Peritoneal Metastases
Advancing knowledge for tumours that spread to this challenging site
Abdominal tumours commonly spread (metastasise) to the peritoneum, which is a layer of tissue that lines the abdominal wall. These tumours have poor prognosis compared to tumours of other organs such as the liver and lung. Examples of abdominal tumours include colorectal cancer and appendix tumours.
Colorectal Cancer is diagnosed in over 40,000 people per year in the UK. Sadly, despite the most up to date treatments, 40% of people die from the disease within five years, which happens mostly a result of metastases. When patients are administered chemotherapy and conventional surgery, those with colorectal peritoneal metastases have significantly poorer outlooks (16.3 months) compared to those with lung (24.6 months) and liver (19.1 months) metastases.
Appendix Tumours have an incidence in the UK population of between one to two million per annum and classified as rare and as a result are poorly understood. They include Low-grade Appendix Mucinous Neoplasms (LAMNs), Adenocarcinomas and ex-Goblet Cell Carcinoid tumours which aggressively spread to the peritoneum and present late. In the case of LAMNs, metastasis results in a condition called Pseudomyxoma Peritonei (PMP) where mucinous tumours grow to fill the abdomen peritoneal which ultimately leads to a bad prognosis and the shortening of life.
(From left to right) Dr Bipasha Chakrabarty (Consultant Histopathologist), Dr Jill Barber (Reader / National Teaching Fellow), Prof. Sarah O’Dwyer (Consultant Surgeon), Dr Nadina Tinsley (Clinical Research Training Fellow), Dr Areti Maria Vasilogianni (Post-Doctoral Research Associate), Dr Patrick Caswell (Senior Lecturer in Cell Matrix Bio & Regen. Med) , Dr Milly McAllister (Post-Doctoral Research Associate), Dr Jorge Barriuso (Clinical Senior Lecturer), Professor Omer Aziz (Consultant Surgeon), Dr Madeleine Strach (Honorary Clinical Research Fellow) & Awen Hasan (PhD student)
Peritoneal Metastasis research in Manchester
Little is known about the molecular events that lead to peritoneal metastasis, and the factors that determine its progression. The scarcity of such basic scientific knowledge is the direct result of how difficult it is to access samples from this site, and in the case of appendix tumours the fact that they are rare.
Our research in Manchester focuses on understanding the mechanisms leading to peritoneal spread, identifying biomarkers that predict outcomes, identifying effective systemic anticancer therapies to improve survival and developing interventions to improve the outcomes for these patients.
The Christie Colorectal and Peritoneal Oncology Centre (CPOC) is a nationally commissioned peritoneal tumour service (NHS England Highly Specialised Service), offering specialist treatments for patients with peritoneal metastases including cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). CPOC is one of the world’s highest volume peritoneal units, with >500 referrals and >170 CRS/HIPEC procedures per year. This offers us the unique opportunity to study peritoneal tumours. We are currently part of a team funded by the National Institute for Health Research (NIHR) reviewing the randomised controlled trial evidence for efficacy and cost-effectiveness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastases from ovarian, colorectal, and gastric cancer.
International Collaborations
The CRUK Accelerator Award (Pseudomyxoma peritonei: building a European multicentric cohort to accelerate new therapeutic perspectives – £3.5m) – In Manchester the CPOC team have established a 5-year multicentre research program with Istituto Nazionale dei Tumori Milano, and Vall d’Hebron Institute of Oncology to prospectively collect and biobank samples from 400 appendix tumours in the UK, Italy, and Spain, undertaking genomic, transcriptomic, proteomic analyses, cell culture, organoid development, prognostic classification, and identifying new treatment options.
University of Sydney – The team have a joint research programme studying the genomics of appendix adenocarcinomas funded through a European Society of Medical Oncology (ESMO) fellowship and a Christie Charitable funds award
Peritoneal Surface Oncology Group International (PSOGI) – CPOC is the largest single contributor to this Laparoscopic CRS/HIPEC international registry as one of the 11 worldwide reference centres performing this new and complex procedure for patients with early peritoneal tumours.
King Hussein Cancer Centre, Jordan – The CPOC team have helped to establish a peritoneal tumour service offering patients cytoreductive surgery with HIPEC in the Middle East. This has involved training a team of surgeons, anaesthetists, and scrub nurse in Manchester as well operating with the team in Jordan to perform their first CRS/HIPEC procedures.
