Observations concerning cancer spread within the peritoneal cavity and concepts supporting an ordered pathophysiology

Publisher Website
Google Scholar
Abstract
A primary cancer arising within the abdomen or pelvis can disseminate by hematogenous routes, lymphatic routes, and through the peritoneal cavity. In this manuscript hematogenous and lymphatic dissemination are referred to as metastases while intraperitoneal dissemination is referred to as spread. Spread may occur preoperatively as a spontaneous event from full-thickness invasion of the bowel wall by invasive cancer or from a bursting of a structure’ by noninvasive cancer. Iatrogenic spread occurs by biopsy or surgical trauma, and is a result of cancer mainpulation for diagnosis or treatment. With invasive (high-grade) cancer, intraperitoneal spread is characterized by randomly proximal distribution because these cancer cells have surface adherence molecules. With low-grade mucinous cancer, intraperitoneal spread is characterized by a redistributed pattern of abdo-minopelvic cancer accumulation. Large volumes of tumor are not found proximal to the primary malignancy; rather, they are on the omentum and beneath the hemidiaphragms as a result of peritoneal fluid resorption, in dependent areas such as the pelvis by gravity, and are excluded from small bowel surfaces as a result of bowel motility.