HIPEC (Hyperthermic Intraperitoneal Chemotherapy)

peritoneal carcinomatosis

Peritoneal carcinomatosis or peritoneal cancer

Every year, hundreds of thousands of patients are diagnosed with “peritoneal cancer”. This diagnosis includes patients with malignant mesothelioma, peritoneal pseudomyxoma (PMP) and peritoneal metastases of malignant tumours located in different regions of the body (colorectal cancer, gastric cancer, appendiceal cancer, ovarian cancer). Some time ago, peritoneal cancer was considered inoperable, the statistics for these patients being totally against them. Currently, treatment for peritoneal cancer patients is evolving every day, with new treatment methods becoming available. One of the current treatments that works for carefully selected patients may include HIPEC (hyperthermic intraperitoneal chemo therapy), which is a complex and challenging procedure. In applying this type of treatment, the expertise of several medical specialists with extensive experience in the treatment of advanced cancers is needed.

All the organs in the abdominal cavity – such as the stomach, intestine – and the abdominal wall are covered with a layer of cells. This covering is called the ‘peritoneal sheet’ or ‘peritoneum’. Unfortunately, the peritoneum can be invaded by cancer cells. This condition is most commonly referred to as “peritoneal cancer” but may also be referred to as peritoneal surface malignancy, peritoneal carcinomatosis, peritoneal metastases or peritoneal pseudomyxoma (PMP).

Peritoneal carcinomatosis originates from cancer cells that are spread from a primary tumour that has a different location in the body. Cancer cells diffuse to the peritoneum, attach and begin to grow and grow on the peritoneal surface. Almost any primary tumour in the human body can cause this disease, but the colon, stomach and ovaries are the most common organs of origin. As a rule, cancer cells continue to grow and form small tumour nodules (between 2 and 5 mm) on the peritoneum. However, larger tumours are not uncommon and sometimes, in advanced stages of disease, conglomerates of nodules form. Peritoneal cancer nodules can occur anywhere in the abdominal cavity, but the most common locations are the diaphragm, pelvis, omentum and intestinal serosa. These cancerous nodules will eventually block the intestines, also causing intra-abdominal fluid accumulation (“neoplastic ascites”). Peritoneal carcinomatosis or peritoneal cancer should be regarded as a very serious and advanced form of cancer.

HIPEC is an acronym for hyperthermic intraperitoneal chemotherapy. It is a medical procedure that involves applying chemotherapy directly into the abdominal cavity, accompanied by heating the chemotherapeutic fluid to a temperature of 41 to 43 degrees. The aim is to prevent the recurrence of cancer disease by acting on microscopic cells that may remain after surgery. The aim of the procedure is to destroy cancer cells in the abdominal cavity and improve the effectiveness of chemotherapy, provided that the systemic effects (sickness) are less severe.

The HIPEC procedure is mainly used to treat advanced abdominal cavity cancers that do not respond to other forms of treatment. This type of cancer can be difficult to treat because cancer cells can spread throughout the abdomen. By applying chemotherapy directly into the abdominal cavity, doctors can destroy cancer cells in that area and, at the same time, heating the chemotherapy fluid at high temperatures can improve the chemotherapy’s effectiveness. All these HIPEC procedures must be preceded by a total removal of the tumours. That is why the most important in this treatment is the expertise of the surgical team who must have extensive experience in digestive and cancer surgery.

The HIPEC procedure aims to radically remove all cancer cells from the abdominal cavity by combining surgery with intra-abdominal administration of high-temperature chemotherapy. The aim of this treatment is to prolong long-term survival or even cure the patient. The operation is performed under general anaesthesia and usually takes 6 to 9 hours. However, some procedures require a much longer operating time.

Typically, a HIPEC procedure has four stages combined into one surgical procedure: exploration, resection, HIPEC and reconstruction.

For some patients, HIPEC can be a life-prolonging or even life-saving treatment. Unfortunately, not all patients with peritoneal carcinomatosis will have a positive outcome after a HIPEC procedure. Each patient needs to be treated and analysed individually, for which several factors should be considered. Some of these factors are: origin of peritoneal cancer, extent of disease, biological status and cancer located outside the abdomen.

In addition to the factors mentioned above, other factors should also be taken into account, depending on the patient, as they may influence recommendations for the best possible medical treatment. In addition, indications for a HIPEC procedure may vary between countries and even between hospitals in the same country, depending on local experience. Ideally, a patient with peritoneal carcinomatosis should be counseled by a multidisciplinary team of experts with specific knowledge of peritoneal cancer to determine the optimal treatment strategy. The strategy may include HIPEC in selected careful patients.

In general, the decision to perform a HIPEC procedure depends on several factors, including the type of cancer, the stage of the disease and the patient’s overall health.

In terms of the effectiveness of the procedure, studies show that HIPEC can improve the survival of colorectal cancer patients. In ovarian cancer, HIPEC can help prevent recurrence of the disease and improve long-term survival. In colorectal cancer, HIPEC can help control symptoms and prolong a patient’s life. However, results vary from case to case, and it is important that the patient discusses all available treatment options with their doctor.

The treatment of patients with peritoneal carcinomatosis and in particular the HIPEC procedure is complex and requires a dedicated, experienced multi-disciplinary team. To achieve the desired results, treatment for peritoneal cancer should only be offered in institutions with optimal surgical knowledge and skills. So is the safe administration of intraperitoneal chemotherapy. These treatments are usually carried out in specialised hospitals with extensive experience in treating abdominal cancer. Worldwide there is currently no quality assurance certificate for HIPEC centres, so patients should research the reputation of a HIPEC centre very carefully before seeking this procedure – treatment.

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