Prognostic features for peritoneal carcinomatosis in colorectal and appendiceal cancer patients when treated by cytoreductive surgery and intraperitoneal chemotherapy

Abstract

Colorectal cancer, including appendix malignancy, disseminates by three routes. Tumor emboli move through lymphatic channels to progress within the lymph nodes. Tumor emboli gain access to small venules and capillaries, and then move along within the portal blood stream to be deposited in liver parenchyma. They progress as liver metastases. Cancer emboli may also gain access to the peritoneal cavity. This comes about through full-thickness invasion of the bowel wall by cancer and exfoliation of tumor cells into the free peritoneal cavity. Alternatively, cancer cells can gain access to the peritoneal cavity at the time of resection of the primary cancer. Lymphatic channels transected by surgical dissection may leak cancer cells. Trauma to the cancer specimen at anatomic sites where there are narrow margins of resection may result in free intraperitoneal cancer cells. Also, blood lost from the specimen may contain tumor emboli that are left behind in the peritoneal space [1], All of these mechanisms can result in peritoneal carcinomatosis.