Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1160 Peritoneal Tumors

adenocarcinoma

ovarian, breast, colon, stomach, pancreas, lung

➣lymphoma and sarcoma

➣ovary and appendix in the case of pseudotumor peritonei

Signs & Symptoms

■ascites (abdominal distention less well tolerated by these patients

than in cirrhotics)

■bowel obstruction as ascites is replaced by solid tumor as the malig-

nancy progresses

tests

■ascitic fluid analysis:

■cytology: positive in 60% of all malignant ascites and >90% peritoneal

carcinomatosis with malignant cells lining the peritoneum

■imaging tests: identify mass lesions, including primary tumor and

peritoneal seeding

Diagnosis

■ascitic fluid cytology

■image-guide biopsy of mass

■diagnostic laparoscopy or laparotomy usually required for mesothe-

lioma

differential diagnosis

n/a

management

What To Do First

■confirm diagnosis with ascitic fluid for cytology, imaging study, or

biopsy

General Measures

■therapeutic paracentesis for comfort

■determine options for palliative therapy

specific therapy

■diuretics not effective in most cases

■therapeutic paracentesis usually required for symptomatic relief

■mesothelioma: best results with radiation in combination with intra-

venous and intraperitoneal chemotherapy

■pelvic lipomatosis: diversion indicated if significant urinary obstruc-

tion