Treatments for primary peritoneal carcinoma

The following are treatment options for the stages of primary peritoneal carcinoma. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Most cases are stage 3 or 4 at the time of diagnosis. Treatment for primary peritoneal carcinoma is the same as for epithelial ovarian cancer of a similar grade and stage.

Surgery is the first treatment for primary peritoneal carcinoma. The types of surgery are:

• removing the uterus, both ovaries and both fallopian tubes (total hysterectomy and bilateral salpingo-oophorectomy)

• omentectomy

• removing as much of the cancer as possible (surgical debulking)

During surgery, the surgeon also removes abnormal-looking tissue samples from different parts of the pelvis, abdomen and lymph nodes. These samples are then analyzed in the lab to find out if the cancer has spread. This part of surgery is called surgical staging.

Surgical procedures to reduce symptoms and relieve pain for stage 4 cancer include:

• paracentesis to remove fluid from the abdomen

• thoracentesis to remove fluid from around the lungs

• placing a feeding tube into the stomach or intestines

• placing a tube (stent) in the large or small intestine or ureter to relieve a blockage caused by a tumour

Chemotherapy is a treatment for primary peritoneal carcinoma. It is given after surgery with carboplatin or cisplatin along with paclitaxel or docetaxel (Taxotere). Carboplatin and paclitaxel given by IV is the chemotherapy that is most often used.

Other chemotherapy drugs that may be used when the cancer recurs include:

• etoposide (Vepesid)

• gemcitabine

• topotecan

• vinorelbine

• pegylated liposomal doxorubicin (Caelyx)

Intraperitoneal chemotherapy may be given instead of intravenous chemotherapy. It may be used to treat small residual tumours (less than 1 cm) after surgical debulking.

Sometimes chemotherapy is given before debulking surgery. If the cancer shrinks from the chemotherapy, surgery can be done to remove as much cancer as possible. More chemotherapy is given after the surgery. This is called interval debulking surgery.

Targeted therapy may be used to treat some advanced primary peritoneal carcinoma. Sometimes a targeted therapy drug is combined with a chemotherapy drug. Targeted therapy drugs used include:

• bevacizumab (Avastin)

• olaparib (Lynparza) for those with a BRCA1 or BRCA2 gene mutation

• niraparib (Zejula)

Olaparib or niraparib may be given as maintenance therapy for recurrent primary peritoneal carcinoma that has responded to chemotherapy with a platinum drug such as carboplatin or cisplatin.

Hormone therapy may be given in addition to chemotherapy to treat advanced primary peritoneal carcinoma. Hormone therapy includes drugs such as:

• anastrozole (Arimidex)

• letrozole (Femara)

• tamoxifen

Radiation therapy is sometimes used to treat advanced primary peritoneal carcinoma.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don't work anymore, they're not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can't have or don't want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Some clinical trials in Canada are open to women with ovarian cancer. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.