Symptoms and Causes of Pseudomyxoma Peritonei (PMP)
The most common symptom of PMP is pain in the abdomen. Other symptoms include:
Nausea and vomiting
Diarrhea or loose stools (diarrhoea)
Weight loss and weight gain (weight gain)
Blood in stool (blood in stool)
Pain during bowel movements (constipation)
Fever and chills (fever and chills)
Pain in the abdomen (abdominal pain)
Pain during sexual activity (sexual pain)
Losing weight without trying (weight loss)
It is important to note that some people with PMP do not show any symptoms.
There is no known cause of PMP. It is unclear why certain people develop this disease and others don’t. For some people, the cause of PMP can be unknown. In about 10 of the cases of PMP, the disease develops in people with a history of pelvic or abdominal surgery, like hysterectomies.
This suggests that some surgeries may cause small injuries leading to the development of PMP. In some cases, the cause of PMP can be a condition called inflammation of the appendix (Appendicitis).
As the lining of the abdomen and pelvis is repeatedly irritated by the PMP cells, some people may experience a low-grade fever or chills. This is known as a “reaction to inflammatory cells” and it tends to worsen when the person has been inactive for a long time (for example, after a major surgery).
Researchers believe that some people may be genetically more likely to develop PMP. People who have a family history of the disease are more likely to develop PMP.
In most cases, the cause of the disease remains unknown (idiopathic).
Who gets pseudomyxoma peritonei (PMP)?
No one knows for certain who gets PMP. PMP is very rare. It can develop at any age, including childhood.
How is pseudomyxoma peritonei (PMP) diagnosed?
The initial symptoms of PMP can be very vague and similar to many other conditions. The first signs of PMP are usually bloody or blood-tinged bowel movements. This may be noticed by the person who has it or by a family member or friend.
If PMP is suspected, your doctor will examine you and ask you questions about your medical history. Your doctor may suggest that you undergo a computed tomography (CT) or ultrasound of the abdomen and pelvis. This can help determine if you have PMP.
If you have a condition called inflammatory appendicitis, your physician may choose to do an appendectomy or remove your appendix. This will help identify if you have inflammatory appendicitis or if you actually have PMP.
If you have PMP, finding and treating the cause of your disease is important. Otherwise, the disease may keep coming back.
How is pseudomyxoma peritonei (PMP) treated?
The goal of treatment for PMP is to remove cancer cells and try to control the disease. Your doctor may suggest surgical procedures to remove the cancer and the areas of inflammation in your abdomen or pelvis.
The type of surgery done depends upon the location of the disease. For example, if the cancer is found only in the appendix, then your doctor may choose to do an appendectomy. If the cancerous growths are in your intestines, then a surgical procedure called a colectomy may be needed.
Sometimes, chemotherapy is also recommended to help treat PMP or inflammatory appendicitis. The type of chemo given depends upon the type of cancer found.
What are the survival rates for pseudomyxoma peritonei (PMP)?
The survival rate for PMP is strongly related to the findings at the time of diagnosis. If a person has inflammatory appendix, then the survival rate is relatively good at about 90 percent. If a person has inflammatory bowel disease with peritoneal carcinomatosis, the survival rate drops to about 50 percent.
If a person has peritoneal carcinomatosis (cancer cells spread throughout the abdomen or pelvis), then the survival rate is only about 10 percent.
It is very important to remember that these survival rates are only estimates and are affected by many different factors. Talk with your doctor about how the disease affects you and what treatment options might be best for you.
What is the prevention of pseudomyxoma peritonei (PMP)?
There is no known way to prevent PMP. Having a family history of the disease may be the only major risk factor at this time.
Test Your Knowledge
Please select the letter of the best answer for each question.
1. Which of the following symptoms is not a common sign of
A. blood in the stool
B. bloody vomit
C. a swollen abdomen
D. soiled undergarments 2. Which of the following is not a factor related to the cause of
A. excess acid in the stomach
B. an inflamed appendix
C. a history of appendicitis
D. a past abdominal or pelvic surgery 3. Which of the following is generally
NOT a treatment for PMP?
B. high protein diet
C. antibiotic therapy
D. surgical procedures 4. Your doctor is considering doing a colectomy because you have a large cancerous tumor in your colon. The surgery will help to:
A. remove the cancerous tumor.
B. remove your colon.
C. stop the spread of cancer cells.
D. increase your survival rate. 5. Which of the following is a sign of
A. difficulty breathing
B. a blue tint to the skin
C. yellow fingernails
D. All of the above
6. You have a feeling that your abdomen may be swollen.
Which of the following should you do?
A. Do nothing and see your primary care physician.
B. Call the Cancer Information Service for your area.
C. Call your primary care physician’s office.
D. Go directly to the emergency room nearest you.
7. Which symptom is a common sign of inflammatory bowel disease?
A. a swollen abdomen
B. bloody vomit
C. bloody diarrhea
D. none of the above 8. Which of the following is true about
A. It sometimes occurs in people who have had a gallbladder removal.
B. It is similar to appendicitis.
C. It can be prevented by eating a diet low in fiber.
D. It can be of genetic origin. 9. Which of the following is
NOT a risk factor for PMP?
A. male gender
B. history of inflammatory bowel disease
C. a family history of the disease
D. smoking cigarettes 10. Which of the following is a common symptom of peritoneal carcinomatosis?
A. bloody diarrhea
B. a swollen abdomen
C. blood in the urine
D. soiled undergarments
Below are some common symptoms associated with pseudomyxoma peritonei (PMP). Check ALL symptoms that you have experienced.
□ Abdominal pain
□ Blood in the stool
□ Low energy level
□ A feeling that your abdomen is swollen
□ Increased urination
□ A feeling that you have to go to the bathroom
□ A poor appetite
□ Loss of weight
□ Feeling tired or fatigued
□ Feeling generally unwell
□ Poor skin quality
□ Fingernails or toenails with a yellowish color
□ A feeling of pressure in your pelvis
□ A heartburn or indigestion-like feeling
Please select the BEST choice for each question.
1. Which of the following symptoms isn’t a common sign of inflammatory bowel disease?
A. a swollen abdomen B. bloody vomit C. bloody diarrhea D.
none of the above
2. Which of the following may be a factor related to acute appendicitis?
A. an inflamed appendix B. an appendix scarred from repeated bouts of appendicitis C. a diet high in fat D.
all of the above
3. All of the following are risk factors for inflammatory bowel disease EXCEPT:
A. being male B. a family history of IBD C. a diet high in red meat D.
all of the above
4. Your friend recently had his gallbladder removed and is experiencing several of the symptoms above.
Which of the following is true?
A. His symptoms are a sign of a possible cancerous tumor. B. Gallstones can be the cause of PMP. C. It is unlikely that his gallbladder removal is related to his current condition. D. His symptoms might be caused by PMP.
5. You have been having a variety of problems and have been feeling unwell for quite some time now.
One of your main concerns is the large swelling around your abdomen.
Which of the following is a possible cause?
A. a large-sized lymph node B. a large-sized organ C. a buildup of gas D. none of the above
6. Your abdomen has been feeling tight for about a week and the pain is becoming more intense.
You are concerned that you may have an inflamed appendix.
Which of the following would be the BEST place to seek immediate medical attention?
A. an urgent care center B. the emergency room C. your primary care physician’s office D. your local pharmacy
7. Your friend recently was diagnosed with inflammatory bowel disease.
He is experiencing several of the symptoms above. You think that he should go see his physician or gastroenterologist to get a proper diagnosis and treatment.
Which of the following is a type of doctor?
A. a gastroenterologist B. an oncologist C. a pathologist D. a dermatologist
8. Your abdomen has swollen to the point where all your clothes are too tight.
You have also been feeling tired and have been suffering from a loss of appetite. This has been going on for several weeks and is beginning to cause you great concern.
Which of the following would be the LEAST helpful in determining what is causing your pain?
A. an ultrasound B. a CT scan C. blood work D. an MRI
9. You have been suffering from frequent and severe abdominal pain that has been getting worse over the past few weeks.
You wake up one morning and your abdomen is extremely swollen. You should seek immediate medical attention because you might have:
A. a perforated ulcer B. acute pancreatitis C. appendicitis D.
an inflamed gallbladder
10. You experience a sudden and severe pain in your lower right side. Your abdomen becomes very swollen and you lose your appetite. This is most likely the result of:
A. a pinched nerve B. the start of a cold C. a perforated colon D.
TEST YOUR UNDERSTANDING Answers
Return to Contents
Progressive Muscle Relaxation
You are taught a method called progressive relaxation, which is an effective way to reduce stress and muscle tension. This method can be done anytime and almost anywhere to help you feel more relaxed and less stressed.
Sit in a comfortable position and close your eyes.
Tense the muscle in your right arm and hold the tension for 10 seconds.
Then, relax the muscle for 20 seconds and take a deep breath.
Move on to another muscle group and repeat this procedure until you have tensed and relaxed all the major muscle groups in your body, including your face.
After completing the muscle relaxation, just sit and experience the different sensations that you are feeling.
When you are done, take a deep breath and open your eyes.
NOTE: This activity should take 10 to 15 minutes to complete.
TEST YOUR KNOWLEDGE Answers
Return to Contents
What Is Stress?
Stress is a normal and everyday part of life. Everyone experiences it from time to time. However, if stress becomes excessive and/or prolonged, it can lead to a wide range of health problems.
Stress can be both psychological and physical in nature. For the purpose of this course, we are going to focus on the biological effects of stress on the body and how to manage or cope with it.
Stress is the body’s natural response to a demanding situation or threat. It prepares you to fight or flee from the situation. When facing a stressful situation, your body enters a state of alarm. The alarm prepares your body to react quickly whether that is to fight or to run away.
During this state of alarm, several changes occur in the body.
The first change is an increase in your heart rate and breathing. This increases the flow of blood to your large muscles, which prepare you to either fight or flee. At the same time, other body functions (such as digestion) are slowed down. This conserves the body’s energy so that you have enough energy to respond to the threat at hand.
The second change that occurs is a release of certain hormones in the body. Nerve cells (neurons) in the brain release a substance known as adrenalin. This is a powerful stimulant that travels to the body through the blood. It reaches the heart, causing it to beat faster.
Adrenalin also reaches the lungs, causing you to breathe faster. This increase in breathing causes you to take faster and deeper breaths.
Other hormones are sent to your muscles, preparing them for quick action. In addition, other hormones are sent to your liver, causing it to release more glucose (a form of energy) into the blood. This increased amount of energy prepares your body to respond quickly to the stressful situation.
Once the stressful situation has passed, your body returns to its normal state. This return to a state of calm is known as the relaxation response.
The relaxation response occurs when your body returns to a state of calm after a stressful situation. Several changes occur during this time.
First, your breathing and heart rate return to a normal rate. As your breathing and heart rate slow down, so does the release of hormones in the body. The slowing of these functions causes a drop in your body’s energy levels. Finally, as your body returns to a state of calm, other bodily functions (such as digestion) are allowed to resume.
NOTE: A complete discussion of the relaxation response would take a whole course to itself. The above is only a very simplified and general description.
Differences Between Stress and Anxiety
Stress and anxiety are often used as synonyms; however, they are actually two different things.
Stress is the body’s natural response to a demanding situation. Whereas anxiety is the result of worry, fear or a state of mental discomfort.
Most of the time, stress is a positive thing. It helps you to function at a higher level during demanding situations. It helps you to perform at your peak.
However, in some cases, stress can be a negative thing. If the demand becomes excessive or the stress is prolonged, it can lead to a state of helplessness. People who experience excessive stress on a regular basis often become burned out. This can lead to a decrease in a person’s overall health and well-being.
Anxiety is generally a negative thing. It is the by-product of worry, fear or a state of mental discomfort. Most of the time, anxiety is the by-product of a stressful situation. It is your mind’s natural response to a situation that you perceive as dangerous or threatening.
It makes you feel uneasy. It makes you feel like you need to do something, even if that something is nothing at all.
It is also possible to have stress without anxiety or anxiety without stress. For example, you may have a demanding job, but not really worry about it. Thus, your job would be a source of stress but not anxiety. You may also have a time where you worry about something, but the actual situation is not that demanding.
For example, a student worries about upcoming exams, but doesn’t really have a demanding course schedule. In this case, the exams would be the source of anxiety, but not stress.
Stress and anxiety can also be internal or external. Internal stress and anxiety are caused by things that go on inside of you. This includes your own thoughts, feelings and actions. For example, doing well on an exam would be an external stressor, but your feelings of worry and anxiety would be internal stressors.
External stressors are things that happen outside of you. They are often outside forces that cause you to feel some sort of stress or anxiety. For example, a car accident would be an external stressor because it causes you to experience some level of stress or anxiety.
Sometimes it can be a combination of both. For example, you may have to give a speech. This would be an external stressor. You may feel nervous, which would be an internal stressor.
Or, you may not feel nervous at all, but your stomach starts to turn and this would also be an internal stressor.
Over time, too much anxiety can wear down your body. As you continue to experience stress and anxiety, your body’s defense mechanisms begin to wear down. This can cause increased susceptibility to health problems. Too much anxiety can also cause you to “burn out.” You may become less motivated to do much of anything.
In some cases, you may become unable to leave the house or even take care of yourself.
Signs and Symptoms of Stress and Anxiety
Stress and anxiety can often go hand in hand. However, they can also occur separately.
Stress is often the precursor to anxiety. As stress increases, there is a higher possibility that it will lead to some level of anxiety. While everyone experiences anxiety from time to time, when this occurs it is important to manage the stress that is causing it. Otherwise, the anxiety could become a prolonged state.
Stress is often a precursor to other health issues. As you continue to experience stress, there is a possibility that it can cause your body to experience other problems. Some of these problems include:
Irritable Bowel Syndrome
High Blood Pressure
Anxiety on the other hand, can cause you to feel uneasy in general. There are several types of anxiety, but some of the more common ones include:
Social Anxiousness: This is a feeling of nervousness in social situations where you are around other people. This may be a gathering of friends or even when you have to speak in front of a group. You may feel your heart start to pound, or you may even feel nauseous.
Emotional Anxiousness: This is a feeling of nervousness and fear about everyday situations. This can occur even when you are with people that you are comfortable with. Situations that may cause you to feel emotional anxiousness include public speaking or even something as simple as ordering food from a restaurant when you are with others.
Panic Attacks: Panic attacks are episodes of intense anxiety. While everyone has felt a little anxious from time to time, this is different. Panic attacks usually occur unexpectedly and the fear that you feel during one is much more intense. During a panic attack, you may feel like you can’t breathe, feel dizzy or even become nauseous.
Generalized Anxiety: This is ongoing and excessive worry about day to day life. You may find yourself worrying excessively about different situations or events that can occur. While everyone worries to some degree, the difference is that generalized anxiety is disproportionate to the situation or event that is causing you to worry.
How to Stop Stress & Anxiety
There are several things that you can do in order to manage your stress and anxiety.
Stress can often cause you to feel tired or fatigued. However, research has shown that exercise can actually help reduce stress. This is because when you exercise it releases endorphins that help improve your mood. This also increases the oxygenated blood flow throughout your body, which promotes a feeling of well-being.
While exercise can help reduce stress, it is important that you find the right type of exercise for you. What helps one person relieve stress may not work for another person. For example, running might make you feel more stressed because it puts you out of breath and causes your heart to pump harder, which may increase your stress levels. On the other hand, yoga may be exactly what you need in order to help relieve your stress.
Feeling anxious is a common problem and there are some foods that can actually make you feel more anxious. The most important things to avoid are caffeine, sugar, alcohol and smoking. These items can actually cause your body to release stress hormones.
Another important thing to remember when it comes to stress and anxiety is to try your best to avoid conflict. Conflicts with others can cause you to feel anxious or even angry. Try your best to avoid arguments and if you find yourself in one then make every effort to resolve the issue as quickly as possible.
Incorporate meditation into your daily routine. Even if you only have a few minutes to spare, taking time to meditate and relax can help your mind and body. This can be done by sitting in a quiet place and clearing your mind of all thoughts. While this might be difficult at first, with practice you’ll find that it gets easier.
How to Manage Your Time
If you find yourself suffering from anxiety or stress, one of the best things that you can do is take control of your time. One of the most common causes of stress is feeling like you don’t have enough time to do the things that are important to you. Managing your time wisely can help you eliminate this source of stress from your life.
If you find yourself always feeling rushed or pressed for time, you may need to make some changes in your daily life. Many people don’t realize that they are actually the cause of their own stress. For example, many people waste a lot of time on the computer or watching TV without even realizing how much time has passed. Instead of watching that extra episode of your favorite TV show, try reading a book instead.
Not only will you be taking an active approach to relaxing, but you’ll also be improving your mind.
If you find yourself needing more down time, it may be helpful to draw up a schedule for yourself of everything that you need to do. This includes work, school and any other activities that are important to you. Allotting specific times to do everything can help you avoid feeling like you’re always in a rush. It will also help you avoid missing out on the little things in life that can be just as important as the big things.
Taking a break from your work to watch the sunset, for example, gives you a chance to relax and reflect. It’s these little moments in life that can bring the most happiness.
How to Get Proper Sleep
Getting enough sleep is vital for your overall health and well-being. When you don’t get enough sleep, your body’s immune system is greatly impaired. Not only will you be more prone to getting sick, but you’ll also be more likely to experience symptoms if you do get sick.
One of the biggest causes of sleep deprivation is screen time. The light from a screen, whether it’s a TV, computer or smartphone, can actually trick your brain into thinking that it’s still daytime. When your brain senses daylight, it puts you in a wide awake mode. At night, this effect is nearly reversed.
This means that if you’re looking at a bright screen before bed, you’ll have a harder time falling asleep.
The amount of sleep that you need varies from person to person. Most adults need between 7 to 9 hours of sleep a night. You may need to try out different amounts to see what works best for you. It’s also important to get good quality sleep.
This means avoiding things like sleeping pills and other medications that might interfere with normal sleep patterns.
If you’re having problems with sleep after trying the tips in this guide, it might be time to visit a doctor.
1. One of the best ways to get a good night’s sleep is to avoid screen time before bed.
This means putting down your phone, tablet, TV or other screens an hour or so before bed. The light from the screen tricks your brain into thinking that it’s still daytime, which helps keep you awake.
2. To get ready for bed, try reading a book.
Reading is a great way to relax before bed. It’s a lot more interesting than counting sheep!
3. If you have problems falling asleep, setting an alarm to wake you after 6 hours can help.
Most people need between 7 to 9 hours of sleep each night. If you lay in bed for longer than 6 hours, you’re likely to become more tired and have a harder time falling asleep.
4. Avoid using medication.
Over the counter sleep aids and pills can be very tempting especially when you’re desperate for sleep. The problem is that these pills can become addictive and cause major health problems. Always try to use natural methods to get to sleep. If all else fails, you might want to seek help from a doctor who can prescribe something to help you sleep without all of the side effects.
5. Don’t exercise right before bed.
Although exercise is very beneficial for your health, it can actually keep you awake when done too close to bedtime. If you need to burn off some energy, try to do so at least 3 hours before bed.
6. Count Sheep!
For countless centuries, this old adage has been passed down from generation to generation. The idea is that by counting sheep, you’ll eventually drift off into dreamland. If you still struggle to fall asleep, consider counting other things like waves or cars.
7. Create a sleep ritual.
Whether it’s listening to a podcast or winding down with a specific activity before bed, your sleep ritual can help you feel more relaxed and get your body ready to fall asleep.
8. Avoid food and drinks that contain a lot of caffeine.
This is pretty straight forward. Caffeine is known for keeping people awake, so it’s best to avoid it for a few hours before bedtime.
9. Do some yoga or stretching before bed.
This can help you to relax before bed. It might also ease any aches or pains that you have.
10. Make your bedroom as dark as possible. Even the smallest amount of light can interfere with sleeping. Black out curtains and consider installing a fan to make your room more dark and comfortable.
11. Try using earplugs or a white noise machine. These items are a great way to drown out any unwanted noise and make it easier to fall asleep.
12. Keep your phone out of the bedroom. This one is important. The bright light and constant distraction of your phone can make it nearly impossible to fall asleep.
If you need an alarm, set it to airplane mode and put it across the room.
13. Keep your bedroom cool. Your body naturally slows down when it’s cold, so a slightly colder room can make it easier to fall asleep.
14. Have a set time to wake up every day. Waking up at the same time every day, even on the weekends, can help your body establish a sleep cycle and make it easier to fall asleep at night.
15. Don’t go to bed unless you’re sleepy. If you’re not feeling tired, there’s no sense in forcing yourself to go to bed. Pick a different activity until you are sleepy.
16. Get some sunlight first thing in the morning. The sun naturally wakes you up, so try to get some direct sunlight or open your curtains as soon as you wake up.
17. Be careful with naps. Although a nap can make you feel more refreshed, they can also interfere with your nighttime sleep cycle. Make sure to limit your nap to 30 minutes and never take one later than 3pm.
18. Be careful with alcohol. Although a glass of wine might make you feel sleepy, the alcohol can actually have the opposite effect by interrupting your sleep cycle.
19. Relax before bed. Take a warm bath or listen to some calming music.
20. Be mindful of your thoughts. Try to rid your mind of any stressful or anxiety provoking thoughts that might be keeping you awake.
21. Have a set time to stop stimulating activities. Whether it’s homework, video games or your favorite TV show, limit your exposure to stimulating activities at least two hours before bedtime.
22. Get some exercise during the day. Although this one is generally recommended, exercise might actually keep you awake if you do it too late in the day. Wait until at least five hours before bedtime to do any vigorous workouts.
23. Manage stress effectively. Even if it’s something small, daily stress can cause you not to sleep well at night. Try some deep breathing or meditation to help you manage your stress before it gets out of hand.
24. Associate your bed with sleep and nothing else. If you do stimulating activities in your bed, such as watching TV or texting, your brain may subconsciously associate your bed with those activities and make it harder to sleep.
25. Track your sleep habits over a few days to see how your sleep patterns change. Use an online tool, such as the one provided by Clemson University, to help you record this data.
Did you know you could be damaging your body just by the way you’re sleeping?
Find out how here.
Sources & references used in this article:
- Long-term survival following treatment of pseudomyxoma peritonei: an analysis of surgical therapy (TJ Miner, J Shia, DP Jaques, DS Klimstra… – Annals of …, 2005 – ncbi.nlm.nih.gov)
- Pseudomyxoma peritonei (RM Smeenk, VJ Verwaal, FAN Zoetmulder – Cancer Treatment Reviews, 2007 – Elsevier)
- Clinical presentation of pseudomyxoma peritonei (P Järvinen, A Lepistö – Scandinavian Journal of Surgery, 2010 – journals.sagepub.com)
- Pseudomyxoma peritonei and the urinary tract: involvement and treatment related complications (RM Smeenk, A Bex, VJ Verwaal… – Journal of surgical …, 2006 – Wiley Online Library)