Peritoneal Carcinomatosis: Principles of Management

The dissemination of cancer on peritoneal surfaces has hitherto been regarded as a terminal condition. Only a few patients with ovarian cancer - a disease where there is extreme drug sensitivity - have been maintained in a disease-free state over the long term. The tumour biology questions are as follows: is the dissemination of cancer on peritoneal surfaces to be regarded as finite spread of malignancy, or as evidence of systematic disease? Is peritoneal carcinomatosis in selected patients a limited process that can be treated for cure, using surgery and chemotherapy? Can treatments lead to a complete resolution of the cancerous process? Most oncologists would regard peritoneal carcinomatosis as a condition that can only be palliated. This volume presents the principles that support aggressive management plans with disease eradication as an end point. Technologies have emerged, bringing about this conceptual change in thinking. They have been developed for complete chemotherapeutic treatment of all peritoneal surfaces. Technologies have been developed for uncovering minute foci of disease in remote portions of the abdomen. Also, surgical and electrosurgical techniques are important aspects of this revised management plan. Even the data management tools required to quantitate improvements in treatment have been developed, and are presented here.