Symptoms and Evaluation
Symptoms
Symptoms of PPC are vague so the disease is usually diagnosed in an advanced stage. At that point, a cure is difficult to achieve.
PPC symptoms are more often gastrointestinal (GI) rather than gynecologic in nature. They include:
- abdominal bloating
- changes in bowel habits
- an early feeling of fullness after eating
When bloating is severe, nausea and vomiting may result. Sometimes, patients with PPC present with a blockage of the intestines. This is related to a tumor on or next to the bowels. Vaginal bleeding is rarely seen in patients with PPC.
Medical Evaluation
Commonly, PPC is diagnosed when a woman sees her doctor for abdominal swelling and bloating. The GI symptoms of PPC are related to the fluid that accumulates. This accumulation of fluid is not normal and is known as ascites. GI symptoms also occur because seedlings of tumor are often found on the outer lining of the intestines. This is a process called carcinomatosis. The omentum is an apron of fatty tissue. It hangs down from the colon and stomach. Often it contains bulky tumor, described as omental caking. A physical exam can reveal the fluid and caking. Often, though, they are subtle and hard to detect especially in obese women.
The usual first step after fluid is found is a CT scan. This is a special type of x-ray that lets doctors assess the entire abdomen and pelvis. Omental caking and ascites, as well as other tumor growths, are commonly seen on the CT scan. Together, they point toward the diagnosis of PPC or ovarian cancer. Other cancers can cause these findings as well. So further tests are needed to rule them out For instance, the findings could be a result of colon, stomach, pancreatic or breast cancer.
Often, the evaluation of ascites begins with a procedure known as a paracentesis. In this procedure, fluid is removed from the abdomen with a needle. The fluid is then examined under the microscope to see if it has any cancer cells. This procedure is not without risks. The process can “seed” the wall of the abdomen with cancer cells. Therefore, it is important to consult with a gynecologic oncologist if you are considering this procedure. It may not be needed. Most patients with these findings will undergo surgery anyway. It might be helpful, though, for a patient who is not a candidate for surgery. It might also be helpful for a patient that might have ascites for reasons that are not cancer. For instance, ascites can result from abnormal function of the liver or heart disease.
Another test that is common when PPC is suspected is a blood test called the CA125. CA125 is a chemical that is made by tumor cells. It is commonly elevated in patients with PPC. It can also be elevated in a variety of benign conditions and other cancers. So an elevated CA125 blood test does not mean you have PPC.
The clinical presentation of PPC is the same as that of epithelial ovarian cancer. Also, PPC and epithelial ovarian cancer appear identical under the microscope. That means the diagnosis of Primary peritoneal cancer is often not completely certain without surgery. The pattern of tumor distribution is often what indicates primary peritoneal rather than ovarian cancer. Patients with PPC are commonly found to have normal ovaries. Or there may be only superficial involvement of the ovaries at the time of pre-surgical imaging or at time of surgery. But the diagnosis can sometimes be uncertain even after surgery. It is important to understand that PPC can occur in women whose ovaries have already been removed.