Peritoneal cancer represents a distinct area of oncology involving malignant growth within the peritoneum, the thin membrane surrounding abdominal organs. While primary peritoneal cancer originates in this lining, secondary peritoneal malignancies develop when cancers from organs such as the ovaries, stomach, colon or appendix spread into the abdominal cavity.
This distinction is important because the treatment pathway depends heavily on the tumour's origin, histological characteristics and extent of disease. Primary peritoneal carcinoma is particularly associated with ovarian and fallopian tube cancer treatment pathways, while peritoneal metastases require consideration of the original cancer type. The National Cancer Institute (NCI) includes primary peritoneal cancer within its evidence-based ovarian epithelial and fallopian tube cancer treatment framework.
HIPEC Is Changing the Conversation around Surgical Cancer Treatment
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One of the most significant developments in peritoneal oncology is hyperthermic intraperitoneal chemotherapy (HIPEC).
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After cytoreductive surgery (CRS), which attempts to remove visible tumour deposits, heated chemotherapy medication is circulated inside the abdominal cavity as part of HIPEC, in contrast to traditional intravenous chemotherapy.
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The procedure has attracted interest because it combines surgical tumour removal with localized drug administration. However, its clinical suitability varies according to cancer type and patient characteristics.
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A 2025 review published in Annals of Surgical Oncology examined national guidelines worldwide for CRS and HIPEC. Its findings highlighted differences in recommendations between malignancies: HIPEC received stronger support for pseudomyxoma peritonei and peritoneal mesothelioma, while its application in colorectal and ovarian cancers remained more controversial.
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This reinforces the importance of evidence-based patient selection rather than treating HIPEC as a universal solution.
PIPAC Introduces a Different Method of Delivering Chemotherapy
Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is attracting attention as an alternative method of administering medication directly into the abdominal cavity.
The technique uses minimally invasive laparoscopic access to deliver chemotherapy as a pressurized aerosol. Researchers are investigating whether this approach can improve drug distribution and provide treatment opportunities for patients whose disease cannot be completely removed surgically.
An important ongoing example is the NCI-listed IMPACT Phase III trial, which is evaluating mitomycin-based PIPAC against standard chemotherapy involving FOLFIRI and bevacizumab in patients with unresectable appendiceal or colorectal cancer with peritoneal metastases. The study illustrates how clinical research is moving beyond conventional systemic treatment to investigate more localized approaches.
Molecular Profiling Is Making Treatment Selection More Individualized
The treatment of primary peritoneal carcinoma increasingly overlaps with precision oncology. Molecular and genetic testing can help clinicians identify characteristics that influence treatment decisions, particularly in ovarian-type cancers.
For example, BRCA1 and BRCA2 alterations and homologous recombination deficiency (HRD) can influence consideration of PARP inhibitor maintenance therapy in appropriate patients. Bevacizumab may also form part of selected treatment combinations.
The NCI identifies chemotherapy, bevacizumab and PARP inhibitors among the treatment options considered for advanced ovarian, fallopian tube and primary peritoneal cancers. This creates an important connection between molecular diagnostics, oncology medicines and personalized treatment planning.
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Diagnostic Laparoscopy Is Helping Specialists Assess Disease Extent
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Imaging alone may not provide a complete picture of peritoneal disease, particularly when small tumour deposits are difficult to identify. CT scans, MRI, pathological examination and diagnostic laparoscopy therefore play complementary roles in treatment planning.
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Specialists may use the Peritoneal Cancer Index (PCI) to assess the distribution and extent of tumour involvement across abdominal regions. This assessment helps determine whether complete cytoreductive surgery is technically achievable and whether a patient should receive systemic treatment before surgery.
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The 2025 NCCN gastric cancer guidance also highlights diagnostic laparoscopy, peritoneal washings and PCI assessment when evaluating selected patients for intraperitoneal treatment approaches.
Clinical Research Is Exploring Treatment beyond Conventional Surgery
Research into peritoneal malignancies is increasingly examining patients who are not suitable candidates for complete surgical tumour removal.
For example, ClinicalTrials.gov records a National Cancer Centre Singapore study (NCT04956068) investigating PIPAC using oxaliplatin or doxorubicin and cisplatin in patients with peritoneal metastases. Its treatment objectives include evaluating safety, disease response and the possibility of converting selected patients to potentially curative surgery.
An important distinction is that this study was listed as suspended in May 2026 while awaiting further funding. Its status demonstrates both the scientific interest in localized chemotherapy and the practical difficulties involved in advancing clinical research.
The Hospital Infrastructure behind Advanced Peritoneal Oncology
The expansion of specialized peritoneal cancer treatment involves more than oncology medicines. Hospitals require experienced surgical oncologists, medical oncologists, anaesthesiologists, pathologists, radiologists and dedicated postoperative care teams.
The treatment ecosystem also involves laparoscopic instruments, chemotherapy delivery systems, temperature-monitoring equipment, infusion technologies, imaging platforms and histopathology services.
These requirements make specialist cancer centres particularly important. For healthcare providers, investment in trained multidisciplinary teams and appropriate infrastructure is essential for delivering complex procedures safely and consistently.
Patient Recovery Is Becoming Part of the Treatment Equation
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Peritoneal malignancies can significantly affect digestion, appetite, abdominal comfort and nutritional status. Patients undergoing extensive abdominal surgery may also require prolonged recovery, nutritional rehabilitation and monitoring for postoperative complications.
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Consequently, supportive oncology services, nutritional assessment, pain management and palliative care remain important parts of treatment planning. The growing emphasis on quality of life also makes patient-reported outcomes an important consideration when evaluating emerging therapies.
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For the healthcare industry, this broadens the relevance of peritoneal oncology beyond surgical procedures and cancer medicines to include rehabilitation, supportive-care products and long-term monitoring.
What the Latest Clinical Developments Mean for Healthcare?
The peritoneal cancer market is increasingly connected to developments across surgical oncology, precision medicine, minimally invasive procedures and specialized cancer-care infrastructure. HIPEC continues to have an established role in selected indications, while PIPAC remains an investigational approach in several settings.
As clinical evidence develops, the distinction between primary peritoneal carcinoma and secondary peritoneal metastases will remain essential when evaluating treatment technologies, pharmaceutical development and hospital investment. The most meaningful progress will come from matching the right treatment to tumour biology, disease distribution and individual patient needs.