How HIPEC Surgery Treats Abdominal Cancers
Any type of Stage IV cancer is serious, but if the cancer spreads to the peritoneum (a membrane that lines the abdomen), it can be particularly difficult to treat.
“These cancers are sort of like glue and they cause blockages of the intestine or they can fill the abdomen up with fluid,” says Kiran Turaga, MD, MPH, chief of Surgical Oncology at Yale Medicine.
An abdomen filled with fluid can cause many uncomfortable symptoms, including fatigue, cramping, blood in the stool, heartburn, weight loss, and swelling. Cancer that originates in the peritoneum is rare, but each year, approximately 60,000 people in the United States have cancer that has spread to the peritoneum from other areas of the body, including from the gastrointestinal tract, appendix, and ovaries.
Chemotherapy delivered intravenously doesn’t easily reach the peritoneum, Dr. Turaga explains. That’s partly because of a peritoneal-blood barrier, which blocks the delivery of chemotherapy to this area. Fortunately, a type of surgery called HIPEC (hypothermic intraperitoneal chemotherapy) can help.
HIPEC is used in conjunction with cytoreductive surgery, which removes all visible tumors from the abdominal cavity. After surgery, HIPEC uses a targeted, heated chemotherapy wash to bathe the peritoneum and surrounding organs to destroy any remaining cancer cells.
“We remove the tumors, and then use this hot chemotherapy, which works on the surfaces to sterilize them,” Dr. Turaga says. “Because it only works on the surfaces and doesn’t penetrate deep, patients don’t have the same side effects as they would from IV chemotherapy. We can deliver high concentrations of chemotherapy, without adding many side effects.”
Heating chemotherapy drugs (to 108° F) allows them to better penetrate tissue because the high temperature expands blood vessels. Plus, the heat itself can kill cancer cells. The heated chemotherapy solution remains in the abdominal cavity for about 90 minutes.
For some people, HIPEC, combined with cytoreductive surgery, can result in a cure. For others, it can make an incurable cancer as manageable as a chronic illness.
In the video above, Dr. Turaga talks more about HIPEC.
