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Pseudomyxoma Peritonei

About

Dr. Deepak Chhabra

Surgical Oncologist

MS. (Bom), DNB, M.R.C.S. (Edin. UK)

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The world knows this man as a consultant oncosurgeon with vast experience in Gastrointestinal and Hepatobiliary-Pancreatic cancers,who specializes in stapled anastomosis for bowel cancers and sphincter saving resections for rectal cancers. In short, he is the person to be contacted for all kinds of cancer related cases.

Richa AgrawalPancreatic Cancer

Thank you Dr Deepak for all you have done for mum, for putting the smile back of her face. I wish you success in all your future endeavors and know that you will continue to touch peoples lives and help them be healthy - the way you have done for my mum….. and me.

Nicola MathiasStomach Cancer

For 67years I've led a very healthy life and thank the "Almighty" for it. However as I said all good things come to an end some time and so be it. Out of the blues was detected the dreadful illness "C" which had shown no signs or symptoms whatsoever..... Time had now come for me to choose a very efficient Oncologist for my treatment.

Patient

My mother was diagnosed of colon cancer, and I was recommended to see Dr Deepak Chhabra for consultation.
The first impression of Dr Chhabra was… he is so young! But after consulting him we realized his level of experience and there was a sense of confidence he spilt over us.We knew we could trust him.....

Neelu GroverColon Cancer
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What is Pseudomyxoma Peritonei

Pseudomyxoma Peritonei is a very rare type of cancer that usually begins in your appendix as a small growth, called a polyp. Or, more rarely, it can start in the ovary or other parts of the bowel. This polyp eventually spreads through the wall of your appendix and spreads cancerous cells to the lining of the abdominal cavity (the peritoneum). These cancerous cells produce mucus, which collects in the abdomen as a jelly like fluid called mucin.

About

How does Pseudomyxoma Peritonei spread?

Pseudomyxoma Peritonei does not act like most cancers and does not spread through the bloodstream or the lymphatic system. It spreads inside the tummy (abdomen), rather than into nearby tissues of the bowel or liver. The mucus collects inside the abdomen and causes symptoms. It develops very slowly and it may be many years before you have any symptoms from this type of cancer.

Causes

What are the causes of Pseudomyxoma Peritonei?

Pseudomyxoma has no known cause. There are no known lifestyle changes that one can make to lower the risk of developing pseudomyxoma peritonei.

Symptoms

What are the common symptoms of Pseudomyxoma Peritonei?

Symptoms can include

  • Abdominal or pelvic pain
  • Abdominal swelling and bloating
  • Changes in bowel habits

Some people will not have any of these symptoms, so Pseudomyxoma Peritonei can be difficult to diagnose. In women, this type of cancer can sometimes be confused with ovarian cancer, because ovarian cancer may also cause a swollen abdomen. Some types of ovarian cancer cells also produce mucin. Often, it is only after an operation to look into the abdomen (a laparotomy) that pseudomyxoma peritonei is properly diagnosed. Once diagnosed, a CT scan can help the doctor find out how far the cancer has spread through the abdomen.

Tests

What tests are carried out to diagnose pancreatic cancer?

This section lists common tests that may be performed and it is not necessary for all the tests to be performed for a patient. Your doctor will select the tests that will assist him /her to have the maximum information about the tumor/ disease.

Ultrasound of the abdomen

This test may be done as one of the initial tests to find out and gives an idea about the extent of spread of mucinous substance in the tummy.

Computerised tomography (CT) scan

A CT scan is a type of x-ray that gives a picture of organs and other structures (including any tumours) in your body. It is used to see more details of a cancer and its relation to the surrounding organs in your body. It also gives information related to cancer spread.

Tumor Biopsy

A biopsy means a diagnosis made under a microscope by a pathologist using a small bit of tissue removed from a suspicious areas or lumps that are found to be abnormal. These tests typically report the presence of abundant mucin (jelly like substance) in the biopsy.

Mucinous tumors are more common in the ovary, appendix and rarely the colon/ rectum. Hence doctors may advise you to do some blood tests like CEA and CA-125 (tumor markers) that may give an idea about the origin of Pseudomyxoma.

Treatment

What is the treatment of Pseudomyxoma Peritonei?

Many years of treating cancer patients and testing treatments in clinical trials has helped doctors know what is likely to work for a particular type and stage of cancer. You will be advised on the best treatment for your cancer. This will depend on the type of cancer you have, where it is and how far it has spread and your general health.

Surgery

Surgery For Pseudomyxoma Peritonei

If possible, you will have surgery combined with chemotherapy into the abdomen. The procedure is called cytoreductive surgery. This removes most or all of the visible tumour in your abdomen. The surgeon strips out the lining of the abdomen, the peritoneum and removes any tissues inside the abdomen affected by pseudomyxoma. This will vary between people, but can include any of the small bowel, large bowel, spleen, liver, and in women the womb and ovaries.

After the surgeon has removed all signs of tumour, you have chemotherapy directly into your abdomen (intraperitoneal chemotherapy). This means putting the chemotherapy drugs straight inside the abdominal cavity, where they can directly come into contact with the cancer cells. You may have a heated solution of mitomycin C put into your abdomen during and after your operation. After your surgery, you may have more intraperitoneal chemotherapy with another drug called fluorouracil put into your abdomen for 4 days. The idea of this treatment is that it will kill off any tumour cells that were left behind after the surgery. The aim is to cure the disease or reduce the risk of it coming back.

The operation itself is long and can sometimes take 10 hours or more. It can take quite a while to recover because of the length of surgery and the removal of any organs affected by the cancer. Sometimes people need more than one operation, several months apart.

This intensive surgery is not suitable for everyone. The surgery takes a very long time and you may be in intensive care or a high dependency unit for up to 5 days. You are fed by a tube into your stomach or a vein, and are likely to be in hospital for 2 to 3 weeks. About 3 out of every 10 people (30%) have serious complications after treatment. About 1 out of 5 patients (20%) need a stoma after surgery.

Many people with pseudomyxoma peritonei will have already had surgery at another hospital because this condition wasn’t suspected to begin with. Even if you have already had surgery, your specialist may recommend further surgery, followed by intraperitoneal chemotherapy.

If your tumour is small and slowly growing your doctor may just keep a close eye on it and may suggest chemotherapy or surgery in the future if it continues to grow.

This type of surgery removes as much of the tumour as possible. It will not cure the pseudomyxoma peritonei but reduces symptoms and can help people to feel comfortable for as long as possible. This might mean removing your womb and ovaries if you are a woman, and sometimes part of your bowel. Unless you have cytoreductive surgery, it is hard to remove all of the tumour. So the tumour will come back. Then you need to have more surgery, and sometimes may need several debulking operations.

If you can’t have cytoreductive surgery you may have chemotherapy. You may have either chemotherapy into a vein or as tablets. These chemotherapy drugs tend not to cause bad side effects and your doctors and nurses will monitor you with regular blood tests and CT scans.