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Peritoneal carcinomatosis is viewed by many experts as a terminal illness with an unfavourable course and prognosis. Existing therapies are controversial and exhibit ambiguous efficacy. We review the current state of the art in therapy for peritoneal metastases of various origin and its historical background. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy compound the treatment of choice as achieving the highest survival rates. Palliative surgery and systemic chemotherapy are an alternative that proved even more aggressive and ineffective in comparative survival evaluations. Manifold studies and expert opinions exist on the efficacy and expedience of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in treatment of peritoneal carcinomatosis. Today, however, their routine use in everyday practice is hotly debated. Despite an evident progress in managing peritoneal metastases, a series of questions remain unsolved. Contentious research data, late diagnosis, low treatment efficacy in severe peritoneal dissemination, a limited applicability of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, all highlight the importance of inventing and developing novel methods for early high-accuracy diagnosis and careful selection of the treatment strategy. Fundamental knowledge of malignant metastasis underlies the choice of patient management and the innovative toolkit for prevention and treatment of peritoneal carcinomatosis.