Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Doctors use Hyperthermic Intraperitoneal Chemotherapy, or HIPEC, to treat cancer of the abdomen, or stomach area.

Certain cancers in the abdomen produce cells that spread into the abdominal cavity (or peritoneum). These cells can be deposited throughout the abdominal cavity from the diaphragm to the pelvis. When tumor cells spread into the abdominal cavity (or the peritoneal cavity) the disease process is called carcinomatosis.

If the cancer is contained only in the abdomen and has not spread to the lungs, bones or lymph nodes outside the abdominal cavity, surgery can be performed to remove the tumors cells with the goal to remove all visible cancer. This surgical process is called cytoreduction. Standard surgical techniques are used to remove visible tumor nodules.

For optimal treatment response, the cytoreduction of tumor is followed by the circulation of concentrated chemotherapy directly into the abdominal cavity at an elevated temperature with the goal of killing any remaining tumor cells. The infusion of heated chemotherapy into the abdominal cavity is called HIPEC which stands for Heated Intraperitoneal Chemotherapy.

Standard chemotherapy is delivered through a port or IV and circulates throughout the body. HIPEC, on the other hand, delivers chemotherapy directly to cancer cells in the abdomen. This form of delivery allows for higher doses of chemotherapy to be exposed to cancer cells. Heating the solution may also improve the amount of chemotherapy that is absorbed by tumor cells and may increase the effectiveness of the chemotherapy.

Cytoreduction of tumor cells and infusion of heated chemotherapy can be used for tumors originating from the appendix, colon, rectum, stomach, small intestine, peritoneal lining, ovary and sarcomas.

The subtypes of cancer that respond best to HIPEC are those that produce mucous (or mucinous tumors), those that have not spread to lymph nodes or to the liver, and those that originate in the appendix or right colon. The subtypes of cancer are the following:

• Mucinous Neoplasms of the Appendix
• Mucinous Adenocarcinoma of the Colon
• Low Volume Carcionmatosis from the Colon, Gastric or Appendiceal Adenocarcinoma
• Primary Peritoneal Carcinoma (Mesothelioma)
• Peritoneal Sarcomatosis

The surgery and heated chemotherapy are used in conjunction with standard IV chemotherapy and is often used as an additional tool to treat cancer.

• Allows for delivery of higher doses of chemotherapy than what can be given in the IV
• Enhances the effectiveness of chemotherapy within the abdomen
• Minimizes the exposure of chemotherapy to the rest of the body
• Improves chemotherapy absorption into any remaining cancer cells
• Reduces some systemic chemotherapy side effects
• Can be a single treatment modality for some cancers

Once maximal removal of tumor has been performed, special tubes (or catheters) are placed into the abdomen to allow entry of the chemotherapy. The tubes are connected to a machine that circulates the chemotherapy in the abdomen. The abdominal skin is then closed temporarily to keep the chemotherapy from spilling out of the abdominal cavity. The chemotherapy is heated to 42° Celsius which is 107.6° Fahrenheit. The chemotherapy is circulated for 90 minutes at this temperature.

Once the chemotherapy circulation is complete, the chemotherapy is removed from the abdomen using suction and diluting the fluid with saline. Once all the fluid is removed, the abdomen is reopened and the entire cavity is inspected including the bowels to make sure all the tissue is healthy. At this point, the bowels are reattached or an ostomy is placed. An ostomy can be created with small intestine (an ileostomy) or with the colon (a colostomy). At this point, the abdominal is now completely closed and the operation is finished.

After surgery, the recovery for the first night will be in the surgical intensive care. The goal of the intensive care stay is to make sure the blood pressure is stable, that pain is controlled, and that breathing is adequate and safe.

Once surgery is complete, you will be taken to the recovery room. Recovery can take several hours. The recovery room ensures that each patient has sufficiently awakened from surgery before going to the intensive care. You will next go to the intensive care unit for at least the first night after surgery. The first night is to ensure close monitoring of vital signs and ensure adequate pain control. The milestones (or goals) of HIPEC surgery include good pain control, early ambulation (or walking), early advancement of a diet, good blood glucose control (even if you are not a diabetic), and preparation for going home.

• Appendiceal Cancer: 3-year survival is 35%-78% depending on the grade of disease and the extent of cytoreduction
• Colon Cancer: 3-year survival is 24%-39% depending on the grade and extent of disease

First year after treatment

• Physical examination every three to six months by your treating team and lab work based on the origin of the tumor
• Abdominal and chest CT scan every three to six months if your treating team determines you are at a high risk of recurrence or if abdominal symptoms such as pain, nausea, inability to pass gas develop

Second year after treatment

• Physical examination every three to six months by your treating team and lab work based on the origin of the tumor
• Abdominal and chest CT scan every three to six months if your treating team determines you are at a high risk of recurrence or if abdominal symptoms such as pain, nausea, inability to pass gas develop

Third year after treatment

• Physical examination every three to six months by your treating team and lab work based on the origin of the tumor
• Abdominal and chest CT scan every three to six months if your treating team determines you are at a high risk of recurrence or if abdominal symptoms such as pain, nausea, inability to pass gas develop

Fourth year after treatment

• Physical examination every six months by your treating team and lab work based on the origin of the tumor
• Abdominal and chest CT scan every six to twelve months if your treating team determines you are at a high risk of recurrence or if abdominal symptoms such as pain, nausea, inability to pass gas develop

Fifth year after treatment

• Physical examination every six months by your treating team and lab work based on the origin of the tumor
• Abdominal and chest CT scan every six to twelve months if your treating team determines you are at a high risk of recurrence or if abdominal symptoms such as pain, nausea, inability to pass gas develop

In addition to regular follow-up care, people recovering from HIPEC surgery are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, exercising, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs.

To learn more about follow-up care for HIPEC, consider asking the following questions of your health care team:

• What is my risk of recurrence?
• What follow-up tests will I need, and how often will I need them? (Examples include blood tests, and CT scans)
• Where will these tests be done?
• Who will be coordinating my follow-up care?
• If I move or need to switch doctors, how do I make sure to continue my recommended follow-up care schedule?
• What signs and symptoms should I watch for?
• What type of follow-up care do I need beyond five years after treatment?
• Where can I find more information about follow-up care?

For more information on our services or to schedule an appointment contact the Gastrointestinal Tumor Service (GITS) at 865-305-GITS (4487).