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Pathophysiology of colorectal peritoneal carcinomatosis: Role of the peritoneum

View Article: PubMed Central - PubMed

ABSTRACT

Colorectal cancer (CRC) is the third most common cancer and the fourth most common cause of cancer-related death worldwide. Besides the lymphatic and haematogenous routes of dissemination, CRC frequently gives rise to transcoelomic spread of tumor cells in the peritoneal cavity, which ultimately leads to peritoneal carcinomatosis (PC). PC is associated with a poor prognosis and bad quality of life for these patients in their terminal stages of disease. A loco-regional treatment modality for PC combining cytoreductive surgery and hyperthermic intraperitoneal peroperative chemotherapy has resulted in promising clinical results. However, this novel approach is associated with significant morbidity and mortality. A comprehensive understanding of the molecular events involved in peritoneal disease spread is paramount in avoiding unnecessary toxicity. The emergence of PC is the result of a molecular crosstalk between cancer cells and host elements, involving several well-defined steps, together known as the peritoneal metastatic cascade. Individual or clumps of tumor cells detach from the primary tumor, gain access to the peritoneal cavity and become susceptible to the regular peritoneal transport. They attach to the distant peritoneum, subsequently invade the subperitoneal space, where angiogenesis sustains proliferation and enables further metastatic growth. These molecular events are not isolated events but rather a continuous and interdependent process. In this manuscript, we review current data regarding the molecular mechanisms underlying the development of colorectal PC, with a special focus on the peritoneum and the role of the surgeon in peritoneal disease spread.

No MeSH data available.


Related in: MedlinePlus

Structure of the peritoneum. The peritoneum is composed of a mesothelium supported by a basement membrane that rests on a layer of submesothelium. The mesothelium consists of a monolayer of either flattened, stretch, squamous-like or cuboidal mesothelial cells. The luminal surface of mesothelial cells has numerous microvilli varying in shape, size and density. Cilia have also been identified on the surface of resting mesothelial cells. The basement membrane consists of a thin laminar network containing type I and IV collagen, proteoglycans and glycoproteins. The submesothelium consists of a complex network of extracellular matrix made up of different types of collagen, glycoproteins, glycosaminoglycans and proteoglycans. Blood vessels, lymphatics, and various cells types (fibroblasts, resident tissue macrophages, and mast cells) are also found is this layer. ECM: Extracellular matrix.
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Figure 1: Structure of the peritoneum. The peritoneum is composed of a mesothelium supported by a basement membrane that rests on a layer of submesothelium. The mesothelium consists of a monolayer of either flattened, stretch, squamous-like or cuboidal mesothelial cells. The luminal surface of mesothelial cells has numerous microvilli varying in shape, size and density. Cilia have also been identified on the surface of resting mesothelial cells. The basement membrane consists of a thin laminar network containing type I and IV collagen, proteoglycans and glycoproteins. The submesothelium consists of a complex network of extracellular matrix made up of different types of collagen, glycoproteins, glycosaminoglycans and proteoglycans. Blood vessels, lymphatics, and various cells types (fibroblasts, resident tissue macrophages, and mast cells) are also found is this layer. ECM: Extracellular matrix.

Mentions: The peritoneum is the largest and most complex serous membrane of the human body[24]. The visceral peritoneum, covering the intra-abdominal organs and mesenteries, forms a continuous layer with the parietal peritoneum, which lines the abdominal wall and pelvic cavities[24]. It is composed of a monolayer of mesothelial cells supported by a basement membrane that rests on a layer of connective tissue, also referred to as the submesothelium (Figure 1)[25].


Pathophysiology of colorectal peritoneal carcinomatosis: Role of the peritoneum
Structure of the peritoneum. The peritoneum is composed of a mesothelium supported by a basement membrane that rests on a layer of submesothelium. The mesothelium consists of a monolayer of either flattened, stretch, squamous-like or cuboidal mesothelial cells. The luminal surface of mesothelial cells has numerous microvilli varying in shape, size and density. Cilia have also been identified on the surface of resting mesothelial cells. The basement membrane consists of a thin laminar network containing type I and IV collagen, proteoglycans and glycoproteins. The submesothelium consists of a complex network of extracellular matrix made up of different types of collagen, glycoproteins, glycosaminoglycans and proteoglycans. Blood vessels, lymphatics, and various cells types (fibroblasts, resident tissue macrophages, and mast cells) are also found is this layer. ECM: Extracellular matrix.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016368&req=5

Figure 1: Structure of the peritoneum. The peritoneum is composed of a mesothelium supported by a basement membrane that rests on a layer of submesothelium. The mesothelium consists of a monolayer of either flattened, stretch, squamous-like or cuboidal mesothelial cells. The luminal surface of mesothelial cells has numerous microvilli varying in shape, size and density. Cilia have also been identified on the surface of resting mesothelial cells. The basement membrane consists of a thin laminar network containing type I and IV collagen, proteoglycans and glycoproteins. The submesothelium consists of a complex network of extracellular matrix made up of different types of collagen, glycoproteins, glycosaminoglycans and proteoglycans. Blood vessels, lymphatics, and various cells types (fibroblasts, resident tissue macrophages, and mast cells) are also found is this layer. ECM: Extracellular matrix.
Mentions: The peritoneum is the largest and most complex serous membrane of the human body[24]. The visceral peritoneum, covering the intra-abdominal organs and mesenteries, forms a continuous layer with the parietal peritoneum, which lines the abdominal wall and pelvic cavities[24]. It is composed of a monolayer of mesothelial cells supported by a basement membrane that rests on a layer of connective tissue, also referred to as the submesothelium (Figure 1)[25].

View Article: PubMed Central - PubMed

ABSTRACT

Colorectal cancer (CRC) is the third most common cancer and the fourth most common cause of cancer-related death worldwide. Besides the lymphatic and haematogenous routes of dissemination, CRC frequently gives rise to transcoelomic spread of tumor cells in the peritoneal cavity, which ultimately leads to peritoneal carcinomatosis (PC). PC is associated with a poor prognosis and bad quality of life for these patients in their terminal stages of disease. A loco-regional treatment modality for PC combining cytoreductive surgery and hyperthermic intraperitoneal peroperative chemotherapy has resulted in promising clinical results. However, this novel approach is associated with significant morbidity and mortality. A comprehensive understanding of the molecular events involved in peritoneal disease spread is paramount in avoiding unnecessary toxicity. The emergence of PC is the result of a molecular crosstalk between cancer cells and host elements, involving several well-defined steps, together known as the peritoneal metastatic cascade. Individual or clumps of tumor cells detach from the primary tumor, gain access to the peritoneal cavity and become susceptible to the regular peritoneal transport. They attach to the distant peritoneum, subsequently invade the subperitoneal space, where angiogenesis sustains proliferation and enables further metastatic growth. These molecular events are not isolated events but rather a continuous and interdependent process. In this manuscript, we review current data regarding the molecular mechanisms underlying the development of colorectal PC, with a special focus on the peritoneum and the role of the surgeon in peritoneal disease spread.

No MeSH data available.


Related in: MedlinePlus