Pseudomyxoma Peritonei (PMP) is a rare cancer affecting approximately two individuals per million worldwide. This article provides a comprehensive overview of diet guidelines for PMP cancer, drawing on available research and expert insights.
Understanding Pseudomyxoma Peritonei (PMP)
PMP is characterized by the accumulation of mucin, a jelly-like substance, and mucus-secreting tumor cells within the abdomen and pelvis. In most instances, PMP originates from an appendiceal tumor that has ruptured, spreading to the surrounding peritoneal surfaces. Rarely, these tumors can arise in other organs. The rupture of the appendix can mimic acute appendicitis, but sometimes, appendiceal mucinous tumors leak mucin and tumor cells over a prolonged period before diagnosis.
Treatment of PMP
Treatment for PMP depends on individual circumstances and overall health. In some cases, healthcare providers can effectively treat and often cure PMP. The primary treatment often involves invasive surgery to remove all organs with cancerous tissue. This may include cytoreductive surgery (CRS) combined with heated intraperitoneal chemotherapy (HIPEC).
Surgical Procedures
Different surgical procedures may be employed to treat PMP, including:
- Bowel resection: Removal of the small or large intestine if mucin is present.
- Cholecystectomy: Removal of the gallbladder.
- Hysterectomy with bilateral salpingo-oophorectomy: Removal of the fallopian tubes, ovaries, and uterus.
- Liver capsulectomy: Removal of part of the surface of the liver.
- Omentectomy: Removal of the layer of fat covering the front of the belly.
- Peritonectomy: Removal of the peritoneum, the membrane lining the inside of the abdomen and pelvis.
- Splenectomy: Removal of the spleen.
Potential Complications of Surgery
Surgery to remove organs carries risks, including hemorrhage, infection, and anastomotic leak (leakage from new bowel connections). Major surgery can lead to life-threatening complications, with a mortality rate of about 1% to 2%.
Read also: Overview of Metabolic Diets in Cancer Research
Nonsurgical Treatments
Nonsurgical treatments for PMP may include:
- Active surveillance: Regular monitoring of overall health, imaging tests, and blood tests for early or slow-growing PMP when the risks of surgery outweigh the benefits.
- Palliative care: Focuses on relieving symptoms and improving quality of life.
The Role of Nutrition in PMP Management
Maintaining adequate nutrition is crucial for PMP patients, especially after surgery. It can alleviate gastrointestinal symptoms, reduce treatment-associated complications, and decrease nutritional risk, potentially impacting survival.
Dietary Intake and Nutritional Outcomes
Current literature reveals that dietary intakes and nutritional outcomes following PMP/appendix cancer surgery are poorly reported. A review of studies up to April 2025 identified only five studies meeting eligibility criteria, involving a total of 324 patients. The outcomes assessed included nutritional status, quality of life, nutritional support, nutritional impact symptoms, and nutritional deficiency. Notably, no studies assessed specific food or macro/micronutrient intakes.
Enteral Nutrition (EN) vs. Total Parenteral Nutrition (TPN)
Nutritional support is an important therapeutic progression for severe abdominal illnesses or major abdominal surgery. Total parenteral nutrition (TPN) and enteral nutrition (EN) are the major nutritional support options for postoperative patients. EN, performed via oral, nasogastric, or jejunum tube, offers advantages such as protecting immunity, balancing metabolic responses, and alleviating stress reactions, potentially improving clinical outcomes compared to TPN.
A retrospective study analyzing PMP patients who underwent CRS plus HIPEC found that the EN group had higher postoperative absolute lymphocyte count, hemoglobin, and albumin levels compared to the TPN group. Additionally, the EN group experienced a shorter postoperative hospital stay and a lower complication rate. Logistic regression analysis indicated that EN was an independent protective factor for postoperative hospital stay in PMP patients.
Read also: Managing Canine Lymphoma with Diet
Specific Dietary Recommendations
While research on diet and peritoneal cancer is limited, general guidelines suggest that a diet high in fruits, vegetables, and whole grains, and low in saturated fat, sodium, and added sugar may be beneficial.
- Whole Grains: Consuming around 90 grams of whole grains per day may help reduce cancer mortality risk. Examples include certain types of bread, oats, millet, quinoa, barley, and brown rice.
- Protein: Adequate protein intake is essential to maintain immune system function, grow and repair tissues. Sources of protein include dairy products (fat-free or low-fat milk, yogurt, and cheese), lean meat and poultry, eggs, seafood, beans, peas, lentils, nuts, and certain seeds.
It's essential to avoid:
- Added sugar
- Saturated fats
- Sodium
The Mucin Connection
Mucin, a heavily glycosylated protein secreted into the intestines, protects the gut walls. In PMP, epithelial cells secrete mucin ectopically into the peritoneal cavity. Research is exploring the use of enzymes like bromelain and N-acetyl cysteine to break down mucin.
Individualized Nutrition Plans
Given the complexity of PMP and its treatment, individualized nutrition plans are crucial. Consulting with a medical team, including an oncologist and a registered dietitian, is essential for receiving specific nutrition advice tailored to individual health, treatment, and overall outlook.
Lifestyle Factors
While no specific causes have been definitively identified for appendix cancer (including PMP), several lifestyle factors may play a role:
Read also: Managing Pancreatic Cancer with Diet
- Excess Body Fat: Linked to several cancer types.
- Tobacco Use: A leading risk factor for many cancers.
The Importance of Research and Awareness
Continued research and advocacy are pivotal for rare cancers like appendix cancer and PMP. Sharing information and personal stories helps demystify the disease and prompt more significant attention from the medical community.
tags: #pmp #cancer #diet #guidelines