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Symptoms, Treatment and Diet for Pseudomyxoma Peritonei

Feb 26, 2021

Highlights

A diet containing genistein, bromelain rich foods(pineapple) and foods such as mulberry, nectarine, blackseed and ajwain may be beneficial for patients with Pseudomyxoma peritonei (PMP), a rare cancer characterized by excessive mucus production in the peritoneal cavity. However, citric acid containing foods such as bottle gourd, amaranth, common pea and cocoa may not be right for these patients while undergoing treatment. Also cabbage supplements and linoleic acid containing supplements such as asafoetida, cardamom, poppy and bamboo should be avoided while undergoing treatment with the prodrug of 5-FU. Hence, while managing cancers such as Pseudomyxoma peritonei (PMP), it is important to follow a nutrition plan/diet personalized to your cancer type and treatment, to stay safe, reduce symptoms and reap maximum benefits.



What is Pseudomyxoma Peritonei?

Pseudomyxoma peritonei (PMP) is a rare cancer that usually starts in the appendix, and sometimes in ovaries, bladder or bowel. This disease is characterized by excessive mucus accumulation within the peritoneal cavity where it is unable to degrade or drain away. The mucus is made up of mucin and salts in water. Over a period of time, these secreted mucin forms voluminous gels. MUC2, MUC5AC and MUC5B are few gel-forming mucins which are reported to be found in the PMP secretions. 

The incidence rate of this cancer is only 2 per 1 million people every year.PMP is commonly diagnosed in people who are about 50 years of age, however, it can occur in people of any age. Pseudomyxoma peritonei is often diagnosed in the advanced stages while undergoing tests for other medical conditions. 

Symptoms Treatment and Diet for Pseudomyxoma Peritonei

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What are the Signs and Symptoms of Pseudomyxoma Peritonei?

Pseudomyxoma peritonei (PMP) is a slow growing cancer. Following are some of the signs and symptoms that may be caused by PMP. 

  • Abdominal or pelvic pain
  • Weight gain or increase in waist size
  • Swelling on the abdomen
  • Enlarged ovary
  • Lack of appetite
  • Inflammation of the appendix (appendicitis)
  • Sudden changes in bowel habits

Though many of these symptoms may also be caused by various other health conditions, consult your doctor if you experience these symptoms to rule out the possible chances of Pseudomyxoma peritonei (PMP).

What are the Treatment options for Pseudomyxoma Peritonei?

The treatment for Pseudomyxoma peritonei (PMP) may be decided based on different factors including the stage and extent of spread of the cancer, cancer characteristics, patient’s general health and medical history and whether the cancer can be removed completely by surgery. The common treatment options for Pseudomyxoma peritonei (PMP) include:

  • Watchful waiting 
  • Surgery
    • For the complete removal of all visible tumour
    • For tumour debulking
  • Chemotherapy

What is the role of Diet/Foods in Patients with Pseudomyxoma Peritonei?

When it comes to managing Pseudomyxoma Peritonei (PMP), following a personalized diet including the right foods and supplements that can control the mucous production, support treatment and reduce the symptoms becomes crucial. Below are some examples of foods/supplements that may be associated with Pseudomyxoma Peritonei.

1. Intake of Bromelain rich foods may help reduce Mucin Production in Pseudomyxoma Peritonei

Based on an experimental study done by the researchers from the The University of New South Wales, in Australia, they highlighted that taking bromelain, a key bioactive ingredient of pineapple, along with  N-acetylcysteine may have impact on both growth and mucin production in mucin-expressing tumor cells. Hence, they suggested that bromelain with N-acetylcysteine may be a promising candidate towards the development of novel therapeutic approaches to gastrointestinal malignancies which involved mucin pathology such as increased expression of MUC2 and/or MUC5AC, as well as in reducing the adverse effects of the aberrantly secreted gel-forming mucins in diseases like pseudomyxoma peritonei. (Afshin Amini et al, Oncotarget ., 2015)

Hence, eating bromelain-rich foods as part of the diet may be beneficial for patients with pseudomyxoma peritonei.

2. Intake of Genistein may help reduce Mucin production in Pseudomyxoma Peritonei

Genistien is a key active ingredient found in soy foods. In a scientific paper published in the American Journal of Pathology in 2002, Jerome T O’Connell et al highlighted that the primary epithelial cell cultures obtained from pseudomyxoma peritonei expressed MUC2 and that the enhanced expression of MUC2 in these cell lines in response to methylation inhibition by a drug  called 5-azacytidine and exposure to Pseudomonas aeruginosa lipopolysaccharide could be inhibited by genistein pretreatment. (Jerome T. O’Connell, Am J Pathol., 2002)

Hence, genistein may have the potential to control the expression of MUC2 and may be beneficial for PMP patients.

3. Intake of Dietary Supplements containing Linoleic acid should be avoided by PMP Patients undergoing treatment with the prodrug of 5-FU

Unlike foods, dietary supplements contain very high concentrations of the bioactive ingredients present in food. Hence, before consuming dietary supplements, PMP patients undergoing treatment should be aware of the fact that these ingredients may modulate the activity of the drug metabolizing enzymes – CYPs, which may ultimately end up reducing the therapeutic efficacy of the drug or result in abnormally increasing the drug concentration, thereby elevating the toxicity.

Supplements of asafoetida, cardamom, poppy and bamboo contain significant amounts of a bioactive ingredient called linoleic acid, which acts as an inhibitor of many drug metabolizing enzymes including CYP1A2, CYP2A6 and CYP2E1. (Hsien-Tsung Yao et al, Life Sci., 2006)

Drugs such as 5-FU prodrugs (which are converted to active Fluorouracil) which are used for the treatment of PMP are metabolized by the enzymes – CYP1A2 and CYP2A6. (T Komatsu et al, Drug Metab Dispos., 2000) Hence, consuming linoleic acid containing supplements by PMP patients undergoing treatment with the prodrug of 5-FU, can lead to reduced concentrations of 5-FU and may impact its therapeutic efficacy. 

Dietary supplements of asafoetida, cardamom, poppy and bamboo containing significant amounts of linoleic acid should hence be avoided by PMP patients undergoing treatment with 5-FU prodrugs.

4. Intake of Cabbage Supplements should be avoided by PMP patients undergoing treatment with the prodrug of 5-FU

Cabbage is a very healthy vegetable, belonging to the cruciferous vegetable family. However, dietary supplements of cabbage contains high amounts of its active ingredients including indole-3-carbinol, quercetin, isorhamnetin and kaempferol which can modulate (enhance or inhibit) many drug metabolizing enzymes such as CYP1A2, which plays an important role in the metabolism of the prodrug of 5-FU, the prodrug of Fluorouracil. (T Komatsu et al, Drug Metab Dispos., 2000; Jay Savai et al, Drug Metab Pers Ther., 2015; Mirza Bojić et al, Molecules., 2019; V A Tutelyan et al, Bull Exp Biol Med., 2012)

Hence, PMP patients undergoing treatment with 5-FU prodrugs should avoid Cabbage supplements as its ingredients may interfere with the drug metabolism and concentration, and finally may impact its therapeutic efficacy or lead to toxicity.

5. Other Foods Associated with PMP Patients undergoing standard of care treatment

  • Along with other ingredients, foods such as bottle gourd, amaranth, common pea and cocoa also contains a key ingredient called citric acid which reduces the standard of care  treatment efficacy by activating ROS induced AP1 signaling and ROS induced NRF2 signaling and by inhibiting oxidative stress. Hence, PMP patients should limit the intake of bottle gourd, amaranth, common pea and cocoa while undergoing treatment.
  • Morusin, chlorogenic acid, carvacrol and beta-sitosterol are one of the many active ingredients of mulberry, nectarine, blackseed and ajwain respectively. These have the potential to inhibit angiogenesis (development of new blood vessels to supply food and oxygen to the tumors), proliferation and cell survival and may be beneficial for PMP patients. (Sang Woo Cho et al, Am J Cancer Res., 2017; Xiaokang Wang et al, J Pharm Pharmacol., 2019; Wei Dai et al, Onco Targets Ther., 2016; Song Hyo Sook et al, Phytother Res., 2014) Hence consuming mulberry, nectarine, blackseed and ajwain may be beneficial for patients with Pseudomyxoma peritonei (PMP).

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Conclusion

While including genistein, bromelain rich foods(pineapple) and foods such as mulberry, nectarine, blackseed and ajwain may be beneficial in reducing symptoms of patients with Pseudomyxoma peritonei (PMP), citric acid containing foods such as bottle gourd, amaranth, common pea and cocoa may not be right for these patients while undergoing treatment. Also cabbage supplements and linoleic acid containing supplements such as asafoetida, cardamom, poppy and bamboo should be avoided when undergoing treatment with the prodrug of 5-FU, the prodrug of Fluorouracil. Before taking any dietary supplements, consult with your healthcare professional to avoid any undesired interactions with your ongoing treatments.

“What should I eat?” is the most frequently asked question to cancer dieticians and physicians. The right answer depends upon cancer type, underlying genomics, current treatments, any allergies, lifestyle information, and factors like BMI.

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Cancer patients often have to deal with different chemotherapy side effects which affect their quality of life and look out for alternative therapies for cancer. Taking the right nutrition and supplements based on scientific considerations (avoiding guesswork and random selection) is the best natural remedy for cancer and treatment related side-effects.