Colorectal cancer is one of the common malignancies in Hong Kong. When the disease progresses to an advanced stage, a proportion of patients develop peritoneal metastasis, which has traditionally been considered challenging with poorer prognosis. However, with advances in medical technology, clinical oncologist Dr. Lam Ka On points out that peritoneal metastasis in colorectal cancer is not necessarily a terminal condition. Various locoregional treatment options now offer suitable patients a realistic chance of cure, bringing new hope to those with advanced disease.
Common Symptoms and Challenges of Peritoneal Metastasis
While most advanced colorectal cancers primarily metastasize to the liver, clinical data indicate that approximately 20–30% of patients with advanced colorectal cancer develop peritoneal involvement. Symptoms may include abdominal distension, ascites accumulation, and in severe cases, intestinal obstruction or perforation. Dr. Lam explains that conventional approaches mainly rely on systemic chemotherapy or palliative care. Due to the anatomical barrier of the peritoneum, drugs often fail to reach therapeutic concentrations at the tumour site, resulting in limited efficacy. Many patients feel hopeless upon hearing the diagnosis of peritoneal spread.
New Direction: Combining Systemic and Locoregional Therapies
Modern cancer management has shifted towards integrating systemic and locoregional treatments for advanced colorectal cancer. According to Dr. Lam, patients should first undergo genetic testing for markers such as RAS, BRAF, HER2 and MSI status to guide the selection of appropriate systemic therapies, including chemotherapy, targeted agents or immunotherapy. When systemic treatment achieves good tumour control and reduces disease burden, locoregional approaches with curative intent can be considered.
One established method is heated intraperitoneal chemotherapy (HIPEC), in which heated chemotherapeutic agents are delivered into the abdominal cavity via surgical or catheter access, enhancing cytotoxicity through hyperthermia. A more recent technique is pressurised intraperitoneal aerosol chemotherapy (PIPAC), which atomises the drug into fine particles and delivers them under high pressure, significantly improving penetration into tumour tissue and local disease control. Dr. Lam notes that these locoregional treatments are generally suitable for patients with limited metastatic burden who respond well to systemic therapy.
Early Screening Remains the Key to Prevention and Better Outcomes
The transformation from colorectal polyps to cancer often takes 20 to 30 years, underscoring the importance of regular screening. Dr. Lam urges individuals with long-term digestive issues or a family history of colorectal cancer to undergo regular colorectal health screenings. The Faecal Occult Blood (FOB) test is a key screening tool for colorectal cancer. If deemed necessary by a doctor or if the test yields a positive result, a follow-up colonoscopy may be required. Additionally, the Hong Kong government offers a Colorectal Cancer Screening Programme for eligible Hong Kong residents (aged 50–75 with no apparent symptoms). This programme enables early dection and removal of polyps, significantly reducing the risk of developing cancer. Dr. Lam adds, anyone experiencing rectal bleeding, persistent change in bowel habits (such as frequent diarrhoea or constipation), unexplained anaemia (fatigue, shortness of breath), abdominal bloating, right upper quadrant pain, or bone pain should seek medical attention promptly.
Facing the Disease Positively and Choosing the Right Plan
In closing, Dr. Lam reminds patients that multiple treatment options exist for advanced colorectal cancer, each with its benefits and side effects. Rather than giving up upon hearing “advanced stage”, patients should engage in detailed discussions with their primary oncologist to tailor the most appropriate plan. Patients in need are encouraged to consult their clinical oncologist for the latest treatment options. At the same time, regular colorectal cancer screening remains the most effective way to prevent disease and improve survival.
More information about colorectal cancer: Colorectal Cancer
More about Tamarind Specialists’ Colorectal Health Screening: Colorectal Health Screening
Frequently Asked Questions Q&A
Q1: Is peritoneal metastasis in colorectal cancer always incurable?
A: Not necessarily. While traditional treatments have limited effect, combining systemic therapy with locoregional approaches (such as HIPEC or PIPAC) can offer curative potential in selected patients. Early assessment and personalised planning are crucial.
Q2: What are the main symptoms of peritoneal metastasis?
A: Common signs include abdominal bloating, ascites, bowel obstruction, perforation, anaemia, fatigue, and abdominal pain.
Q3: Who is suitable for PIPAC or heated intraperitoneal chemotherapy?
A: These are generally indicated for patients with limited metastatic disease and good response to systemic treatments (chemotherapy, targeted therapy or immunotherapy). Suitability is determined by the treating doctor.
Q4: How can colorectal cancer be prevented or detected early?
A: Individuals with long-term digestive issues or a family history of colorectal cancer should undergo regular colorectal health screenings. The Tamarind Specialists Centre in our medical group offers Colorectal Health Screening, which includes Faecal Occult Blood (FOB) test coupled with liver and renal function tests and several other cancer markers, providing an overview of digestive system health. After consulting with doctor or FOB test result positive, individuals can add a colonoscopy as a follow up. If you experience changes in bowel habits, blood in stool, or anemia, seek medical attention immediately.
Q5: What is Colorectal Cancer (CRC) Screening Programme?
A: Eligible Hong Kong residents (aged 50–75 with no apparent symptoms) can voluntarily participate in the government’s CRC Screening Programme for regular colon examinations.
Q6: What should patients consider during colorectal cancer treatment?
A: Different options carry different side effects. Patients should discuss thoroughly with their primary oncologist to select the best plan and maintain a positive outlook.
Related Media Coverage (Traditional Chinese Version Only):
The articles are intended to provide general information only and do not constitute medical opinions nor medical diagnoses. They should not be used as a substitute for personal consultation with a qualified health professional regarding the reader’s medical condition. All preventive and therapeutic approaches carry varying degrees of efficacy, side effects and risks. If you have any concerns, please consult your healthcare professional.
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