HIPEC Treatment Targets Tough Cancers by‘ Bathing ’Tumors in Chemo
Applying heated chemotherapy directly to cancer cells can help some patients with an aggressive form of the disease .
The biggest threat cancer poses happens when it spreads throughout the body .
Cancer that has spread to the lining of the abdominal cavity is particularly tricky . Once these advanced cancers have entered that area , they ’ re notoriously difficult to treat . Surgery alone is rarely successful , and traditional chemotherapy yields limited results .
But a treatment called HIPEC offers hope .
HIPEC , which stands for hyperthermic intraperitoneal chemotherapy , involves applying heated chemotherapy directly into the abdomen after surgery .
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“ For a number of different cancers , this seems to be our best opportunity to either cure or control the cancer much better than any other type of treatment , ” says Clifford Cho , M . D . , chief of hepatopancreatobiliary and advanced gastrointestinal surgery at Michigan Medicine . “ It ’ s something that has been around for a while but recently has started to pick up speed . ”
Cho , who has trained in the procedure and recently introduced it at the University of Michigan Rogel Cancer Center , answered common questions about HIPEC :
How HIPEC treatment works
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 .
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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 .
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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 .
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