OVERVIEW
HIPEC (Hyperthermic Intraperitoneal Chemotherapy) surgery is a unique and targeted treatment approach that is primarily recommended for certain abdominal cancers. This procedure involves delivering heated chemotherapy drugs directly into the abdominal cavity after cytoreductive surgery (removing as much cancer tissue as possible), which is a part of certain abdomen cancer treatment plans involving the appendix, stomach, and colon. The heat enhances the effectiveness of the chemotherapy drugs, increasing their ability to kill cancer cells.
What is HIPEC (Hyperthermic Intraperitoneal Chemotherapy) Surgery?
HIPEC surgery is a specialized treatment approach used to treat advanced abdominal cancers, including appendix, colon, or ovary cancers. During HIPEC surgery, the surgeon first removes visible tumors from the abdominal cavity (cytoreductive surgery). Then, heated chemotherapy drugs are circulated throughout the abdomen. This process helps to kill any remaining cancer cells and microscopic tumors while minimizing damage to healthy tissues. HIPEC offers a localized treatment approach, targeting cancer cells directly, thereby improving patient outcomes.
What Types of Cancer Does HIPEC Surgery Treat?
HIPEC surgery treats the following types of cancer:
Appendix Cancer
HIPEC surgery for appendix cancer involves removing visible tumors from the abdomen, followed by circulating heated chemotherapy to target the remaining cancer cells. The procedure aims to improve outcomes, especially for advanced forms of appendix cancer.
Adrenal Cancer
HIPEC surgery for adrenal cancer is performed when the disease has invaded the tissues and organs of the abdominal cavity. Adrenal cancer is also treated with surgery, during which the affected adrenal gland is removed.
Colon Cancer
HIPEC surgery for colon cancer involves a two-step approach. Surgeons first remove visible tumors from the abdomen, including those originating in the colon. Then, heated chemotherapy is circulated within the abdominal cavity to target the remaining colon cancer cells. Chemo for colon cancer is also used to manage metastatic colon cancer, along with other treatment options.
Liver Cancer
Chemo for liver cancer is one of the most commonly recommended treatment options. HIPEC surgery is not commonly used for liver cancer treatment, as the liver is located outside the abdominal cavity. However, HIPEC surgery is performed if the liver cancer has metastasized to the tissues and organs of the abdominal cavity.
Ovarian Cancer
HIPEC surgery is not a standard approach for ovarian cancer treatment. However, HIPEC may be recommended for ovarian cancers that have spread to the lining of the abdomen. The procedure involves two parts: first, the cancer surgeon performs cytoreductive or debulking cancer surgery, which removes as much macroscopic (visible) and microscopic cancer tissue as possible. This is followed by circulating heated chemotherapy drugs within the abdominal cavity to kill the malignant cells. In the advanced stages, administering chemo for ovarian cancer through HIPEC has been found to delay disease progression and control symptoms.
Pancreatic Cancer
Chemotherapy for pancreatic cancer is one of the most effective treatment approaches. However, chemotherapy through HIPEC is not a standard treatment for pancreatic cancer. HIPEC surgery may be recommended in pancreatic cancer cases where the disease has spread to the abdominal cavity.
Mesothelioma
HIPEC surgery may also be recommended for the management of peritoneal mesothelioma. This procedure has two parts: the debulking surgery, where surgeons remove as much cancerous tissue as possible. This surgery is followed by the HIPEC chemo treatment, wherein heated chemotherapy drugs are made to circulate inside the abdominal cavity, where they kill the residual cancer cells. This treatment approach has been found to improve survival rates.
Stomach Cancer
The administration of chemotherapy drugs for stomach cancer management positively impacts survival rates and the overall treatment results. However, administering chemo for stomach cancer through HIPEC is not a standard approach. HIPEC is only recommended in cases where stomach cancer has spread to the peritoneum, which is the tissue that lines the abdominal cavity.
Peritoneal Cancer
Peritoneal cancer refers to advanced-stage cancer that affects the peritoneum, a thin tissue lining present over the abdominal cavity. HIPEC surgery for peritoneal cancer aims to eliminate cancer cells, thereby improving overall health outcomes for patients.
Rectal Cancer
In rare cases, rectal cancers that have spread to the abdominal cavity are managed with HIPEC surgery. Chemo for rectal cancer through HIPEC is not a standard approach for rectal cancer management. In patients with advanced-stage rectal cancer that has spread to the abdominal cavity, HIPEC may delay the disease progression, prolong survival, and alleviate symptoms associated with the disease.
How is HIPEC Surgery Performed?
HIPEC surgery is a two-step process.
Cytoreductive Surgery
Cytoreductive surgery, which is performed before HIPEC, involves the removal of macroscopic and microscopic cancerous tissue from the abdominal cavity. Surgeons precisely excise tumors, aiming for complete eradication.
HIPEC Procedure
This refers to the administration of chemo after surgery. During HIPEC, heated chemotherapy drugs are administered into the abdominal cavity. After removing visible tumors, surgeons circulate the chemotherapy solution, targeting any remaining cancer cells. This combined approach aims to eradicate residual disease.
How does HIPEC Procedure Work?
A SPECT scan consists of two steps:
Hyperthermic
The hyperthermic characteristic of the HIPEC procedure involves elevating the temperature of the chemotherapy solution circulated within the abdominal cavity to approximately 41–43 °C. This elevated temperature enhances the effectiveness of the chemotherapy, improving its ability to penetrate cancer cells and increasing treatment efficacy against abdominal cancers.
Intraperitoneal
The intraperitoneal characteristic of HIPEC treatment involves delivering chemotherapy directly into the abdominal cavity. The heated chemotherapy solution is circulated within the peritoneal space, targeting any remaining cancer cells. This localized delivery maximizes chemotherapy concentration in the area of need, improving treatment outcomes. It also helps reduce damage to healthy cells and the side effects associated with it.
What Should You Expect When You Have a HIPEC Operation?
The patients may expect the following during and after a HIPEC surgery:
During HIPEC
The procedure of HIPEC surgery is divided into two parts: cytoreductive surgery and HIPEC, or hyperthermic intraperitoneal chemotherapy. First, surgeons will perform cytoreductive surgery to remove as much cancer tissue as possible from the abdominal cavity. Once this is completed, a heated chemotherapy solution will be circulated within the abdomen for a specified duration, typically around 1-2 hours. The nurse will closely monitor vital signs throughout the procedure, ensuring comfort and safety. After surgery, you'll be closely monitored in the hospital for recovery and potential side effects of the treatment.
After HIPEC
After HIPEC surgery, patients may expect to remain in the hospital for some time. They may experience fatigue, pain, and discomfort, which medication can manage. The patient is closely monitored for complications and provided with support as needed. Patients may need to follow specific dietary and activity guidelines as they recover. Attending follow-up appointments is essential to evaluating the condition and adjusting the treatment plan if necessary.
What are the Potential Advantages of HIPEC Operation?
The potential advantages of HIPEC cancer treatment surgery include:
Less Serious Side Effects
HIPEC surgery may have fewer systemic side effects than traditional chemotherapy, as the chemotherapy is confined to the abdominal cavity. This localized delivery minimizes exposure to healthy tissues and organs, reducing common side effects like nausea, vomiting, and hair loss.
More Intense Chemotherapy
HIPEC surgery is a highly intensive treatment approach wherein heated chemotherapy drugs are administered directly into the abdominal cavity. By localizing the treatment, HIPEC maximizes the concentration of chemotherapy drugs in the abdominal cavity, which facilitates better targeting of cancer cells.
Single-Session Treatment
HIPEC surgery is, typically, a single-session treatment approach. After cytoreductive surgery to remove visible tumors, the heated chemotherapy solution is circulated within the abdomen for a specified duration, typically around 1-2 hours.
Enhanced Targeting of Cancer Cells, Which May Not Be Possible With Standard Chemotherapy
During HIPEC surgery, various cancer drugs used in chemotherapy are delivered precisely to the abdominal cavity and not to the entire body. Standard chemotherapy is systemic, travels throughout the body, and destroys cancer cells and healthy cells. HIPEC, on the other hand, is localized and only targets cells in the abdominal cavity. Due to its enhanced accuracy and efficiency, HIPEC can be a better treatment approach for certain abdominal cancers than standard chemotherapy.
What are the Side Effects of HIPEC Surgery?
Some of the side effects of HIPEC surgery are:
Diarrhea
Diarrhea can occur as a side effect of HIPEC surgery. The heated chemotherapy solution may irritate the intestines, leading to diarrhea.
Nausea and Vomiting
Nausea and vomiting may occur after HIPEC surgery, often due to the impact of HIPEC chemotherapy on the gastrointestinal tract, such as in chemo for stomach cancer.
Pain
During HIPEC surgery, patients may experience discomfort or pain, which can vary depending on individual tolerance levels and the extent of the procedure.
Weight Loss
Weight loss during HIPEC surgery can occur due to various factors. The stress of surgery, changes in appetite, and potential gastrointestinal side effects may contribute to temporary weight loss post-surgery.
Bloating
Bloating during HIPEC surgery can occur due to the accumulation of gas in the abdominal cavity, which is common during abdominal surgeries. It may result from the surgical procedure, the use of anesthesia, or the heated chemotherapy solution.
Depression
Depression during HIPEC surgery is possible due to the stress of the procedure, concerns about the cancer diagnosis, and potential changes in lifestyle and body image. Patients may have sadness, anxiety, or hopelessness. To manage the emotional distress associated with cancer and its treatment efficiently, one may consider psycho-oncology counseling.
Fatigue
Fatigue during HIPEC surgery can occur due to the physical and emotional effects of the procedure. The stress of surgery, anesthesia, and potential side effects like nausea and pain can contribute to feelings of exhaustion.
Constipation
Constipation after HIPEC surgery can occur due to various factors, such as anesthesia, pain medications, dietary changes, and reduced physical activity.
Why Should You Choose HCG for HIPEC Surgery?
HCG Cancer Centre is a top cancer treatment hospital in India for the diagnosis and treatment of various early-stage and advanced-stage cancers originating from different body organs. This cancer hospital is equipped with the latest treatment options for managing advanced abdominal cancers, including HIPEC operation. We have globally trained HIPEC surgeons with experience managing complex abdominal cancer with enhanced personalization and patient-centricity. The operating rooms here are equipped with state-of-the-art facilities and advanced instruments to improve outcomes.
HIPEC Surgeons at HCG Oncology
Across the HCG network, we have some of the best HIPEC surgeons in India who have completed their specialized training at reputed national and international medical institutes. From the first consultation to the follow-up after treatment, these specialists are trained to put their patients at the center of their care journey, involve them in treatment-related discussions, and help patients lead a fulfilling life after their treatment at HCG.
Conclusion
HIPEC surgery serves as a targeted approach for certain advanced-stage abdominal cancers by delivering heated chemotherapy directly into the abdominal cavity. While outcomes vary, HIPEC can provide significant benefits, including improved disease control and potentially extended survival, offering hope for patients with advanced cancers.
Frequently Asked Questions
After HIPEC surgery, you may gradually resume eating once bowel function returns and your medical team approves. Typically, this occurs within a few days to a week post-surgery, starting with clear liquids and advancing to a regular diet as tolerated.
HIPEC surgery can be associated with varying levels of discomfort or pain, depending on factors such as individual pain tolerance, the extent of the procedure, and post-operative care.
HIPEC can be used as both a palliative and curative treatment, depending on the individual patient's circumstances and the stage of their cancer. HIPEC surgery may also be used in patients with no cure for stomach cancer (advanced stomach cancer) to manage symptoms.
Yes, you may undergo HIPEC surgery more than once, depending on your circumstances, such as the development of a new tumor or a cancer recurrence.
To prepare for HIPEC surgery, consult your medical team, undergo evaluations, educate yourself about the procedure, follow pre-operative instructions, arrange support, and plan post-operative care.
In open HIPEC, the abdomen is left open during surgery, allowing direct access to the abdominal cavity.
In closed HIPEC, the abdomen is closed after cytoreductive surgery, and the heated chemotherapy solution is circulated through closed tubing systems.
The success of HIPEC surgery can vary depending on factors such as the type and stage of cancer, the extent of tumor removal during surgery, and individual patient factors.
The life expectancy after HIPEC surgery varies widely. It depends on factors such as the type and stage of cancer, the extent of tumor removal during surgery, response to treatment, and individual patient factors such as overall health and age.
Hair loss is not a common side effect of HIPEC surgery because the chemotherapy drugs used are delivered directly into the abdominal cavity, targeting cancer cells in that area.
