Carcinomatosis · What Is It, Types, Diagnosis, and More

The signs and symptoms of carcinomatosis depend on the specific subtype present. Peritoneal carcinomatosis often presents with symptoms of bloating, distension, pain, nausea, indigestion, anorexia, weight loss, and constipation. Common signs of carcinomatosis include a palpable abdominal mass and ascites. Leptomeningeal carcinomatosis can present with diverse neurologic manifestations, including headaches, visual disruptions (e.g., diplopia, or double vision), hearing impairment, and seizures; as well as back pain, and mood changes (e.g., depression, anxiety).  

Spread of tumors in LC can disrupt and obstruct the flow of cerebrospinal fluid (CSF), giving rise to nausea, vomiting, drowsiness, and headaches that intensify with changes in position. Lastly, pulmonary lymphangitic carcinomatosis can present with respiratory symptoms such as shortness of breath, dry cough, and systemic symptoms including fatigue and weight loss.  

The diagnosis of peritoneal carcinomatosis typically involves imaging studies, most commonly a computed tomography (CT) scan. In some instances, an initial ultrasound may be performed, and magnetic resonance imaging (MRI) can also play a role in diagnosis. Additionally, positron emission tomography-computed tomography (PET-CT) scans are utilized to detect smaller tumors or tumors in early stages that may not be visible through standard CT and MRI alone.  

 Invasive procedures for PC diagnosis include abdominal percutaneous paracentesis, which is used for ascitic fluid analysis, assessment of tumor markers (e.g., CA19-9 and carcinoembryonic antigen [CEA]), and cytology to examine the cancer cells. Additionally, diagnostic laparoscopy can allow for direct visualization of the peritoneal cavity, enabling biopsy of suspected lesions and accurate tumor staging. For LC, diagnostic evaluation includes lumbar puncture and CSF cytology to identify malignant cells, and neuro-imaging through high-quality MRI of the brain and spine to localize the lesions. PLC is diagnosed with CT imaging which can reveal peribronchovascular thickening, pulmonary nodules, and enlarged lymph nodes. Biopsies may be obtained to confirm the diagnosis through a transbronchial approach or an open lung biopsy approach. 

The treatment approach for carcinomatosis varies depending on the specific type. Generally, systemic chemotherapy may be used to target primary tumors for various types of carcinomatosis. Treatment for peritoneal carcinomatosis can be challenging and may involve a combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). This specific type of chemotherapy modality aims to increase the concentration of drugs in the localized area while limiting the amount of systemic dispersion, thereby reducing medication toxicities and adverse events. Systemic chemotherapy drugs (e.g., fluorouracil-leucovorin) can also be employed as part of the treatment strategy for PC.

Leptomeningeal carcinomatosis is often considered a late-stage complication with limited treatment options. Therapeutic modalities may include radiation therapy targeted at symptomatic lesions identified through neuroimaging. Intrathecal chemotherapy drugs (e.g., methotrexate) may be utilized to reduce tumor cells in the CSF and leptomeningeal deposits to prevent further seeding. PLC management revolves around providing supportive care and addressing the underlying malignancy. Chemoradiation and surgical resection may be considered. There have been case reports of tyrosine kinase inhibitors (e.g., apatinib) and specific monoclonal antibodies (e.g., bevacizumab, cetuximab) used in treatment for PLC, though their efficacy remains largely unknown.