What is HIPEC?
Hyperthermic (or Heated) Intraperitoneal Chemotherapy (HIPEC) is a surgical procedure that’s giving new hope to patients with abdominal cancers. Immediately after removing visible tumors through what’s called cytoreductive surgery, your surgeons pump a powerful dose of heated chemotherapy inside a patient’s abdomen.
In fact, HIPEC is a cancer treatment that pumps warm chemotherapy drugs into your abdomen. You get one very large dose of chemotherapy, but it's not as toxic. That’s because the drugs aren’t injected into your bloodstream, so they don’t move around your body as much as chemotherapy given through an IV.
The chemotherapy drugs are heated to about 105-109 degrees F. Cancer cells can't handle heat as well as healthy cells. The heat also helps the drugs enter your cells more easily and work better.
HIPEC is major surgery, and you'll spend time recovering in the hospital.
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What kinds of cancer can be treated with this procedure?
The most common tumors treated by HIPEC are:
. Appendix tumors such as
. Pseudomyxoma peritonei
. Low-grade appendiceal mucinous neoplasm
. Adrenal cancer
. Malignant ascites
. Pancreatic cancer
. Desmoplastic small round cell tumors (typically occurs in adolescents or young adults)
. Peritoneal cancer
. Other locally advanced cancers in the abdomen.
Who are the good candidates for HIPEC Treatment?
As with any aggressive treatment, not all patients are eligible for HIPEC treatment.
Peritoneal mesothelioma patients must:
. Be healthy enough for surgery
. Not have heart disease or other serious chronic conditions
. Not have more than one bowel obstruction or partial obstruction
. Have a low peritoneal cancer index score (which estimates tumor growth and tumor spread).
. Have an epithelial cell type (other cell types are carefully considered)
Doctors look for patients who are otherwise healthy except for their cancer diagnosis. They conduct assessments to determine a patient’s overall health, which they call performance status.
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What are the benefits of HIPEC procedures?
. HIPEC allows for a higher concentration of chemotherapy to be delivered into the abdomen more effectively and safer than standard chemotherapy, which is delivered intravenously.
. This type of chemotherapy is best at killing cancer cells that are too small to be seen with the naked eye.
. Chemotherapy delivered through HIPEC causes fewer side effects than intravenous chemotherapy. This is because the high concentrations of chemotherapy solution are unable to cross what is known as the peritoneal plasma barrier.
. Experts say that pairing surgery and HIPEC together may be more beneficial than chemotherapy alone.
Side Effects of HIPEC
. Wound infections
. Urinary tract infections
. Blood clots
. Bowel obstruction
. Disruption of normal bowel motility (which reduces appetite)
. Fistula (a connection between the skin and intestines)
. Myelosuppression (bone marrow produces fewer platelets and blood cells)
During Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
The HIPEC process
The procedure has two phases: Cytoreductive surgery followed by heated chemotherapy.
Phase I: Surgery
First, doctors perform cytoreductive surgery to remove as much tumor growth as possible from the abdominal cavity. You'll get general anesthesia, so you won’t be “awake” for it.
HIPEC without surgery is ineffective because the chemo drugs cannot penetrate deep into cancerous tumors. In some cases, complete removal of the tumors is impossible and patients may need to explore other treatment options.
Phase II: Chemotherapy Bath
Mesothelioma doctors any remaining cancer cells with heated chemotherapy immediately after surgery to extend survival and prevent cancer recurrence.
The usual chemotherapy drugs, including carboplatin, cisplatin, doxorubicin, gemcitabine and pemetrexed, have all been used for heated chemotherapy. Instead of injecting these drugs into your blood, doctors deliver them directly to the chest or abdomen.
How the HIPEC machine works?
. Doctors insert catheters into the abdominal cavity and connect them to the perfusion system, which heats the chemotherapy solution and pumps it to and from the body.
. As the solution flows through the machine, a heating element raises it to between 105 and 109 F. Cancer cells start to die when heated to around 104 F, while normal cells can survive up to 111 F.
. A doctor massages the abdomen by hand to ensure the solution is fully mixed. This step helps the drugs reach remaining cancer cells.
. The chemotherapy drugs flow between the patient and perfusion system for about one hour.
. When the chemotherapy bath is finished, doctors drain the medicated solution from the body.
. The cavity is later rinsed with only a saline solution before the catheter is removed and incision is closed.
The entire procedure, including surgery and HIPEC, may take between six and 18 hours to complete because surgery times vary. The more the cancer has spread within the abdomen, the longer surgery will take.
After Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Recovery after HIPEC
After surgery, you'll spend about 2 days in intensive care. Doctors and other health care professionals will check you for fluid loss and will test your electrolytes and blood glucose levels.
You'll get insulin if your blood sugar level gets too high because this can slow down wound healing, make infection more likely, and cause other problems. You'll most likely get antibiotics to help ward off infection. And you'll be given pain meds while the surgical wound heals, probably in the form of an epidural.
As for eating, you might start off with IV nutrition, but the goal will be for you to eat solid foods as soon as possible. Doing so will help get your bowel function back to normal faster.
Once you move out of intensive care, you'll stay at the hospital to continue healing for another 6-20 days, on average, while you recover.
The most challenging aspect of recovery is fatigue. It will likely take two to three months until you begin to feel back to normal. Until then, it is important to stay active (within your limits) and maintain good nutrition.
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