated chemotherapy delivered inside the abdomen during the operation to target microscopic residual cells. The benefit depends on the tumour type and how complete the removal is, and the decision is made by a specialised multidisciplinary team. Early referral to a specialised centre matters a great deal.
For years, the spread of a cancer to the peritoneum was considered an end stage, with no meaningful options. In recent years, however, the combination of specialised surgery and local chemotherapy has changed the picture for selected patients. Let's look at what this means, plainly and precisely.
What is peritoneal disease
The peritoneum is the thin membrane that lines the organs and the inside of the abdomen. When cancer cells spread to it, we call this peritoneal carcinomatosis. It occurs most often with cancers of the colon, the ovaries, the stomach and the appendix (pseudomyxoma), as well as with peritoneal mesothelioma.
What cytoreductive surgery (CRS) and HIPEC are
The modern approach combines two parts:
- Cytoreductive surgery (CRS): the meticulous removal of all visible disease from the peritoneum and the affected organs. The goal is to leave no visible tumour (complete cytoreduction).
- HIPEC (heated intraperitoneal chemotherapy): immediately afterwards, a heated chemotherapy solution circulates inside the abdomen for a set time, to destroy the microscopic residue that cannot be seen with the eye. The heat enhances the drug's action, while local delivery allows high concentrations with fewer systemic side effects.
Who is a candidate
This method is not for everyone. It requires the disease to be confined to the peritoneum, its complete removal to be achievable, and the patient to be in good general condition. The tumour type and the extent of disease are decisive. The final choice is always made by a specialised multidisciplinary team (MDT), based on international guidelines.
What the evidence shows
The benefit varies by tumour type. It is best established in pseudomyxoma peritonei (appendiceal tumours) and in selected cases of ovarian and colorectal cancer, while in other settings (e.g. gastric) the indication is more specialised. In suitable patients, the method can offer long-term survival or even cure — something that was previously not possible.
Recovery
CRS/HIPEC is a major operation: it usually requires a stay in a high-dependency unit and a longer hospital stay and recovery than a standard procedure. This is precisely why careful patient selection and the team's experience are so important.
Why early referral matters
Because suitability depends on how limited the disease is, early assessment at a specialised centre can make the difference. If you or someone close to you has a diagnosis of peritoneal disease, it is worth discussing the possibility of CRS/HIPEC early. See the full page on cytoreductive surgery & HIPEC and the services.
What is peritoneal carcinomatosis?
It is the spread of cancer cells to the peritoneum — the membrane lining the abdominal cavity. It can occur with cancers of the colon, ovaries, stomach or appendix. Once considered untreatable, in selected patients it can now be treated with curative intent.
What is HIPEC?
It is the delivery of heated chemotherapy inside the abdomen, during the operation — after the visible disease has been removed — to destroy microscopic residual cancer cells. It is combined with cytoreductive surgery (CRS).
Which patients are candidates?
Selected patients in whom complete removal of the visible disease is achievable, with the disease confined to the peritoneum and a good general condition. The decision is made by a specialised multidisciplinary team (MDT).
Is it a curative treatment?
In suitable patients and for certain tumour types (e.g. pseudomyxoma/appendiceal tumours, some ovarian and colorectal cancers) it can offer long-term survival or even cure. The benefit varies by tumour type and is individualised.
Where is it performed?
In specialised centres with experienced multidisciplinary teams. Early referral for assessment is important, because it increases the chance that curative treatment is feasible.