Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Overview 

HIPEC, short for hyperthermic intraperitoneal chemotherapy, is a cancer treatment specifically designed for tumors located within the abdominal (peritoneal) cavity. This area encompasses vital organs such as the liver, stomach, and others. HIPEC is commonly employed when cancer has metastasized, or spread, from another part of the body to the abdominal cavity. 

How HIPEC Works: 

• Tumor removal: HIPEC begins with surgeons surgically removing cancerous tumors from the abdominal cavity. This step aims to reduce the tumor burden within the area. 
• Heated chemotherapy: The core principle of HIPEC lies in its ability to target microscopic cancer cells. The term “hyperthermic” refers to the application of heat. Heat, in this context, is cytotoxic, which means it can kill cancer cells. Research has shown that heating certain chemotherapy drugs enhances their effectiveness in killing cancer. During HIPEC, chemotherapy drugs are heated to temperatures ranging from 108 degrees Fahrenheit (41 to 43 degrees Celsius). 
• Intraperitoneal delivery: HIPEC involves the direct injection of chemotherapy drugs into the abdominal cavity. This method allows the drugs to reach tumors that systemic chemotherapy, which is delivered through the bloodstream, cannot effectively target. Importantly, during HIPEC, there is a continuous flow of heated chemotherapy drugs that circulate throughout the abdominal cavity. 

It’s essential to note that while HIPEC may help extend the life of patients with cancer in the abdominal cavity, it is not a curative treatment. Rather, it aims to manage and reduce the cancer’s presence, potentially leading to longer survival. 

[Text Wrapping Break]Reasons for undergoing the procedure  

HIPEC (hyperthermic intraperitoneal chemotherapy) is a treatment option employed by healthcare providers for individuals who have developed metastatic cancer within their abdominal cavity, originating from other parts of their body. When determining the suitability of HIPEC for a patient, several key factors are taken into account: 

• Existing medical conditions: The patient’s overall health and any pre-existing medical conditions play a significant role in the decision-making process. 
• Cancer type: The specific type of cancer that has metastasized into the abdominal cavity is a crucial consideration 
• Physical condition: The patient’s general physical strength and fitness level are evaluated to assess their ability to undergo HIPEC treatment. 
• Surgical history: The patient’s surgical history is examined to ensure that HIPEC is a feasible and safe option. 

HIPEC is commonly used to treat certain types of metastatic cancers, including: 

• Adrenal cancer. 
• Appendix cancer. 
• Colorectal cancer. 
• Liver cancer. 
• Ovarian cancer. 
• Stomach cancer.

In addition to these metastatic cancers, HIPEC may also be used to treat cancers originating in the abdominal region, such as: 

• Primary peritoneal cancer. 
• Peritoneal mesothelioma. 
• Pseudomyxoma peritonei. 

These factors are carefully considered by healthcare providers to determine the appropriateness of HIPEC as a treatment option for individual patients.[Text Wrapping Break] 

Risk

Surgery always entails certain inherent risks, such as the potential for excessive bleeding and infection. The specific risks associated with HIPEC can vary depending on factors like the type of cancer being treated and the chemotherapy drugs administered post-surgery. Your surgeon will provide you with a detailed explanation of the risks associated with HIPEC tailored to your individual case. 

Side effects commonly associated with HIPEC may include: 

• Pain. 
• Nausea and vomiting. 
• Diarrhea. 
• Constipation. 
• Bloating. 
• Weight loss. 
• Fatigue. 
• Depression. 
• Temporary loss of bowel function. 

[Text Wrapping Break]Procedure 

There are two steps to HIPEC surgery:  

• Cytoreductive Surgery: The initial step of HIPEC surgery is called cytoreductive surgery. The surgeon will make an abdominal incision while the patient is unconscious to inspect any obvious malignant tumors and damaged tissue.  
• HIPEC procedure: The HIPEC technique is the second step. A catheter holding the chemotherapy medications will be inserted and pushed into the abdominal cavity by the surgeon once all visible tumors and diseased tissue have been removed from the the stomach. The chemotherapy medications are heated and pumped through the abdomen for one to two hours using a perfusion machine that is attached to the catheters. Before closing the incision, the surgeon will remove any remaining chemotherapy from the abdomen and give it a salt solution washing.  

During the procedure  

One of the two steps of the procedure is called hyperthermic intraperitoneal chemotherapy (HIPEC). The first step is cytoreduction, which is surgery to remove injured abdominal tissue and malignant tumors. Steps in the treatment process include:  

• After receiving general anesthesia, the patient won’t experience any discomfort during the course of therapy.  
• The abdomen will be cut open by the surgeon, who will then remove any malignant tumors and damaged tissue.  
• Their surgeon will make an abdominal incision and place a catheter (or catheters) while they are still under anesthesia.  
• The chemotherapy will be heated to around 108 degrees Fahrenheit (41 degrees Celsius) by a machine that is attached to the catheter or catheters.  
• The chemotherapy will be pushed into the abdomen through the catheter by a pump.  
• The body may be gently shifted from side to side by the surgeon to ensure that the whole abdominal cavity is covered in the heated chemotherapy medicine.  
• Depending on the severity of the abdominal cancer, the therapy might take several hours.  
• After treating the patient, the surgeon will empty the abdomen and clean it with saline to remove the chemotherapy medicines.  
• Any incisions made during the operations will be closed by the surgeon.  

The extent to which the cancer has progressed throughout the abdomen will determine how long the surgery takes. Surgery may be required to treat cancer in an advanced stage.  

After the procedure  

Depending on the type of surgery used to remove the malignant tumor, the circumstances will change. A feeding tube may occasionally be required in order to provide the patient with nourishment while their body heals.  

Large dosages of strong chemotherapy are used in HIPEC, which may have an impact on bowel function. Once they receive therapy, most patients remain in the hospital for a few days to two weeks.  

Outcome 

This innovative technique offers advanced or terminally ill cancer patients expanded treatment options and the potential for improved long-term outcomes.  

There are a few benefits that HIPEC has over traditional chemotherapy.  

• The patient may experience fewer severe side effects because the body can safely absorb and eliminate the small quantity of chemotherapy that does leak out, and since 90% of the chemotherapy stays in the abdominal cavity.  
• In a part of the body that systemic chemotherapy cannot reach or often doesn’t help, the patient will get medications that destroy cancer. The peritoneum is a barrier that systemic chemotherapy cannot get through since it travels throughout the entire body. This is the membrane that encircles the organs that are housed in the abdominal cavity.  
• More malignant cells that remain after surgery can be destroyed by giving them higher dosages or more potent chemotherapy.  
• Instead of needing several therapy sessions spread out over several weeks, the patient will be able to finish treatment after just one session.  

Recovery following treatment can take anywhere from four to twelve weeks, with a few days to two weeks spent in the hospital.  

Call the healthcare provider following HIPEC if they encounter:  

• Fever  
• Nausea and vomiting.  
• Severe swelling.  
• Drainage at the incision site.  
• Pain that worsen overtime.