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The Peritoneal Cancer Index: what your PCI score means | CION Cancer Clinics
The Peritoneal Cancer Index, or PCI, is a number from nought to thirty-nine that describes how much cancer is spread across the lining of the abdomen and where it sits. Surgeons use it to judge whether an operation to remove all visible disease, usually with HIPEC, is realistic. It measures amount, not how aggressive the cancer is, and the same score means very different things in different cancers. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What does a PCI score actually mean?
- How does the surgeon arrive at the number?
- Which words next to the score should you understand?
- Why does the same score mean different things in different cancers?
- What else does the team weigh alongside the PCI?
- What families often assume about the PCI, and what is true
- Common questions about the Peritoneal Cancer Index
The short answer
What does a PCI score actually mean?
The Peritoneal Cancer Index, or PCI, is a number that describes how much cancer is spread across the lining of the abdomen and where it sits. The surgeon divides the abdomen into thirteen regions, scores the largest deposit in each from nought to three, and adds them up. The lowest possible score is nought and the highest is thirty-nine.
What it is used for
It is the main tool a team uses to decide whether an operation to remove all visible disease, usually followed by HIPEC, is realistic. A low score means little disease and a good chance of clearing it. A high score means a lot of disease, and the chance of clearing everything falls. It is a measure of amount, not of how aggressive the cancer is.
Where the number comes from
Most often it is scored during a keyhole look inside the abdomen, or at the start of the main operation. Scans can give a rough estimate, but they miss small deposits, so a PCI from a CT report is usually lower than the true figure. Check whether yours came from a scan or from the surgeon's own eyes.
This page explains the score. It cannot tell you whether your number means surgery is on or off the table. That depends on the cancer type, and the cut-offs differ widely between cancers.How it is scored
How does the surgeon arrive at the number?
The abdomen is divided into regions
Nine regions cover the main abdomen like a grid: the centre, the four corners and the four sides. Four more cover the small bowel, which is long and folded and is scored separately in its upper and lower halves.
Each region is examined
The surgeon looks at, and often feels, every surface in that region: the lining, the bowel, the organs. Only what can be seen or felt counts. Cells too small to see are not part of the score.
The largest deposit sets the region's score
Nought means nothing seen. One means only tiny deposits. Two means deposits up to about the size of a large coin. Three means anything bigger, or deposits that have run together into a sheet.
The thirteen scores are added
That total is the PCI. Two people with the same total can have very different maps, and the map matters as much as the total, because disease on the small bowel is far harder to remove than disease on the lining elsewhere.
Not sure whether this applies to you?
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Which words next to the score should you understand?
- Lesion size, or LS
- The nought-to-three score given to each region. LS-0 is nothing seen; LS-3 is a large or sheet-like deposit.
- Regions 0 to 8
- The nine areas of the main abdomen, numbered from the centre and working around the edges.
- Regions 9 to 12
- The four small-bowel regions. Disease here weighs more heavily in the surgeon's judgement than the number alone suggests.
- Radiological PCI
- An estimate made from a CT or MRI. Useful for planning but usually lower than the score the surgeon finds, because scans miss small deposits.
- Surgical PCI
- The score made by the surgeon looking directly, at laparoscopy or during the operation. This is the one decisions rest on.
- CC score
- A different number, recorded at the end of surgery, that says how much visible disease was left behind. PCI is measured before; CC after.
Reading the number
Why does the same score mean different things in different cancers?
Because the score measures how much disease there is, not how the cancer behaves, and cancers behave very differently on the lining. A score that would end the discussion for one cancer is routine for another.
Slow, jelly-like disease tolerates a high score
Pseudomyxoma peritonei spreads widely but slowly, and rarely travels through the blood. Surgeons regularly operate on very high scores, because if the jelly can be stripped out the result is worthwhile. A high PCI here is a description of a long operation, not a reason to stop.
Faster cancers need a low score
For colorectal cancer that has reached the lining, most teams set a limit somewhere in the middle of the range, above which the operation tends not to help. For stomach cancer the limit is much lower again, because it spreads in a fine, scattered way and the stomach itself usually has to be removed.
The map can override the total
A modest score with heavy small-bowel involvement can be a worse surgical prospect than a higher score spread over the lining, because there is a limit to how much small bowel can be removed. That is why surgeons talk about the distribution as much as the number.
Ask your team two things: what cut-off they use for your cancer, and how much of your score sits on the small bowel.Leave a number, we will call you
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Beyond the number
What else does the team weigh alongside the PCI?
The score is one input. These four sit beside it in every tumour board discussion.
The cancer type and grade
The single biggest factor in how a score is read. The same number can be routine, borderline or a clear no depending on where the cancer started and how fast it grows.
Spread outside the abdomen
Deposits in the liver, lungs or distant lymph glands usually rule the operation out whatever the PCI, because a surface operation cannot reach them.
Response to chemotherapy
For many cancers, chemotherapy through a vein is given first. A score that falls, or holds still, on treatment reads very differently from one that rises.
Fitness for the operation
Heart, lung and kidney function, weight and strength. A low PCI in someone too unwell for a long operation does not make the operation safe.
Sometimes changeable
- Nutrition support for a few weeks
- A supervised exercise programme
- Treating a low haemoglobin first
Commonly believed
What families often assume about the PCI, and what is true
"A high PCI means it is too late for anything."
It means there is a lot of visible disease on the lining. For some cancers that closes the door on surgery; for others it does not. And it says nothing about chemotherapy, fluid control or symptom relief, all of which remain available.
"The PCI on the CT report is the final number."
A scan-based PCI is an estimate and is usually lower than what the surgeon finds. The score that counts is the one made by direct inspection. Do not make plans, or lose hope, on the scan version alone.
"PCI tells you how aggressive the cancer is."
It measures amount and position, nothing else. Grade and type tell you about behaviour. A slow cancer with a high PCI and a fast cancer with a low PCI are very different situations.
"Two people with the same PCI will be treated the same."
Not if the cancers differ, or if one person's score sits mostly on the small bowel. The distribution, the type and fitness all pull on the decision. Compare notes with other families carefully, if at all.
Did you know
The PCI was designed by a surgeon, Paul Sugarbaker, so that teams in different countries could describe the same abdomen the same way. Before it, "widespread" meant whatever the person writing the report thought it meant.
Questions we are asked
Common questions about the Peritoneal Cancer Index
My father's report says PCI 18. Is that high?
It depends entirely on the cancer. For pseudomyxoma it is a modest score. For colorectal cancer it is in the range where teams weigh carefully. For stomach cancer it would usually be above the limit. Ask the team what cut-off they use for his cancer.
Can the PCI go down with chemotherapy?
Yes. Deposits can shrink or disappear on chemotherapy through a vein, and a repeat laparoscopy after treatment sometimes shows a lower score. That change, in either direction, is one of the most useful things a team can learn before deciding on surgery.
Does a PCI of nought mean there is no cancer?
It means nothing was visible on the lining at the time of the look. Cells too small to see can still be present, which is why a fluid wash is often taken at the same time and why follow-up continues. It is a good finding, not the same as no disease.
Why did the surgeon do a laparoscopy just to score it?
Because scans miss small deposits, and the difference between a scan estimate and the real score can change the whole plan. A short keyhole look lets the team decide with their own eyes rather than commit to a long operation on a guess.
Is PCI the same as stage?
No. Stage describes how far a cancer has spread in broad categories. PCI is a detailed count of the disease on the lining of the abdomen only. Two people at the same stage can have very different PCI scores.
What is the difference between PCI and CC score?
PCI is measured before the surgeon starts removing anything and says how much disease there is. The CC score is recorded at the end of the operation and says how much visible disease was left. One is the starting point; the other is the result.
Will the score change during the operation?
The surgeon scores it again at the start of the main operation, and it can differ from the laparoscopy score because more can be seen and felt through an open wound. If it is much higher than expected, the surgeon may stop rather than continue, and you should be told beforehand that this can happen.
Should I get a second opinion on the score?
A second opinion on the plan is reasonable, especially for a borderline score. The number itself is fairly consistent between experienced surgeons, but the cut-off applied to it varies between centres. Take the laparoscopy report, not just the letter, so the second team can see the region-by-region map.
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Dr. Vinay Mamidala
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Dr. Vajja Sandeep Kumar
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Sources
- NICE — Cytoreduction surgery followed by hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis (IPG331)
- National Cancer Institute — Definition of cytoreductive surgery
- Cancer Research UK — Pseudomyxoma peritonei (PMP)
- Cancer Research UK — Advanced bowel cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Completeness of Cytoreduction ScoreThe number recorded at the end of the operationWho Is Eligible for HIPEC?How the PCI fits with fitness and cancer typeHIPEC for Colorectal Peritoneal SpreadThe cancer where the PCI cut-off matters mostHIPEC for Pseudomyxoma PeritoneiThe cancer where a high PCI does not rule surgery outThe Pathology Report After SurgeryReading the rest of the report line by line
Talk to us
A PCI score you are not sure how to read?
Send us the laparoscopy or scan report or call the helpline. A surgical oncologist will explain what the number means for that cancer and which questions to take to your treating team. One helpline serves every CION centre.