Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

What is Peritoneal Cancer?

Peritoneal cancer (peritoneal carcinomatosis) is a variant of progressive, malignant abdominal tumours, which cause multiple metastases on the serous membrane of the abdominal cavity. It develops in every third patient with tumours of the pancreas, stomach and appendix. This complication develops in 10% of patients who suffer from colorectal cancer. Other localisations of the primary tumour which leads to peritoneal cancer include:

• ovaries;
• endometrium;
• fallopian tubes;
• liver;
• gallbladder;
• peritoneum (peritoneal mesothelioma).

There are four stages of the disease. The first stage is characterized by small metastases of up to 5mm in size. All of them are located in one area. At the second stage, the tumours are located diffusely throughout the abdomen. At the third stage, they are from 5 to 20mm in size, whilst at the fourth stage the size of foci may reach over 20mm.

What is HIPEC Surgery?

Surgery remains the main method used to treat patients with abdominal neoplasms. The main tumour is removed. In a case of peritoneal carcinomatosis and the spread of metastases to other organs, a cytoreductive surgery may be performed. This involves the removal of all visible tumour nodes. For this purpose, doctors resect several organs at once.

Nonetheless, the doctors cannot always detect all of the metastatic foci. In addition, many of the foci have microscopic dimensions. Therefore, the probability of cancer recurrence after cytoreductive surgery still remains high. HIPEC (hyperthermic intraperitoneal chemotherapy) serves to reduce this risk. It is used directly during the surgical intervention.

HIPEC surgery allows for the destruction of the remaining foci of tumour cells. The procedure aims to completely eradicate the tumour. If successful, a complete recovery is possible for the patient. However, even if the cancer cannot be cured, HIPEC can significantly increase life expectancy. Approximately two thirds of patients live 5 years or longer after having HIPEC surgery. The procedure also significantly decreases the severity of the symptoms of the disease.

How is the Procedure Performed?

HIPEC is conducted immediately after cytoreduction, that is, after the resection of organs and the destruction of all visible tumour foci.

The doctors place a drainage tube to provide outflow and inflow. Thermal sensors are used to monitor the intra-abdominal temperature. They are located in different parts of the peritoneal cavity. The abdominal skin is sutured with a temporary suture.

The next step is abdominal irrigation with a chemotherapy solution, heated to 42.5 celsius. The total perfusion is about 5 liters. The average flow rate is 700ml per minute. The perfusion is performed using a special apparatus. The average duration of the procedure is an hour and a half. Then, the doctors make a revision of the abdominal cavity. This drains and the surgical wound is sutured.

When treating peritoneal cancer, HIPEC has significant advantages over systemic chemotherapy, where drugs are taken orally or administered intravenously. The advantages are as follows:

• pharmacokinetics – intracavitary administration of drugs can significantly increase the dose;
• hyperthermia – heating of the drug makes it possible to increase the selective antitumor effect, increase the ablastic effect and increase the depth of penetration of the drug into the tumour tissues.

Where Can I Get treatment?

To treat cancer, patients often go to Germany.  This country achieves phenomenal successes in the fight against malignant tumours.  It successfully performs cytoreductive surgical procedures and uses intraperitoneal chemotherapy. The cost of HIPEC ranges from €23.949 to €92.474 and depends on the type of cancer, the extent to which it has spread and the level of the hospital. Here is a list of the best clinics abroad, where patients can undergo treatment:

• Helios Clinic Krefeld. Here, The Department of Abdominal and Minimally Invasive Surgery is responsible for performing cytoreductive surgery with intraperitoneal chemotherapy. The department shows excellent results in the treatment of abdominal cancers. The cost of treatment is about 40 thousand euros.
• Charite University Hospital. This is one of the most reputable medical institutions in Europe. The surgery combined with hyperthermic chemotherapy is performed in the Department of General, Abdominal and Vascular Surgery. Cytoreductive surgery for oncological diseases remains one of the main department’s work focuses. The cost of treatment here reaches 60 thousand euros.
• University Hospital of Ludwig Maximilian University. This hospital is included in the ranking of the top medical facilities specializing in the treatment of abdominal cancers. The cytoreductive surgical procedures with hyperthermic chemotherapy are performed in the Department of General, Abdominal and Transplant Surgery. The treatment cost is 45 thousand euros.

Treatment Organization

If you have symptoms of cancer, you can become a patient at one of Germany’s clinics. Booking Health will help you to organize your treatment in one of the best clinics abroad. Our services and benefits include:

• Selecting the best clinic specializing in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.
• A treatment cost reduction of up to 50% by eliminating coefficients for foreign patients.
• The possibility of undergoing treatment at a date convenient for you.
• An establishment of communication with doctors and the administration team before the start of treatment and after the end of the program.
• The preparation of a treatment program without repeating previously completed examinations.
• Monitoring of the program at all its stages.
• Funds management and the return of any unspent funds.
• The organization of additional examinations.
• Assistance when purchasing and the transmission of medicines.

Booking Health will provide you with a high level of service. We will booka hotel and airline tickets for you, help you to complete the necessary paperwork, meet you at the airport and take you to the clinic by car.

Authors: 

The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

National Center for Biotechnology

Cancer Research Institute

American Cancer Society