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Treatment of cancer spreading in the peritoneum

Historically, the common treatment for spread to the abdominal cavity from different tumors has been systemic chemotherapy based on which organ the spread is originating from. In some cases the treatment has also been combined with surgery with varying degrees of removal of tumor tissue. If there is residual tumor tissue, the surgery is indicated as palliative. The goal of these treatments is increased lifespan and improved quality of life.

In recent years there have been a new treatment where the surgeon attemps to remove any visible residual tumor (maximal cytoreductive surgery (CRS)) followed by chemotherapy in the abdominal cavity at the end of surgery. The chemotherapy is heated and delivered over a short time (hyperthermic intraperitoneal chemotherapy (HIPEC)).

Different tumors can be treated, but particularly peritoneal carcinomatosis from pseudomyxoma peritonei, colorectal cancer and abdominal mesothelioma. Spread from ovarian cancer to the peritoneum is an increasing field internationally, but so far, few with this diagnosis have received treatment.

In Norway, CRS-HIPEC is since 2009 rooted as a national treatment service (19) related to the surgical ward at Oslo University Hospital. Norway is among the few countries that have national  guidelines ensuring equal treatment regardless of residency. The guidelines were created in cooperation with the Directorate of Health and Norwegian Gastrointestinal Cancer Group (NGICG) (5).

Radiation therapy is not administered for peritoneal carcinomatosis.

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