The news of the death of Dudu Braga, son of Roberto Carlos, this Wednesday afternoon, again highlights a rare type of cancer, which is difficult to diagnose: cancer of the peritoneum.
At 52, the music producer was being treated for a disease that affects the internal part of the abdominal cavity and covers organs such as the stomach and intestines, rectum, bladder and uterus. This entire layer is rich in lymphatic system vessels, which function as the body’s defense system.
“Peritoneal cancer is classified as primary carcinoma of the peritoneum and mesothelioma when it originates in the peritoneum itself. They are, however, considered rare”, explains Dr. Arnaldo Urbano Ruiz, general and oncological surgeon, coordinator of the Center for Peritoneal Diseases at Hospital BP, Beneficência Portuguesa of São Paulo.
This was not the case for Dudu Braga, who was diagnosed for the first time in 2019 with pancreatic cancer. “In this case, the disease is called secondary, as it started in some organ in the region. In addition to the pancreas, peritoneum cancer can start in the colon, ovary, uterus, appendix, stomach, intestine, breast or endometrium, and then spread to other organs”, explains the specialist.
According to Dr. Arnaldo, cancer of the peritoneum can be completely asymptomatic. However, abdominal pain, diarrhea, nausea, increased waist circumference, ascites (fluid in the abdomen), fever, weight loss, fatigue, loss of appetite, anemia, and digestive disturbances may indicate the illness.
“In the presence of one or more of the symptoms described, it is very important to see a doctor for an accurate diagnosis.”
Treatment for cancer varies greatly depending on the location of the tumor, the patient’s health status, and also the time elapsed between the onset of the disease and diagnosis.
Surgery is one of the possibilities, which will be evaluated by the doctor according to each case. Its complexity varies and can be high in cases such as peritoneal carcinomatosis. In this case, the surgery is extremely aggressive and highly complex compared to organ transplants.
Peritoneal carcinomatosis is performed by peritoniectomy (or cytoreductive surgery) with hyperthermic intraperitoneal chemotherapy (HIPEC). The procedure consists of removing the entire diseased peritoneum and, if necessary, removing other organs and applying chemotherapy.
Some cases of colon and stomach cancer, peritoneal pseudomyxoma, primary cancer of the peritoneum and ovary can also be treated with this technique.
According to the primary site of origin of the carcinomatosis, cytoreductive surgery and HIPEC are performed. However, there are cases in which there is only an indication for cytoreductive surgery without HIPEC.
“Whatever the treatment indicated by the physician, it is important that it be carried out in centers with experience in the procedures, located in referenced hospitals, with a multidisciplinary team specially trained for these situations. In addition to a properly equipped ICU and surgical center, the team also needs surgeons, cardiologists, clinicians, scrub nurses, anesthesiologists, physiotherapists and speech therapists who are prepared and qualified to take care of these patients”, explains Dr. Arnaldo.