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HIPEC attacks peritoneal malignancies with a one-two punch

HIPEC
Advances in cancer treatment, particularly in surgical approaches such as HIPEC, are offering new options to patients with advanced abdominal cancers, including peritoneal surface malignancies.

It is not a disease you hear about often. Perhaps that’s because peritoneal surface malignancies are rare, though very serious. But advances in cancer treatment, particularly in surgical approaches, are offering more options to patients with advanced abdominal cancers, including peritoneal surface malignancies.

“I see innovations in this field helping to prolong survival in some patients with appendix, colon and ovarian cancers,” says Hatem Halabi, MD, a Surgical Oncologist at Cancer Treatment Centers of America® (CTCA), Chicago. “New treatments are being provided in addition to systemic chemotherapy.”

It is not a disease you hear about often. Perhaps that’s because peritoneal surface malignancies are rare, though very serious. But advances in cancer treatment, particularly 

What are peritoneal surface malignancies?

The abdomen is lined with a thin, clear membrane called the peritoneum. A peritoneal surface malignancy, or carcinomatosis, develops when a tumor forms on top layers of that lining. Tumors that go undetected in the appendix, rectum and colon, stomach, ovaries or other organs may spread to peritoneal surfaces.

Until recently, treatment options were limited to offering patients relief from symptoms, with little progress made in killing the cancer or stopping it from recurring. Surgical advances have since led to a two-step treatment option for people with peritoneal surface malignancies: hyperthermic intraperitoneal chemotherapy, or HIPEC. The first step involves cytoreductive surgery, which removes visible tumors in the abdomen. Next, chemotherapy drugs are heated and sterilized, then delivered to the abdomen immediately after surgery.

Potential HIPEC benefits

Unlike traditional chemotherapy treatments, HIPEC is not available in pill form, nor can it be injected into an intravenous (IV) line. Instead, oncologists add the chemotherapy drugs to a heated saline solution and pump the mixture into the patient’s abdomen.

“The reason why we use heat in combination with chemotherapy in the HIPEC treatment is to broaden the effect on cancer cells,” says Julian Schink, MD, Chief Medical Officer for CTCA®. “Normal cells can withstand somewhat higher temperatures, but heat weakens cancer cells and makes them more susceptible to the chemotherapy. Higher temperatures can allow us to destroy more tumor cells using chemotherapy, and expose the cancer to 10 to 100 times higher concentrations of the drug.”

HIPEC is designed to destroy cancer cells that remain in the abdomen after surgery, which may result in some potential benefits. For instance, some HIPEC patients may experience fewer side effects than those who with traditional chemotherapy, which delivers drugs into the bloodstream. One downside of systemic chemotherapy is that, because the bloodstream sends the drugs throughout the body, healthy cells may be harmed in addition to cancer cells. Depleting healthy cells often causes side effects like hair loss and nausea. Because HIPEC is a targeted approach that only treats the area where the cancer has formed, it is designed to produce less severe side effects.

For those who experience side effects, supportive care services may help patients maintain the strength and endurance needed to stay on their treatment regimen. A nutritionist, for example, may recommend a diet designed to offset nausea and avoid malnutrition, while a naturopathic support provider may help patients manage diarrhea and fatigue.

Learn about maintaining a healthy weight during cancer treatment.