1. What is it? Any common name for this procedure?
HIPEC is an intensive, concentrated form of liquid chemotherapy that is heated and circulated directly inside the abdominal cavity. Unlike traditional chemotherapy, which is delivered through the bloodstream (systemic), HIPEC is a localized treatment. It is performed at the end of a surgery while the patient is still under anesthesia.
The solution is heated to approximately 41°C to 42°C (about the temperature of a warm bath). This heat is critical because it makes cancer cells more "porous" and easier to kill while also directly damaging the proteins within the tumor cells.
Common Names:
- Hot Chemotherapy
- Intraperitoneal Hyperthermic Chemoperfusion (IPHC)
- Chemo Bath
2. Common Indications: When is it Recommended?
HIPEC is not a standalone treatment; it is almost always performed immediately after Cytoreductive Surgery (CRS) once all visible tumors have been removed.
- Appendix Cancer (Pseudomyxoma Peritonei): The most successful application of HIPEC.
- Colorectal Cancer: When the cancer has spread specifically to the peritoneal lining (Stage IV).
- Ovarian Cancer: Often used for advanced-stage or recurrent ovarian cancer to kill microscopic cells on the surface of the bowels and diaphragm.
- Peritoneal Mesothelioma: An aggressive cancer of the abdominal lining.
- Stomach (Gastric) Cancer: In specific cases where the cancer has "shed" into the abdominal fluid.
3. List of Associated Diseases and Conditions
- Peritoneal Carcinomatosis: The spread of any abdominal cancer to the lining of the cavity.
- Malignant Ascites: A condition where cancer causes the abdomen to fill with liters of fluid; HIPEC can help stop this fluid from returning.
4. List of Screening Tests and Assessment Tools
Before HIPEC is approved, doctors must ensure the chemotherapy will actually reach the remaining cancer cells.
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Tool
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Purpose
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Peritoneal Cancer Index (PCI)
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A map used during surgery; a lower score (less spread) usually predicts a better response to HIPEC.
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Diagnostic Laparoscopy
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To ensure there aren't heavy "plaques" of cancer on the small bowel, which would make the chemo less effective.
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Kidney Function Tests (Creatinine)
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Because the body absorbs some of the chemo, your kidneys must be strong enough to filter it out afterward.
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5. Am I Eligible for This Evaluation?
- Successful Debulking: You are eligible if the surgeon can remove all or nearly all visible cancer (nodes <2>
- Confined to Abdomen: The cancer must not have spread to the lungs, liver (parenchyma), or bones.
- Organ Health: You must have adequate bone marrow, liver, and kidney function to handle the concentrated drugs.
6. The Procedure: What Happens Inside?
- Step 1: The Debulking: The surgeon spends several hours removing all visible tumors.
- Step 2: The Perfusion: Catheters are placed in the abdomen and connected to a specialized HIPEC machine.
- Step 3: The Bath: The heated chemo is pumped in and "shaken" or circulated for 30 to 90 minutes.
- Step 4: The Rinse: The chemo is drained, the abdomen is rinsed with saline, and the incisions are closed.
7. Post-Care and Recovery
- High-Intensity Monitoring: Patients often stay in the ICU for 24–48 hours to monitor fluid balance and kidney function.
- Nutrition: A "J-tube" (feeding tube) is sometimes placed during surgery because the bowels can be "stunned" by the heat and chemo and may not work for 1–2 weeks.
- Fever/Inflammation: It is normal to feel very warm or have a mild fever for a few days as the body processes the "thermal" part of the treatment.
8. Benefits of HIPEC
- Higher Drug Concentration: The dose of chemo used in HIPEC is much higher than what could be safely given through an IV, but because it stays in the abdomen, it doesn't cause the same level of hair loss or full-body sickness.
- Heat Synergy: The heat itself is a cancer-killer and significantly boosts the power of the drugs.
- Single Treatment: Unlike months of IV chemo, HIPEC is a one-time "hit" delivered directly to the target.
- Increased Life Expectancy: For certain cancers, HIPEC has extended survival from months to many years.
