Marco Lotti MD

I am not interested here in giving a definition of peritoneal carcinosis, but in trying to explain its meaning, especially as regards its role in influencing the course of the disease and the life of those who suffer from it.

I do not entirely agree with the definition that most professionals give of peritoneal carcinosis, as the spread of a tumor from the organ of origin (usually the ovary or digestive tract) to the membrane that lines the abdominal cavity (the peritoneum). I prefer to define it as the presence of tumor in the peritoneal membrane (which covers not only the abdominal cavity but also many of its organs) and in the space between the organs that this membrane covers.Let me clarify why it is important to think about the terms "presence" and "space between the abdominal organs".

Cancer cells are usually said to spread out like seeds into the abdominal cavity by detaching themselves from the surface of the tumor of origin (for example, from a tumor of the stomach or another abdominal organ). These cells then grow in size and form nodules and plaques that can infiltrate the intestine, causing its occlusion; they can also produce a significant amount of fluid (ascites) which consumes the body's proteins, swells the abdomen and crushes the abdominal organs, compromising their functioning.

All of this is true, but it is a reductive explanation.

First of all, carcinosis can arise directly from the peritoneal membrane, it can derive from an organ of the abdomen, or it can reach the peritoneum even starting from a non-abdominal organ (for example, from breast cancer). Furthermore, diffusion does not occur only by seeding, but can also occur by other routes, including the lymphatic one. It is therefore not simply the spread of a primary tumor, caused by the detachment of cells: rather, the presence of carcinosis indicates that, within a tumor, some cells have developed new capabilities, which make them particularly suitable for colonizing the internal surface of the abdomen, the membrane through which the abdominal organs come into contact with each other and, above all, the vital space necessary for the survival of these organs.

Therefore, problems do not start only when cancer nodules grow into the peritoneum and crush or infiltrate the abdominal organs, or when they close the intestine. Talking about cancer nodules, or reducing the problem of removing or treating these nodules, is certainly an understatement. The problems begin much earlier, at the very moment when the space in which the abdominal organs live (abdominal cavity) and their communication routes (the peritoneal membrane and peritoneal fluid) have to deal with a new tenant who, in a silent and devious manner, will eventually colonize them. I try to better explain myself with the following example, in which I invite you for a moment to pretend yourself to be an abdominal organ, for example the intestine, living in the abdominal cavity, your city ...

“You wake up. From the open window, the crisp morning air brings you the scent of flowers and the chatter of the first passers-by.

You look out. The sun shines over the tables of a cafe, among the flowerbeds at the side of the road.

You go down for a walk. Walk in silence listening to the songs of the birds, and the noises coming from the windows of the surrounding houses, where some latecomers are waking up.

Then you get to the river, and lie down on the grass to think, lulled by the sound of flowing water ".

Now rewind the tape.

“You wake up to the noise of the horns, which torments you despite having barred the window and lowered the shutter.

You open the window to see what happens. Between the smoke and the stench of the exhausts, a column of cars occupies the road, blocked by an overturned waste bin.

You go down for a walk to calm yourself. The door is blocked by two scooters left after being used by some rude. A little further on, the excrement of a dog just abandoned. You have to climb over them and find your way between one car and another.

You get to the river. You are looking for a place to lie down on the grass, but it is occupied by the tables of the corner pub, which spreads its music loudly, together with the commercials of a nearby shopping center, preventing you from thinking and concentrating. Not even the only bench is free, transformed into the bike-sharing parking lot ".

I invite you to think about the fact that peritoneal carcinomatosis has two fundamental characteristics in common with cars, noise, pollution, scooters, advertising, and uncontrolled bike-sharing.

The first one is that they are all products of human activity. All tumors arise from mutations of normal cells, grow by consuming their own resources, but above all perversely exploit the same functioning mechanisms, taking advantage in particular of the more aggressive ones (what about the lack of empathy of wild parking attendants ...).

The second, and perhaps more important one, is that their presence profoundly modifies the life of the inhabitants of the city, their habits, their serenity, until it irremediably compromises their functioning. And all this happens long before the available space is completely occupied, because it is the space itself and the relationships between the inhabitants that are distorted, and modified in a dysfunctional way for the inhabitants, but functional for the new guests.

Treating carcinosis is not simply to remove the lumps or to treat the abdominal cavity with chemotherapy. It is a question of entering the treatment path of a systemic disease (which inevitably also includes different treatments, such as intravenous chemotherapy, biological therapy or radiotherapy and, hopefully, also a path of psychotherapy), trying to intervene on the harmful effects of the presence of the tumor in the abdominal cavity. To solve it if possible, or to allow people suffering from it to limit its consequences: consequences that often heavily affect their quality of life and almost inevitably force them to interrupt their treatment path.