Treatment for peritoneal metastasis cancer
HIPEC (Hyperthermic Intra Peritoneal Chemotherapy)
What is HIPEC?
HIPEC or Hyperthermic Intra Peritoneal Chemotherapy is the chemotherapy treatment using high temperature of 42°C flowing through abdomen to eliminate the sporadic cancer cells within the abdominal area. The treatment is usually employed together with Cytoreductive surgery (CRS) to remove as much tumour as possible before applying the chemotherapy.
What is CRS?
CRS is shortened for Cytoreductive surgery which is the surgery aiming to reduce tumour cells to the smallest fragment before continuing to HIPEC treatment. The leftover tumour should not be bigger than 3 millimetres in each position for the effective result. The combination of CRS and HIPEC provides higher survival rate for the patients than the traditional approach.
Who is suitable for the CRS+HIPEC treatment?
The patients with peritoneal metastasis cancer diagnosis without the spread to other organs outside an abdomen such as bones or lungs. The symptoms of the patients are bloated abdomen with or without pain which can be found after tumour surgery in colon, ovary, and appendix.
Pre-treatment physical examination
To find the precise origin of the cancer for most suitable treatment, the patients are required to do a detailed physical examination.
The process of treatment
Most of CRS will also resect the organ where tumours are attached to as well as dissect parietal peritoneum which cover the diseased organ. The operation lasts at least 6 hours and continues with HIPEC treatment about 60 – 90 minutes after the surgery.
The peritoneal metastasis cancer in which HIPEC is effective
1. Cancer of Appendix
2. Ovarian Cancer
3. Psuedomyxoma Peritoneii
4. Peritoneal Mesothelioma
5. Colon Cancer
6. Gastric Cancer
The benefits of HIPEC over the traditional chemotherapy
The traditional method of chemotherapy injecting through veins cannot effectively pass to the sporadic tumour in abdomen and ascites. The concentration of the chemical substances is also lessened due to transportation process and not enough to eliminate large amount of cancer cells. HIPEC, on the other hand, will directly deliver the chemical substances to the tumour cells in abdomen. With warm temperature the concentration of the chemical substances is considered to increase by 30 times higher than normal and have better performance to eliminate the cancer cells. Furthermore, the direct delivery of the chemical substances to abdomen has fewer complications comparing to the delivery through vein.
However, not all the patients with peritoneal metastasis cancer diagnosis can receive CRS+HIPEC treatment. The screening process must be carefully run to assure that the patient is suitable for the treatment as the surgery is complicated and has high risk for complications.
Preparation for CRS with HIPEC treatment
1. Check all the x-ray results.
2. Check all the previous surgery.
3. Check the result tumour tissue examination.
4. Summarise all the previous chemotherapy.
5. Do some specific blood examinations (Tumour marker e.g. CEA, CA19.9, CA125).
CRS = Remove tumour mass + Peritonectomy
Statistics of the CRS – HIPEC treatment result in 20 – 40% survival rate in 5 years varied in different type of cancer.
The cost of the CRS – HIPEC treatment is approximate 1.5 – 2 million baht including 7 – 10 days in hospital.
Complications rate is around 15%
Mortality rate is around 5 – 10 %