so what exactly do all those words mean?
When you are newly diagnosed with pseudomyxoma peritonei, it can be very confusing, almost bewildering. There are so many expressions to learn and options to understand – we are here to help with that. Our information is written by patients and reviewed by specialists – that gives you an insight from your point of view that you know is correct.
Your appendix is on your right-hand side, just inside your hip and is a small tube, shaped like a worm. It’s about 10cm long, a bit longer than your finger. It’s attached to your large intestine (your colon) where it meets with your small intestine. It is closed at one end and open where it connects to your intestines. Your appendix has a lining that produces mucus as does your small intestine. It can also contract like your small intestine, though unlike your intestines, food does not pass through it – there is no where for it to go.
Your body produces mucus to protect the lining of the tubes in your body, including the intestines and appendix. This mucus is made up of mucin and salts in water. The mucus is produced by a thin layer of epithelial cells that line the inside of your appendix and intestine.
Until recently, it was thought that the appendix had no purpose – that it was a remnant that we had used in earlier times. Now it is thought to play a part in the immune system although it isn’t fully understood what that role is. Your appendix is attached to your caecum, part of your colon. As a result, appendix cancer is considered a colorectal cancer although the standard of care for treatment is different to other colorectal cancers.
Epithelial cells make up one of four tissue types in your body (the others are connective tissue, muscle tissue and nervous tissue). As well as lining the major cavities of your body and forming the structure of your lungs, epithelial cells line most organs including your stomach and you small intestine. You also have them inside your nose – you will be quite familiar with their ability to produce mucus if you have ever suffered from the common cold!
Names are very confusing – the small intestine is sometimes called the small bowel. The large intestine is sometimes called the large bowel or the colon.
What is Pseudomyxoma Peritonei?
Pseudomyxoma peritonei is pronounced ‘sue-doh-mix-oh-muh pary-ih-ton-nee-i’ and is often abbreviated to PMP. In most cases, it starts in the appendix; more rarely, it can start in other parts of the body such as the bowel, an ovary or the bladder. It affects around two people per million each year of all ages, both men and women.
A tumour develops in the appendix from a polyp which is a small growth on the inner lining of your appendix. At this early stage, the tumour is rarely discovered as it doesn’t cause any symptoms. Left untreated, the tumour grows and eventually bursts through the wall of the appendix into your abdominal cavity where more tumours then develop. These tumours then secrete a jelly-like substance called mucin which accumulates in your abdominal cavity. It is this build up of mucin that causes symptoms, the abdomen swells leading to the characteristic ‘jelly belly’ and vital organs are compressed.
PMP isn’t like other types of cancer as it seldom spreads through the bloodstream or lymphatic system. It stays contained within the abdomen where it spreads along the inner surfaces, spread by the mucin. It is not currently known what causes PMP. The name ‘pseudomyxoma peritonei’ means “false mucinous tumour of the peritoneum”; the peritoneum is another name for your abdominal cavity.
Spotting the symptoms
PMP symptoms usually take a while to appear; some patients don’t show any symptoms for several years. Symptoms of PMP vary widely between patients so it’s hard to say what to look for. As the disease progresses, many patients report:
• Abdominal swelling or an increase in abdominal girth
• Changes in bowel habit
• Loss of appetite
• Pelvic or abdominal pain
• General fatigue
• Bowel irritation
These symptoms can be caused by lots of medical conditions other than PMP. However, due to the nature of this cancer, it’s vital to rule out PMP as a cause. Any unexplained symptoms should always be discussed with your doctor.
Where can I go for treatment?
In the UK, there’s two hospitals which are recommended by the National Institute for Clinical Excellence (NICE) for the treatment of PMP. These are the Basingstoke and North Hampshire Hospital and the Christie Hospital in Manchester. Both of these hospitals have an NHS Peritoneal Malignancy/Tumour team specialising in PMP. Both also see patients privately in separate clinics.
The referral process to either Basingstoke or to the Christie depends on which part of the UK you live in. If you have any questions about your referral, please contact us and we can point you in the right direction.
Pseudomyxoma Survivor doesn’t endorse any particular surgeon, specialist or cancer treatment centre. We simply share practical information or national guidelines. We do hold information for other countries which is currently under review and will be published in time. If you need some help, let us know.