Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

What is hyperthermic intraperitoneal chemotherapy (HIPEC)?

Hyperthermic intraperitoneal chemotherapy (HIPEC) is cancer treatment for tumors in your abdominal (peritoneal) cavity. This is the place in your belly that holds your liver, stomach and several other organs. During treatment, surgeons remove cancerous tumors. Then, they circulate heated (“hyperthermic”) chemotherapy drugs inside your belly to kill any remaining cancer cells.

Healthcare providers typically use HIPEC to treat cancer that’s spread (metastasized) from another part of your body to your peritoneal cavity. Metastatic cancers that HIPEC treats include:

• Adrenal cancer
• Appendix cancer
• Colorectal cancer
• Liver cancer
• Ovarian cancer
• Stomach cancer

They may also use HIPEC to treat cancers that start in your belly, like:

• Primary peritoneal cancer
• Peritoneal mesothelioma
• Pseudomyxoma pertonei

HIPEC doesn’t cure cancer, but treatments may help you live longer. Your healthcare provider will review the pros and cons of treatment with you.

How should I prepare for this procedure?

Your healthcare provider will work with you closely to prepare you for HIPEC. This is an intensive cancer treatment and procedure. You’ll want to be in the best possible health — both physically and mentally — beforehand. Preparation may involve:

• Quitting smoking
• Stopping alcohol use
• Using an incentive spirometer to strengthen your lungs
• Joining a support group or connecting with a therapist who works with people living with cancer

What happens during HIPEC?

Hyperthermic intraperitoneal chemotherapy is the second part of a two-part process. The first part is cytoreductive surgery (CRS). This surgery removes cancerous tumors and diseased tissue from your abdominal cavity. You’ll receive general anesthesia that puts you to sleep for surgery and for the HIPEC treatment that follows. That way, you won’t feel any pain.

During the HIPEC procedure, your healthcare provider will:

1. Insert a catheter through a cut (incision) in your belly. The catheter will be connected to a machine that heats the chemotherapy to about 108 degrees Fahrenheit (41 degrees Celsius).
2. Deliver the chemotherapy drugs. The machine will pump the heated chemotherapy drugs through the catheter and into your belly.
3. Distribute the chemotherapy. Your provider may gently move your body from side to side so the chemotherapy washes over your belly cavity. (Think of rinsing a bowl by tilting it side to side.)
4. Drain the chemotherapy. Your provider will drain the chemotherapy drugs from your peritoneal cavity. Then, they’ll rinse it with saline.
5. Close your incisions. Your surgeon will close any cuts made during cytoreductive surgery or HIPEC.

How long does this procedure take?

On average, cytoreductive surgery and HIPEC together take from five to 10 and a half hours. The chemotherapy infusion part typically takes from 30 minutes up to two hours of the total time. Much depends on the amount of cancer in your belly.

What are the potential benefits and risks of HIPEC?

HIPEC allows you to receive cancer-killing drugs in an area of your body that systemic chemotherapy can’t normally reach. Systemic chemotherapy travels through your entire body via your bloodstream. But it can’t get past your peritoneum barrier. This is the membrane that lines your abdominal cavity.

But HIPEC bypasses the barrier and kills cancer cells directly.

Other benefits include:

• High-dose (powerful) chemotherapy. The heat makes the chemo even more toxic to cancer. The direct application allows the treatment to penetrate tumors, killing the cancer cells inside.
• Fewer treatment sessions. You’re able to complete treatment in a single session. With systemic chemotherapy, treatment usually involves several sessions, or “rounds,” of chemotherapy.
• Fewer side effects. The chemotherapy is mostly limited to your abdominal cavity. This means you may have fewer side effects than with systemic chemotherapy.

Still, all surgeries carry risks, like excessive bleeding and infection. HIPEC risks vary depending on the type of cancer and the type of chemotherapy drugs you receive. Your provider will explain the risks involved based on your unique treatment.

What happens after this procedure?

What happens after HIPEC depends on your situation. For example, you may need to stay in the intensive care unit (ICU) for a few days. In the ICU, you may be on a ventilator to help with breathing.

In the next few days or weeks while you’re in the hospital, you may need to use a feeding tube to receive nutrition while your system recovers. That’s because HIPEC involves large doses of powerful chemotherapy that can affect bowel function.

During recovery, you may also experience side effects like:

• Bloated stomach
• Constipation
• Diarrhea
• Fatigue
• Nausea and vomiting
• Pain at the incision site
• Swelling (the saline rinse can cause parts of your body to retain fluid immediately after)

What’s the recovery time for HIPEC?

It can take four to 12 weeks to recover from the treatment. This includes several days to two weeks of recovery in the hospital. Your healthcare provider will explain what you’ll need to do to prepare for at-home recovery.

Can cancer come back after HIPEC surgery?

It’s important to remember that HIPEC doesn’t cure cancer. The tumors in your belly can come back (recur). Likewise, you may develop new tumors if cancer outside your abdomen spreads there.

But for many people, HIPEC means longer survival with fewer symptoms. A recent study about the benefits of HIPEC found that it extended the life expectancy of people with advanced ovarian cancer. In this study, people received CRS and HIPEC after getting systemic chemotherapy.

Still, your prognosis (likely treatment outcome) depends on lots of factors. Ask your healthcare provider which factors will impact the results you should expect.

When should I call my healthcare provider?

After HIPEC, call your provider if you experience:

• Fever above 101 degrees F (38.3 degrees C)
• Nausea and vomiting that don’t improve
• Severe swelling, warmth or drainage around your incision site
• Worsening pain

These signs may mean an infection or that you’re not healing as you should. It’s important to seek care immediately to get your recovery back on track.

What drugs are used in hyperthermic intraperitoneal chemotherapy?

The most common chemotherapy drugs used for HIPEC include:

• Carboplatin
• Cisplatin
• Doxorubicin
• Flurorouracil
• Mitomycin
• Oxaliplatin
• Paclitaxel

They’re all powerful cancer fighters, but there are slight differences in how they work. Your provider can explain which drug or drug combinations they’ve chosen and why.