Explaining HIPEC treatment for cancers that have spread to the peritoneum

Learning that your cancer has spread can be terrifying. But there are treatments available to lengthen life and improve its quality, even for some of the most advanced cancer cases.

One such procedure combines surgery with targeted, heated chemotherapy to help manage late-stage cancers that have spread to the peritoneum – a thin membrane that lines the abdominal and pelvic cavity and covers the surfaces of some organs.

HIPEC, or hyperthermic intraperitoneal chemotherapy, involves a two-part surgery, during which the inside of the belly is bathed with a heated chemo rinse after visible tumors have been removed.

Here’s how HIPEC works, who it may help and what to expect during recovery.

What is HIPEC?

HIPEC is a one-time chemotherapy treatment delivered during surgery. It’s used in combination with cytoreductive surgery – surgery to remove all visible tumor inside your abdomen – to help treat cancer that affects your peritoneal surfaces.

The chemotherapy is circulated in the abdominal cavity as a hot “bath” to target microscopic cancer cells after surgeons remove visible tumors.

Combining both procedures, the operation is often called cytoreductive surgery (CRS) with HIPEC.

Conditions commonly treated by CRS/HIPEC

HIPEC is used for cancers that involve the peritoneum – the lining of the abdominal cavity and surfaces of abdominal organs. This includes the rare cancer that starts in the peritoneum or cancers that spread to the cavity from other areas.

Examples include:

• Peritoneal mesothelioma
• Cancers originating in the colon, rectum, appendix or other places along the gastrointestinal tract
• Cancers originating in the ovaries

How HIPEC differs from “traditional” chemotherapy

Traditional systemic chemotherapy travels through the bloodstream to reach cancer cells throughout the body. It’s not highly effective at penetrating the peritoneum to treat cancers that have spread to this location.

HIPEC is localized. The chemotherapy is concentrated in the abdominal cavity to directly contact tumor cells, and systemic absorption is minimized. Because the peritoneum acts as a barrier between the belly area and the rest of the body, HIPEC can be delivered at high doses with significantly less absorption into the bloodstream, minimizing potential side effects.

The goal is to get a high concentration in the belly while limiting the effect the chemo has throughout the body.

Why chemotherapy is heated for HIPEC

During HIPEC, chemotherapy is heated to about 108 degrees.

This heat increases the cancer-killing effect of chemotherapy and can help the drugs penetrate more deeply.

Heat itself can also kill cancer cells.

Who is a good candidate for HIPEC?

HIPEC is a highly individualized treatment option, and whether it’s appropriate depends on the primary cancer type and the extent of cancer that’s present.

A key factor in determining if HIPEC is appropriate is finding out how likely it is that surgeons can remove all visible tumors during the first part of the operation. HIPEC may be less successful if that’s not possible.

Also, because it involves a long, complex operation, patients generally need to be in reasonably good overall health.

Surgery with HIPEC, step-by-step

The full procedure, including tumor removal, typically lasts all day, depending on how much tumor needs to be removed.

• After the patient is under anesthesia, surgeons make an incision down the middle of the abdomen. They then systematically evaluate the extent of the tumor, some of which may not have been visible on pre-surgery CT scans.
• Surgeons remove any visible tumor. This can include removing part of the peritoneum, fatty tissue or organs that are affected by tumors.
• Tubes are placed in the abdomen to deliver the chemotherapy, and the incision is temporarily closed.
• This heated chemotherapy is sent through the tubes via a perfusion/heating machine, and the solution circulates in the abdominal cavity, typically for 60–90 minutes.
• After the HIPEC treatment is completed, the chemotherapy solution is removed, and the incision is reopened to inspect and perform any needed repairs/connections.
• The incision is then closed, and the operation is concluded.

Patients often stay in the hospital to recover for one to two weeks. Overall recovery can take up to six months or longer.

Why HIPEC is needed after tumor removal

While surgery removes tumors that can be seen, HIPEC targets microscopic cancer cells that may remain.

It works best when there is little to no visible tumor left.

HIPEC risks, side effects and recovery expectations

Even though HIPEC is a localized treatment, it can still have side effects, including temporary changes in kidney function, bowel function and blood counts. Other side effects can include changes in taste, hair thinning and wound issues.

Successful HIPEC: What happens next

If tumors are completely removed and HIPEC is successfully performed, a patient’s disease can be controlled for a longer period of time compared with other treatment options.

The impact of treatment varies widely depending on the type of cancer. Some patients, for example, can take a long break from systemic chemotherapy. Others might benefit from symptom relief or less pain caused by the buildup of tumors.

Can cancer come back after HIPEC?

Cancer recurrence can happen after HIPEC, and the likelihood strongly depends on the type of cancer, the amount of tumor and whether surgery could remove the tumors completely.

The clinical care team behind HIPEC

Cancer that has spread is a complex issue, and CRS/HIPEC is often just one of the many parts of treatment that can be important for controlling disease.

CRS/HIPEC can be a major undertaking.

Support and guidance for a patient’s overall treatment plan, which may include this type of major operation and long-term recovery, requires a multidisciplinary team of surgeons, specialized medical and radiation oncologists, pathologists, anesthesiologists, operating room staff, nurses and patient-care resource managers, among others.

This helps ensure a wide range of expertise and experience for multidisciplinary treatment, as well as for support during surgical recovery.

Because some conditions treated with CRS/HIPEC are rare with limited research available, experience and expertise can be critical.