It's normal to feel a lot of fear when your doctor tells you that cancer has spread inside your stomach, that is, your abdominal cavity. In addition to the usual chemotherapy, today we are going to talk about a more effective treatment method that is specific to these cases. This is called HIPEC. Let's see what it is like.
Simply put, what is HIPEC?
The full meaning of HIPEC is Hyperthermic Intraperitoneal Chemotherapy . Although the name may sound complicated, what happens is very simple. This is a two-part cancer treatment.
Imagine that you have a cancerous tumor inside your abdomen (abdominal cavity). This cavity is where our vital organs like our liver and stomach are located.
1. First step: The doctors will first perform surgery and remove almost all of the cancerous tumors that are visible inside the stomach.
2. Second step: Then, to destroy any remaining cancer cells that are not visible to the eye, a highly heated (Hyperthermic) chemotherapy solution is injected directly into the abdomen (intraperitoneal) to thoroughly wash and open the cavity.
Simply put, this treatment involves removing the cancerous tumors and flushing the inside of the stomach with heated chemotherapy drugs to destroy any remaining cancer cells.
What types of cancer is this treatment given for?
HIPEC treatment is usually used for cancers that have spread (metastasized) from elsewhere in the body to the abdomen, that is, the abdominal cavity. It is also sometimes used for cancers that start in the abdomen itself.
| Cancer type | Description |
|---|---|
| Metastatic Cancers | |
| Cancer of the adrenal gland | Appendix Cancer |
| Colon cancer | Colorectal Cancer |
| Ovarian cancer | Ovarian Cancer |
| Stomach cancer | Stomach Cancer |
| Liver cancer | Liver Cancer |
| Adrenal gland cancer | Adrenal Cancer |
| Primary Peritoneal Cancers | |
| Primary abdominal cavity cancer | Primary Peritoneal Cancer |
| Peritoneal mesothelioma | Peritoneal Mesothelioma |
| Pseudomyxoma peritonei | Pseudomyxoma Peritonei |
The important thing is that HIPEC treatment may not completely cure the cancer. However, this treatment allows patients to live longer and with a better quality of life . Your doctor will explain the advantages and disadvantages of this treatment to you.
How should you prepare before this surgery?
This is a very serious, major surgery and treatment. Therefore, it is very important that you are in the best possible physical and mental health before you undergo it. Your doctor will tell you everything you need to know to prepare you. This may include:
- If you smoke, stop it completely.
- Avoiding alcohol.
- Strengthen your lungs by doing breathing exercises (using a device like an incentive spirometer).
- Joining a support group with others who are battling cancer like you or meeting with a counselor can be a great way to strengthen your mental health.
What happens during treatment?
As we talked about earlier, this is a two-part process.
Part One: Cytoreductive Surgery (CRS)
This is the first and biggest step. Surgeons will cut out and remove all of the visible cancerous growths and diseased tissue inside your abdomen. You will be under general anesthesia throughout this entire procedure. So you will not feel any pain. You will be in a deep sleep.
Part Two: HIPEC Treatment
This part is done right after the cancerous tumor is removed, while you are under anesthesia.
1. Inserting a tube: The doctor will make a small incision in the skin of your abdomen and insert a tube (catheter) through it into your abdomen. This tube is connected to a machine that heats the chemotherapy drugs.
2. Administering heated chemotherapy: This machine heats the chemotherapy to about 41 degrees Celsius (108 degrees Fahrenheit). The heated liquid is then pumped through the tube into your stomach.
3. Dispensing the medicine: Next, the doctor will slowly turn your body from side to side to ensure that the medicine reaches every nook and cranny of your stomach. Just like we shake a basin, this will thoroughly wash the inside of your stomach with the medicine.
4. Removal of the medication: After about 30 to 90 minutes, the chemo drugs that were sent into the stomach are taken out again. Then, the stomach is washed out again with saline solution.
5. Stitching the incisions: Finally, all the incisions made during the surgery are stitched closed.
The entire process, including surgery and HIPEC, can take anywhere from 5 to 10 hours , depending on how far the cancer has spread within the stomach.
What are the benefits and risks of HIPEC treatment?
Like any treatment, HIPEC has both benefits and risks.
| Benefits | Risks |
|---|---|
| High-concentration chemotherapy: Because chemotherapy drugs are delivered directly to the site of cancer cells, they can be given in much stronger doses than regular chemotherapy. Heating the drugs further increases their ability to kill cancer. | Common risks of surgery: The risks of any major surgery, such as excessive bleeding and infection, are common to this one as well. |
| Reduced side effects: Since the medicine is given only inside the stomach, less of it gets absorbed into the bloodstream and travels throughout the body. This can reduce the side effects of regular chemotherapy, such as hair loss and excessive vomiting. | Specific risks: There may be specific risks depending on the type of chemotherapy given and the type of cancer you have. Your doctor will explain these to you separately. |
| Treatment is completed in one go: There is no need to go through multiple rounds like regular chemotherapy. This treatment is done in one go with the surgery. | Recovery time: Since this is a major surgery, it can take weeks or months to recover. |
What happens after treatment?
Things may change depending on your condition after surgery.
- Stay in the Intensive Care Unit (ICU): You may be kept in the ICU for a few days after surgery, where you will be closely monitored. You may also be connected to a ventilator to help you breathe.
- Feeding through a tube: Until your bowel function returns to normal, you may be given liquid food through a feeding tube inserted through your nose.
- Side effects: The following may occur during the recovery period:
- Filling the stomach
- Constipation or diarrhea
- Excessive fatigue
- Nausea and vomiting
- Pain around the cut roads
- Swelling (due to the saline solution used to wash the inside of the stomach)
How long does it take to heal?
It can take anywhere from 4 to 12 weeks to fully recover from this treatment. This includes a few days to two weeks in the hospital. Your doctor will give you instructions on how to take care of yourself after you go home.
What time should I call the doctor?
If you develop any of these symptoms after returning home, you should call your doctor immediately.
Seek immediate medical attention if your fever is higher than 38.3 degrees Celsius (101°F), you have persistent nausea and vomiting, your incision is very swollen, hot, and oozing pus, or your pain is getting worse. These may be signs of an infection.
Types of medications used for HIPEC
There are several types of chemotherapy drugs that are commonly used for this treatment. The doctor will explain which drugs you are being given and why.
- Carboplatin
- Cisplatin
- Doxorubicin
- Mitomycin
- Oxaliplatin
Doctors only recommend HIPEC treatment if the benefits clearly outweigh the risks. If you are recommended this treatment, be sure to ask your doctor why and what results you can expect based on your condition.
Take-Home Message
- HIPEC is a specific treatment for cancer that has spread to the abdominal cavity. It involves surgically removing the cancer cells and injecting heated chemotherapy drugs into the abdomen.
- This may not be a complete cure for cancer, but it can greatly help extend life and reduce symptoms.
- Since this is a major surgery, it is very important to be well prepared physically and mentally.
- It may take several weeks or months to heal, and side effects may occur during that time.
- It is essential to have an open and thorough discussion with your doctor about whether this treatment is right for you and what its pros and cons are.
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