Hyperthermic Intraperitoneal Chemotherapy
Used with surgery, this treatment targets abdominal cancers that have spread into the abdomen. Contact 734-647-8902 to arrange for a consult.
The biggest threat cancer poses happens when it spreads throughout the body. One particularly tricky spot is cancer that’s spread to the lining of the abdominal cavity (peritoneum and/or peritoneal cavity). These advanced cancers are notoriously difficult to treat. Surgery alone is rarely successful, and traditional chemotherapy yields limited results.
Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a process in which heated chemotherapy is pumped directly into the abdomen after surgery.
Read about two people who have had HIPEC
Adrenal Cancer Patient Treated with HIPEC
HIPEC Combines Chemotherapy and Surgery to Target Abdominal Cysts
What kinds of cancer can be treated with this procedure?
The most common tumors treated by HIPEC are:
- colorectal cancers
- appendix tumors such as
- pseudomyxoma peritonei
- low-grade appendiceal mucinous neoplasm
Other cancers treated by HIPEC are:
- mesothelioma
- adrenal cancer
- ovarian cancer
- liver cancer
- pancreatic cancer
Is HIPEC used for diseases other than cancer?
HIPEC is also an effective palliative therapy for people with malignant ascites, or an accumulation of fluid buildup in the abdomen. This is a side effect of having tumors lining the peritoneum. A one-time HIPEC treatment can replace repeated visits for paracentesis for some patients.
Watch animation of a HIPEC procedure
How do you know if you qualify?
Some people have metastatic cancer that is spread in the body in the typical way, which is through the blood stream. For those people, standard chemotherapy is by far the best.
Most of what this process treats are intra-abdominal cancers that, for reasons that aren’t totally clear, sometimes metastasize not by getting into the blood stream and going to different organs, but actually spilling over into the abdominal cavity.
We rely on CAT scans and MRI scans to show us the location and distribution of the tumors, which can help us decide if someone qualifies for HIPEC.
The HIPEC process
First, surgeons remove all visible tumors from the abdomen. This is known as cytoreductive surgery. While the patient is still in the operating room, a heated chemotherapy drug is pumped through the abdominal cavity. Surgeons rock the patient back and forth on the operating table for about 2 hours to ensure direct contact with all of the remaining cancer cells.
Delivering the chemo this way also means that it does not get absorbed systemically. It goes right to where the tumor cells are and doesn’t have the kind of systemic side effects that can come with traditional chemotherapy.
What patients should know
This operation can be very long. Depending on how many tumors need to be removed, the tumor removal portion of the operation can take anywhere from a couple of hours to as many as eight or nine hours, and chemotherapy application takes another two hours.
Talk to your doctor to learn if this procedure is for you, or call 734--647-8902 for more information.
Questions and Answers about HIPEC
With Clifford Cho, M.D., chief of hepatopancreatobiliary and advanced gastrointestinal surgery at Michigan Medicine and is lead of the surgery team for gastrointestinal cancer care at the U-M Rogel Cancer Center
What kinds of cancer can this procedure treat?
Cho: This process addresses cancers that are grouped together under the term peritoneal surface malignancies, or PSM. This describes the way some cancers spread. It can encompass colon cancer, appendix cancer, mesothelioma cancer and adrenal cancer.
Mostly, we’re talking about intra-abdominal cancers that, for reasons that aren’t totally clear, sometimes metastasize not by getting into the bloodstream and going to different organs, but actually sort of spilling over into the abdominal cavity.
Surgery by itself has never worked well because it’s impossible to get rid of all of it. It’s just the nature of the way it spreads. It’s like trying to pull out dandelions; you just can’t get them all.
But if you combine it with HIPEC, there is some evidence that it makes a big impact.
How do you know if you qualify for HIPEC?
Cho: Some people have metastatic cancer that is spread in the body in the typical way, which is through the bloodstream. For those people, standard chemotherapy is by far the best.
Some people have this pattern where the cancer is not so much inside the liver or inside the lungs or inside the bones, but it’s more inside the lining of the belly. We rely on CAT scans and MRI scans to show us the location and distribution of the tumors, which can help us decide if someone qualifies for HIPEC.
Now, some people have both ways of developing metastatic disease -- through the bloodstream and into the abdominal cavity. For those people we are careful, because it’s hard to do both treatments concurrently. We have to make those decisions very carefully.
Can you describe the process?
Cho: Assuming we go through the whole process and they’re good candidates, the operation itself can be very long. It really is driven more by how much tumor there is that we have to remove (from the abdomen). Sometimes the removal of the tumor portion only takes a couple of hours, but sometimes that alone can take eight or nine hours.
After we remove all the tumors we can see, we fill up the belly with chemo. It’s heated chemo, so it penetrates the tissue. Basically, what we’re doing is bathing any leftover cancer cells in chemotherapy. This way, you get direct contact to the cancer cells with the chemo as opposed to when you give it traditionally through a port or through a vein.
Delivering the chemo this way also means that it does not get absorbed systemically. It goes right to where the tumor cells are and doesn’t have the kind of systemic side effects that we always worry about with traditional chemotherapy.
What should patients know before the operation prior to HIPEC?
Cho: The challenge with this type of disease is that it is hard to know, even with a CAT scan, exactly what the operation is going to entail.
Sometimes we must remove multiple organs -- because many times it’s not just a big tumor but seeding of little tumor deposits throughout the abdominal cavity. You might not know what you will need to remove until you do the operation.
Also, because of the duration of the operation and how much tumor removal there is, oftentimes even if everything goes perfectly, people can be in the hospital for over a week. Usually the reason is because the bowel falls asleep, which is the natural response to a big operation. And because this is a bigger operation than most, that sometimes lasts longer.
Can HIPEC offer a second chance to some people who might otherwise be facing palliative care?
Cho: Under the right circumstances, yes. This is a way of treating some tumors that are otherwise just inaccessible.