How Pseudomyxoma Peritonei (PMP) Is Treated

Pseudomyxoma peritonei (PMP) is a cancer that often grows slowly. The main treatments for PMP are surgery and chemotherapy. Your treatment depends on the size of the cancer and your overall health.

Your doctor will explain the different treatments and their side effects. They will also talk to you about what to consider when making treatment decisions. This article will explain what treatments are available for PMP and their potential side effects.

Operating room staff performing hospital surgery

Shannon Fagan/Getty Images

Surgeries and Specialist-Driven Procedures

Where possible, you’ll have surgery combined with chemotherapy injected directly into your abdomen. It's called cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Although HIPEC usually is not curative, it can extend a patient's life expectancy three to five years.

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.

The aim of the operation is to remove as much of the PMP as possible. This often means removing:

  • The spleen
  • The fatty layers in the abdomen (the omentum)
  • The gallbladder
  • The lowest part of your bowel (rectum)
  • The womb (uterus) and ovaries if you are a woman
  • In some cases, part of the bowel

When the surgeon has removed all signs of PMP, they will place a heated chemotherapy liquid into the peritoneal space.

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. The chemotherapy is heated to 110 degrees Fahrenheit (43 degrees Celsius), which kills cancer cells but is nonthreatening to healthy cells. After 60–90 minutes, the chemotherapy liquid is drained from the abdomen and the surgeon finishes the operation.

This is major surgery. The operation can take over 10 hours, recovery can be slow, and there's a significant risk of postoperative complications. After the surgery, you will stay in intensive care for a few days and in a hospital room for about two to three weeks.

Debulking Surgery

If it is not possible to remove all the PMP with cytoreductive surgery, you may have a type of surgery called debulking. This is when the surgeon removes as much of the PMP as possible. They may also remove part of the membrane lining the abdominal cavity (the peritoneum) and part of the bowel.

In a recent study, 205 patients undergoing debulking surgery had an overall survival of 47% at three years, 30% at five years, and 22% at 10 years after surgery, with a median survival of 32.8 months.

The debulking surgery will not remove all of the PMP. You may need another debulking surgery later.

Chemotherapy

If you cannot have surgery, you may need chemotherapy to slow the growth of PMP and to reduce symptoms. You can take chemotherapy as oral tablets or as a drip (infusion) into a vein.

Side effects of chemotherapy may include fatigue, loss of appetite, nausea, and diarrhea.

Prescriptions

As PMP progresses, fluid accumulates in the abdomen, eventually leading to bowel obstruction. Because this bowel obstruction is frequently inoperable, the main aim of treatment is to relieve the associated symptoms of pain, nausea, and vomiting.

Common treatments include:

Home Remedies and Lifestyle

There are several lifestyle changes you can make, including:

  • Reducing your stress level to help you maintain your physical and mental health
  • Sleeping around eight hours each night
  • Eating a healthy diet to help you manage cancer side effects, recover quicker, and improve health

Talk to your doctor about your nutritional needs during your treatments. Some cancer centers have nutritionists on staff who can assist you, and some offer classes on nutrition and cancer as well.

Most oncologists recommend getting the nutrients you need primarily through food sources and not supplements. While some cancer treatments may cause vitamin deficiencies, there is a concern that some vitamin and mineral supplements may interfere with cancer treatments.

Over-the-Counter (OTC) Therapies

Your medical team may recommend various over-the-counter products for the relief of symptoms or side effects of your medications. For example, OTC pain relievers would be the first choice before prescription pain medications.

It is always important that you report any OTC medications, supplements, and herbal remedies to your healthcare team. There is a risk of interactions with your prescription medications and other forms of treatment (such as bleeding if aspirin is taken before surgery).

Complementary and Alternative Medicine (CAM)

There is little evidence to suggest that any of these treatments can cure cancer or slow its growth, but there is positive evidence that CAM may help people cope with the symptoms of cancer and cancer treatments.

Some of these integrative therapies include:

  • Acupuncture
  • Massage therapy
  • Meditation
  • Yoga
  • Tai chi
  • Art therapy

Complementary therapies are designed for use along with conventional medical treatments (such as surgery and chemotherapy) and can increase your sense of control, decrease stress and anxiety, manage fatigue, and improve your mood. 

Summary

Treatment for PMP is primarily surgery and chemotherapy. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is the most effective treatment. It is a serious and invasive procedure with a long recovery period.

A Word From Verywell 

If you are diagnosed with PMP, speak to your healthcare provider about the best treatment for your circumstances. A doctor can discuss the risks and side effects of available therapies and help you weigh your options, so you can choose the plan that will best preserve your quality of life and offer the best chance of survival.

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6 Sources
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