Before a cancer diagnosis in an advanced stage, there are plenty of feelings that the patient experiences: uncertainty, fear, anger, denial… One of the most common ones is related to the lack of information and with it, all doubts emerge; ‘who can help me?’, ‘what is the most suitable treatment for me?’ or ‘what are my options?’.
One of the most innovative treatments for peritoneal carcinomatosis, the most advanced stage or metastatic stage of abdominal cancer, is the cytoreduction + HIPEC surgical technique, one of the specialties of J. Torrent Institute – Surgical Oncology.
In this article, we intend to answer the main questions about the treatment of advanced oncological surgery.
1. What is HIPEC?
HIPEC is a technique that consists in the performance of a cytoreductive surgery, that is, the surgical removal of all the peritoneal surfaces of the abdomen affected by a tumor. After the excision of all the carcinogenic zones, a dose of heated chemotherapy – at 41 or 42 degrees centigrade – directly inside of abdominal cavity. This process allows to eliminate the microscopic cancer-causing cells that may have remained in the abdomen after the surgery.
2. Why is the chemotherapy applied at high temperature?
It has been proved that heat has an anti-tumor effect, as it increases the penetration of the medication into the cells. As opposed to traditional chemotherapy, that is delivered via intravenous injection, the HIPEC treatment gets to act directly above the cancer-causing cells in the abdomen.
3. Can the HIPEC be applied as the treatment for all kinds of cancer?
No, it cannot. The HIPEC is a specific technique to treat cancers located abdominally. Currently, HIPEC can treat the following tumors:
- Ovarian cancer
- Peritoneal carcinomatosis from colorectal origin
- Carcinomatosis from a gastric origin (digestive cancers)
- Peritoneal Pseudomyxoma (PMP)
- Mesothelioma peritoneal Cancer
4. What does HIPEC stand for?
The acronyms come from the terms Hyperthermic IntraPeritoneal Chemotherapy.
5. How is the patient’s recovery after the medical procedure?
After a HIPEC, the patient usually spends a period of 7-10 days of hospitalization, and subsequently, a phase of resting at home that can extend along a month, approximately.
6. Are there studies that endorse the efficiency of HIPEC in the treatment of peritoneal carcinomatosis?
Yes, there are various studies that present positive conclusions. The study of reference would be the one published by the prestigious medical magazine “The New England Journal of Medicine” focused in its efficiency before ovarian cancer, under the name of “Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer”, from various authors (January 2018; 378:230-240).
This study, tested on 245 patients with ovarian cancer in stage III, shows that the group of patients that were intervened by a cytoreduction and a HIPEC, had an average of 11.8 more months of life that the group of patients treated without HIPEC surgery. If you would like to have more information about it, you can read the study here.
7. Which are the average rates of survival after the application of HIPEC treatments?
After the performance of a successful cytoreduction and HIPEC, “an average of 5 years survival are achieved in cancers from a colorectal origin, with a healing of up to 16% of that patients. More than 10 years of survival are achieved for ovarian cancers”, as Juan José Torrent explains, a gynecologist specialized in oncological surgery the director of J. Torrent Institute – Surgical Oncology.
These numbers, of course, depend on the disease progress status of each patient, as well as the typology of detected cancer.
8. Does the patient enjoy a good quality of life after the surgical intervention?
Yes, he does. The living standards of patients after the HIPEC is generally very good, basically because they do not have to undergo to other treatments, in case cancer does not show evidence again. Moreover, the performance of new definitive ostomy no longer needed generally (intestinal derivations in the abdomen), so the patient enjoys of an important autonomy.
9. Can this technique be applied to all patients diagnosed with peritoneal carcinomatosis?
No, it cannot. HIPEC can be applied once the proliferation of the metastasis is still controlled, according to the specialists’ assessment. In the cases in which HIPEC cannot be applied, another surgery can be performed, in this case, a laparoscopic surgery, called PIPAC. On this occasion, though the laparoscopic surgery, the chemotherapy is applied in an aerosol format, directly to the cancer-causing cells on the abdomen. If you want to know more about PIPAC, you can read more about it here.
10. What are the steps to follow if I am interested in HIPEC or PIPAC treatments?
In J. Torrent Institute – Surgical Oncology, located in Barcelona, a multidisciplinary team specialized in high complexity oncological surgery, like HIPEC, is at your disposal. If you desire to have more information about this surgery, you can contact the institute through our webpage.