Omental cake is a radiological finding indicative of thickening in the greater omentum, an important part of the peritoneum, the membrane that lines the abdominal cavity. It can be a sign of metastasis or other disease. Care providers may recommend a biopsy to learn more about the nature of the thickening and determine what, if any, action might be appropriate. Patients with this warning sign can discuss the implications with their doctors to learn more about the situation and how to proceed.
The greater omentum consists of folded peritoneum which stores fat and plays a role in some immune processes. When omental cake forms, it means soft tissue has invaded the fat, which will change its appearance on medical imaging studies. Thickening may also occur, enlarging the greater omentum. It may be possible to see lesions in the abdomen which could provide important clues into the cause of the changes. For example, signs of tumors could be present.
Unusual radiological findings are not necessarily an immediate cause for concern, because they need to be put in context. A radiologist may recommend a repeat test, possibly using different equipment or a new angle, to confirm the findings. What appears to be omental cake might be an artifact on the film, for example, or the result of poor image processing. Radiologists can also consider patient history. In a patient with a history of uterine cancer, for example, this condition might not be an unexpected finding.
In a biopsy, a surgeon can take a small sample from the area of interest, using the scans for guidance to locate the area of greatest buildup. A pathologist can review the samples in a lab to learn more about the origins of the omental cake. Tumor cells, for example, can be traced to determine where they started growing, which can be critical for the development of a treatment plan. The pathologist may ask to see the scans to learn more about the nature of the situation.
Treatment options after finding the thickening depend on what is causing it. Patients may need surgery, chemotherapy, and radiation to address cancers of the abdomen, for example. Once cancers start to metastasize to the peritoneum they can be much more difficult to treat, but they are not necessarily fatal. Outcomes can depend on the specific cancer, the patient’s medical history, and overall level of health.