The main treatments for pseudomyxoma peritonei (PMP) are surgery and chemotherapy. Your treatment depends on the size of the cancer and your general health.
You might not start treatment straight away. Your doctor closely monitors your cancer in case you need treatment in the future. This is called watch and wait.
If you need treatment you might have:
- surgery combined with chemotherapy into the tummy (abdomen)
- surgery to remove as much cancer as possible (debulking surgery)
- chemotherapy
Watch and wait
Your doctor might decide to closely monitor your cancer if it’s small and slow growing and you don’t currently need treatment. Your doctor will check up on you regularly. Watch and wait can also sometimes be called active surveillance. They do this with blood tests and scans.
You might find it hard to cope with this and struggle with feeling that no action is being taken.
- Read more about coping with cancer
Surgery combined with chemotherapy into the abdomen
Where possible, you’ll have surgery combined with chemotherapy. This is given directly into your tummy (abdomen). It's called cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC)
You have to be well enough to have this intensive surgery. And the surgeon needs to be able to remove the disease without affecting your vital organs.
It involves:
- the surgeon removing any tissue affected by PMP
- having heated chemotherapy drugs put directly into your abdomen during the surgery (HIPEC)
The surgery
The aim is to remove all of the visible PMP cells in your abdomen. So there will be no cancer cells left that could start to grow again. The surgeon strips out the lining of the abdomen (the peritoneum). They then remove any tissues affected by PMP.
The operation varies between people, but can include removing:
- part of the bowel
- the spleen
- cancer attached to the surface of the liver
- the fatty layers in the abdomen (the omentum)
- the gallbladder
- the lowest part of your bowel (rectum)
- the womb and ovaries if you are a woman
- the bellybutton
- the affected lining of your abdomen (peritoneum)
Your spleen helps to fight infection. Some people need to have their spleen removed. So you might need to have some vaccinations before, or just after, the operation. And you will need to take antibiotics for the rest of your life because of changes to your immune system.
This can be major surgery. The operation can take around 10 hours and your recovery can be slow. Sometimes people need more than one operation, several months apart.
Chemotherapy during surgery (intraperitoneal chemotherapy)
The surgeon puts heated chemotherapy into the peritoneal space inside your tummy (abdomen). This happens during your operation. It is called hyperthermic intraperitoneal chemotherapy, or HIPEC.
Chemotherapy uses anti cancer drugs to destroy cancer cells. The aim is to kill any PMP cells that remain in the abdomen. Heating the chemotherapy can improve how well it works.
You usually have a chemotherapy drug called mitomycin C. You sometimes have other drugs, such as oxaliplatin.
- A to Z cancer drugs list
After surgery
You might bein intensive care or a high dependency unit for 24 to 48 hours. You might also have:
- a catheter (tube in the bladder)
- an epidural (tube in the spine for pain relief)
- a nasogastric tube (tube down your nose into your stomach to stop you being sick)
- drains in the tummy
- feeding through a drip into a vein (intravenous), also called parenteral nutrition (PN) for about 2 weeks
You’re likely to be in hospital for 2 to 3 weeks. Some people may also need a blood transfusion after the operation. It takes a long time to be able to recover from this operation. It can be at least 6 months before you are fully active again and able to work.
About 30 out of every 100 people (30%) have complications after treatment. This might be less in some treatment centres. About 20 out of 100 patients (20%) need astomaafter surgery. A stoma is where the bowel is brought out to the surface of the tummy. It is covered by a bag after surgery. About half of these people only need the stoma for 3 to 6 months, after which the bowel is put back together.
- Read more about having a stoma
It is important that your surgeon discuss the treatment's risks and benefits with you. Only then you can consent to this surgery.
- Read more general information about having surgery
Debulking surgery
Debulking surgery aims to remove as much of the cancer as possible. It does not remove the cancer completely.
Debulking surgery helps to make a diagnosis and get samples of the tumour. It can also remove mucin. It won’t cure PMP but might ease your symptoms.It could also mean that you can then have cytoreductive surgery withHIPEC.
Debulking surgery might mean removing part of your bowel. The surgeon might remove your womb and ovaries if you are a woman.
Unless the surgeon can remove the whole cancer, it's very likely to come back. Because of this, you might have debulking surgery more than once.
Chemotherapy
You might have chemotherapy if you can’t have surgery. You are more likely to have chemotherapy if:
- your cancer is causing symptoms
- CT scans show your cancer is growing quickly
You might have eithermitomycin C into a vein with or withoutcapecitabineas tablets. Doctors sometimes use other drugs.
It is important that you discuss the pros and cons of having treatment with your specialist. If your cancer is slow growing, the doctor might suggest that they monitor you. They will only suggest chemotherapy if your cancer is growing quickly or causing symptoms.
There hasn't yet been enough research into the benefits of 
for PMP.
Specialist centres for pseudomyxoma peritonei
The National Institute for Health and Care Excellence (NICE)has produced guidance for PMP. The guidance is on cytoreductive surgery with intraperitoneal chemotherapy. They recommend that people with PMP have treatment in a specialist centre.
There are 2 designated UK specialist treatment centres. This is because pseudomyxoma peritonei is very rare. The centres are:
- the Peritoneal Malignancy Institute at Basingstoke and North Hampshire NHS Foundation Trust
- the Colorectal and Peritoneal Oncology Centre at The Christie NHS Foundation Trust in Manchester
Many people with pseudomyxoma peritonei have treatment at another hospital first. This is because PMP wasn't suspected. Even if you have already had surgery, your specialist might suggest further surgery. This might be followed by intraperitoneal chemotherapy.
Research into treatment for pseudomyxoma peritonei
Researchers around the world are trying to improve treatments for pseudomyxoma peritonei. But because this type of cancer is so rare, it is difficult to do trials.
Doctors are looking at:
- drugs to relieve symptoms when PMP comes back or surgery is not possible
- chemotherapy for PMP
Where to get support and information
It can be very difficult to find support if you have a rare type of cancer. You are likely to find support from people at your local cancer support group. They will share your experience of being diagnosed with cancer and possibly of having major surgery. But you may want to try to contact other people who have the same condition as you.
If you want to find people to share experiences with online, you could useCancer Chat, our online forum.
- Visit Cancer Chat
Pseudomyxoma Survivor
Pseudomyxoma Survivoris a registered charity, run by patients and caregivers. They offer a befriending service called Pseudomyxoma Buddies, as well as provide practical and emotional support to people affected by PMP.
Talk to the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday.
