I’ve recently been asked what patients may have done to cause their appendix cancer to recur more aggressively. In this blog I’ll share some thoughts on why pseudomyxoma peritonei (PMP) may change over time and the strategies you might employ to combat these changes. It’s an important discussion because it’s natural for PMP to change and it’s not necessarily something we can control. Obviously, we want to do the best we can to manage the things in our control, but life is always a balancing act.
Cancer is by definition normal cells that have mutated genetically, often due to a combination of factors, some of which we control and some o
f which we do not. Those factors which are uncontrollable include the genetics we inherit from our parents and the pollution in our environment. Factors we can control include our diet, exercise and amount of rest we get. But it’s often a mixed bag of what we control and what we can’t, even for the things we’re able to manage.
Cancer patients struggle daily with the emotional challenges of worrying about their well-being and (potentially) the physical challenges stemming from the aggressive treatments enlisted in the hopes of curing them of PMP. It’s easy to imagine how this would have a direct impact on a patient’s stress level and amount of sleep they get. Perhaps more difficult to imagine is, although cancer patients want to eat a healthy diet of fruits and vegetables, it may be more difficult than usual due to nausea from chemotherapy or intestinal blockages following surgical procedures. In the balance of all things, what’s most important is that patients get enough calories to maintain their weight, take all medications as prescribed by their doctors and maximize the amount of fruits and vegetables they can tolerate.
Once PMP is established its tendency is to change and become resistant to treatments. Cancerous cells have inherently lost the natural ability that our healthy cells have: to monitor their health and to kill themselves if they become unhealthy (the normal ability of a cell to kill itself when unhealthy is called apoptosis). As cancer cells multiply over time, they also continue to mutate and change unchecked due to their faulty reparative systems. These continual changes can cause the cancer to stop responding to treatments it responded to before (cancer is called refractory when it stops responding to treatment that worked before). This is a normal part of how cancer works, unfortunately.
The standard of care for the treatment of appendix cancer and PMP is cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS HIPEC). The hope for CRS HIPEC is to remove all PMP in the body, all at once in one shot. If you have a higher grade tumor, chemotherapy may be added in case there’s any microscopic, persistent or residual disease not removed by CRS HIPEC (chemotherapy administered immediately following another treatment in the hopes of eradicating any remaining disease is called consolidation therapy).
Please understand that just because PMP becomes resistant to one treatment, doesn’t mean it can’t ultimately be controlled through another. We are aware of patients that have repeated CRS HIPEC and used a different chemotherapeutic agent during HIPEC, which has ultimately gotten rid of the disease (typically Mitomycin C is used, but we’re heard of other agents, like Melphalan, being successfully used in repeat surgeries). This is something you can discuss with your physicians as a possibility for you or the patient you’re caring for.
Most importantly, and sometimes most difficult to understand (and this is where things get philosophical), whether you’re fighting cancer or not, our encouragement is for you to make the most of every day you have. We know PMP patients and caregivers across the continuum of the journey of life, and no matter what your circumstances, you can do great things. It’s not always easy but you can manage life even with PMP. At the PMP Pals Network we’re more than happy to introduce you to other patients and caregivers that have navigated these waters. If you’re interested in learning more, send us an email at firstname.lastname@example.org or submit a request for a mentor at pmppals.net, and our team will get back to you right away. We have HOPE for YOU.
Chris Piekarski – President, PMP Pals. PMP Survivor since 2004.