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Cancer Information

Peritoneal Metastases (Peritoneal Cancer)

Peritoneal Metastases (Peritoneal Cancer)

​The peritoneum is a membrane that covers the inner lining of the abdominal cavity and the organs lying in there. It helps to support these organs and contains the blood vessels and nerves that supply them. The space in the abdominal cavity covered by the peritoneum is known as the peritoneal cavity (Figure 1).


Figure 1: Peritoneal Cavity

Metastasis occurs when cancer spreads from its original site to other parts of the body. Peritoneal metastases refer to cancer that has spread to the peritoneum from other organs. When cancer spreads from other organs, it is considered advanced and denote Stage IV disease in most cases. 

Cancers that develop from the peritoneum itself, such as primary peritoneal cancer or peritoneal mesothelioma, are very rare.


​Patients who suffer from cancers mainly of abdominal origins such as gastric (stomach), ovarian, colorectal, appendix and pancreas cancers are at risk of developing peritoneal metastases. Less commonly, other cancers can also spread to the peritoneum.

*People who think they may be at risk should discuss this with their doctor.

Complications related to peritoneal metastases:

  • Ascites: Peritoneal metastases tend to produce fluid in the abdomen, known as ascites, which causes abdominal distension (Figure 2).
  • Intestinal obstruction: Peritoneal metastases may cause blockage of the intestines.
  • Hydronephrosis: The kidney ureters may be blocked by peritoneal metastases. This may affect the kidney function.

Some common symptoms include:

  • Bloating
  • Abdominal pain
  • Nausea and vomiting
  • Constipation
  • Loss of appetite
  • Weight loss

Figure 2: Ascites due to peritoneal metastasis

*A doctor should be consulted if the symptoms above occur. 

​Peritoneal metastases develop as cancer spreads. Presently, besides controlling the original cancer, there is little more that can be done to prevent peritoneal metastases. Patients who experience the symptoms mentioned above should seek medical assistance for a thorough evaluation.


​The diagnosis of peritoneal cancer can be difficult. Imaging (such as CT or MRI scans), needle drainage of ascitic fluid for analysis, keyhole surgery, or a combination of these may be required to confirm the diagnosis of peritoneal metastases. 


​Peritoneal metastasis is difficult to treat and is best managed by a multi-disciplinary team that includes surgeons and medical oncologists. 

  • Systemic chemotherapy: Chemotherapy drugs given intravenously or sometimes in combination with oral tablets circulate through the whole body. This type of treatment is suitable for cancers that have metastasised to multiple parts of the body.

  • Cytoreductive Surgery (CRS) with Hyperthermic lntraperitoneal Chemotherapy (HIPEC):
    CRS is an extensive surgery that removes all visible cancers within the abdominal cavity. At the end of CRS, a heated chemotherapy solution is applied in the peritoneal cavity to destroy the remaining cancer cells that cannot be seen with the naked eye.

  • Intra-peritoneal (IP) chemotherapy: IP chemotherapy (Figure 3) is injected into the peritoneal cavity via an intraperitoneal port that is inserted via keyhole surgery. The port is buried under the skin and connected to a catheter that enters the peritoneal space.
    • Find out more about the clinical trial at this page.
    • Read about IP chemotherapy in the news here.

Figure 3: Set-up of IP Chemotherapy


  • Pressurised Intra-Peritoneal Aerosol Chemotherapy (PIPAC): PIPAC (Figure 4) is a novel method of delivering chemotherapy in an aerosol form directly into the peritoneal cavity aiming for better distribution and penetration of the drug into the cancer cells. It is performed as a short keyhole surgery under general anaesthesia. It is still an experimental procedure in Singapore. In NCIS, clinical trials are being conducted using PIPAC as salvage therapy for advanced cancers with peritoneal metastases. Find out more about the clinical trial at this page.

Figure 4: Set-up of Pressurised Intra-Peritoneal Aerosol Chemotherapy (PIPAC)

​At NCIS, patients with peritoneal metastases (peritoneal cancer) will be managed by a multidisciplinary team. This team includes oncologists, surgeons, radiologists, pathologists, dieticians and other allied health workers. Patients are discussed at a multidisciplinary meeting to ensure that the best treatment options are offered to patients. Multiple ongoing research initiatives and trials ongoing at NCIS allow our patients access to cutting-edge treatments.