Hyperthermic Intraperitoneal Chemotherapy (HIPEC) affects cancer cells in the abdominal cavity, as close as possible to the area where the primary tumor was located. In contrast, conventional chemotherapy circulates throughout the body.
Hyperthermic chemotherapy of the abdominal cavity allows a higher concentration of drugs to be used. Heating the solution improves the effect of chemotherapy on the tumor.
The mechanism of HIPEC action
During surgery, all visible tumors are removed, but cancer cells may still remain in the abdominal cavity. If these cells are not destroyed, they will give rise to new foci, a relapse will occur, and the entire effect of the treatment will be nullified.
HIPEC helps to solve this problem. Through catheters connected to a special apparatus, the patient’s abdominal cavity is washed with a chemotherapeutic solution heated to 42-43°C. The procedure lasts for 30-90 minutes, after which the solution is completely removed from the abdominal cavity. Healthcare professionals constantly control the flow rate, pressure, and volume of the solution.
Why is intraperitoneal chemotherapy used?
Intraperitoneal chemotherapy is a treatment option for some patients with high-risk localized or metastatic malignancies of the abdomen. The use of a neonatal PICC line can be considered in these cases to manage post-chemotherapy complications such as bowel obstruction, ileus, and venous thromboembolism. These devices are inserted through an abdominal incision and positioned towards the pelvis on either side of the bladder. After removal of chemotherapy, they may also facilitate drainage after intraperitoneal hemorrhage or perforation.
Many types of cancers arising from the abdominal organs can also affect the abdominal membrane, called the “peritoneum.” Peritoneum is a tissue that facilitates the friction of organs by secreting a small amount of fluid that covers both the inside surface of the abdominal wall and the surface of the organs.
In cancers originating from the intraperitoneal organs, the cancer cells metastasize to the peritoneum. This usually indicates that the cancer has reached its final stage. For cancers associated with the peritoneum, conventional chemotherapy is ineffective because medications cannot reach the peritoneum.
The basic principle for treating abdominal cancer is the removal of the affected peritoneum and internal organs using cytoreductive surgery. Intraperitoneal chemotherapy is carried out after this operation in order to destroy the residual metastases.
Why does heating a chemotherapeutic drug give more benefits?
The heating of chemotherapeutic drugs gives the following positive effects:
- Heat helps to improve the penetration of drugs into tissues.
- Heat increases the destructive effect of a chemotherapeutic agent on cancer cells.
- Heat has an antitumor effect itself.
- As a result of heat, the drug is distributed evenly over all surfaces within the abdomen.
In addition, during HIPEC, you can monitor how the drug affects kidney function. Many physiological parameters (body temperature, coagulation, hemodynamics, etc.) can be normalized during the procedure. Moreover, tumor cells are mechanically eliminated from the surface of the small intestine and layers of fibrin clots.
When is HIPEC performed?
This therapy is most often used to treat ovarian cancer in women. In addition, it is used for cancer of the colon, stomach, appendix and cancers of the peritoneum. In recent years, it has also been used in pancreatic cancer. Peritoneal disease often involves the accumulation of fluid (ascites) in the abdominal cavity. These causes bloating of the patient’s abdomen, as well as spreading cancer cells to the diaphragm and other intra-abdominal organs.
Usually the fluid is removed via laparocentesis, but this does not solve the problem completely. Ascites will appear again as its root cause remains. Many patients with this disease are told that doctors cannot help them. In such patients cytoreductive surgery and HIPEC are used.
What are the contraindications for HIPEC?
HIPEC is not used for the therapy of metastases located outside the abdominal region. The oncological process should be localized only in the abdominal cavity. In addition, HIPEC chemotherapy is not used in patients with multiple liver metastases that cannot be removed. However, if metastases are not numerous HIPEC can be performed.
In patients with severe damage to the small intestine HIPEC is not performed. Most of these cases cannot be diagnosed before a surgery, it is possible to detect them only during the operation itself. Most candidates for this therapy are patients at the last stage of the disease, whose life expectancy is limited to several months. For them, this is the last hope for survival.
Where can I undergo the HIPEC treatment?
HIPEC procedures have been actively applied worldwide for several years. In recent years, the technology has been improved. This technology is widely used abroad, in particular in Germany, where a number of healthcare institutions have modern equipment for this procedure.
In German clinics, you can undergo diagnostics and treatment as soon as possible. You can learn more about the HIPEC surgery on the Booking Health website, having reviewed all the programs and methods of treatment abroad.