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CRS/HIPEC & Peritoneal Carcinomatosis Overview

Section Overview:

Understanding Peritoneal Carcinomatosis.
Understanding CRS/HIPEC.
Who should get CRS/HIPEC?
How to find a doctor.
Questions to ask your doctor.

UndertandingPeritonealCarc

Understanding Peritoneal Carcinomatosis.

What is peritoneal carcinomatosis?

Peritoneal carcinomatosis, also referred to as peritoneal metastases, is the diffuse spread of cancer in the abdominal cavity that may or may not involve solid organs such as the liver, spleen, and lymph nodes. It is caused by peritoneal surface malignancies, which can originate from a wide variety or tumors, including the appendix, colon, rectum, stomach, ovaries, and small bowel, as well as from primary peritoneal tumors, sarcomas, and mesothelioma (a rare form of cancer that develops from the protective lining that covers many of the body's internal organs, the mesothelium). Other abdominal and extra-abdominal cancers, such as pancreatic, gallbladder, or breast, can also lead to this condition; however, they tend to have a poorer prognosis. In the past, these cancers were considered incurable tumors; however, we have learned that they respond well to aggressive therapy consisting of cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (HIPEC).

What are the symptoms of peritoneal carcinomatosis?

- Abdominal pain - Abdominal swelling or bloating - Change in bowel habits, such as recurrent diarrhea or constipation - Lumps of tissue in the abdomen - Unexplained weight loss

What are the symptoms of peritoneal carcinomatosis?

Peritoneal carcinomatosis is best treated with aggressive cytoreductive surgery utilized in conjunction with hyperthermic intraperitoneal chemotherapy (HIPEC). Only a small number of surgeons across the country and the world perform this procedure. Depending on your tumor type, systemic (traditional) chemotherapy and/or radiation may also be recommended in combination with cytoreductive surgery and HIPEC. A poor understanding of the disease by physicians, including surgical and medical oncologists and other healthcare providers, has led to late referrals for the appropriate treatment. While not all patients are candidates for the procedure, it is important that you are evaluated by a surgical oncologist who specializes in HIPEC procedures and peritoneal surface malignancies.

Understanding CRS/HIPEC

Understanding CRS/HIPEC

What is Cytoreductive Surgery?

Cytoreductive surgery is the aggressive removal or destruction of all or most of the visible tumors in the abdomen. Performing cytoreductive surgery requires the surgical expertise of an experienced surgeon. The length of the surgery depends on the amount of disease that is present. The surgery is often long, averaging between 7-10 hours, sometimes longer, to ensure a thorough inspection and complete removal of all tumors throughout the abdomen. The goal of cytoreductive surgery is to remove all visible tumors. In medical terms, this is called a “complete cytoreduction” and is measured using the completeness of cytoreduction score (CC-score). A completeness of cytoreduction score of 0 (CC-0, no visible disease remaining) or 1 (CC-1, only small nodules

What is Hyperthermic Intraperitoneal Chemotherapy (HIPEC)?urgery?

HIPEC is used in conjunction with cytoreductive surgery and refers to the procedure of heated chemotherapy being circulated into the abdomen for 90 minutes to destroy non-visible or microscopic tumor cells. The chemotherapy solution is heated to a temperature of 42 degrees Centigrade (107.5 degrees Fahrenheit) to treat any microscopic residual disease. Heat helps kill the cancer cells and also enhances the effect of some chemotherapy drugs.

How is HIPEC done?

Following the cytoreductive surgery, several catheters (tubes) are inserted in the abdomen. The tubes are attached to a specialized HIPEC perfusion machine that moves the heated chemotherapy solution into the abdominal cavity and then back out for a constant flow. This method allows the heated chemotherapy to reach all corners of the abdominal cavity and treat the cancer cells that could potentially form new tumors.

What are the benefits of HIPEC?

Studies have shown HIPEC to be considerably more valuable than traditional surgery alone for cancers of the abdominal cavity. Used in conjunction with cytoreductive surgery, HIPEC can improve survival and quality of life for patients who otherwise have been told there are no other treatment options. In most instances, HIPEC offers better results than systemic chemotherapy due to the timing of the drug administration and the direct contact of the higher concentration of chemotherapy with the cancerous cells. While many patients can benefit from HIPEC treatment, some patients will not be candidates for this procedure.

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