Peritoneal cancer, which affects the membrane lining the abdominal cavity, causes multiple foci of malignant neoplasms. Doctors do not always manage to find and remove them all. Therefore, the risk of relapse after surgical treatment will remain high. To reduce it, doctors use HIPEC – hyperthermic intraperitoneal chemotherapy.
What is peritoneal cancer?
Peritoneal cancer (peritoneal carcinomatosis) is a variant of the progression of malignant abdominal tumors, which causes multiple metastases on the serous membrane of the abdominal cavity. It develops in every third patient with tumors of the pancreas, stomach and appendix. This complication develops in 10% of patients suffering from colorectal cancer. Other localizations of the primary tumor that lead 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 up to 5 mm in size. All of them are located in one area. In the second stage, the tumors are located diffusely throughout the abdomen. At the third stage, they are from 5 to 20 mm in size, while at the fourth stage the size of foci may reach over 20 mm.
What is HIPEC surgery?
Surgery remains the main method of treating patients with abdominal neoplasms. The main tumor is removed. In case of peritoneal carcinomatosis and the spread of metastases to other organs, there may be performed cytoreductive surgery. It involves the removal of all visible tumor nodes. For this purpose, doctors resect several organs at once.
Nonetheless, the doctor cannot always detect all metastatic foci. In addition, many of them have microscopic dimensions. Therefore, the probability of cancer recurrence after cytoreductive surgery remains high. HIPEC (hyperthermic intraperitoneal chemotherapy) serves to reduce it. It is made directly during the surgical intervention.
HIPEC surgery allows for the destruction of the remaining foci of tumor cells. The procedure aims to completely eradicate the tumor. If successful, complete recovery of the patient is possible. But even if cancer cannot be cured, HIPEC can significantly increase the life expectancy. Approximately two thirds of patients after using HIPEC surgery live 5 years or longer. The procedure also significantly decreases the severity of 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 tumor foci.
The doctors place drainage 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 the abdominal irrigation with a chemotherapy solution heated to 42.5 degrees. The total perfusion is about 5 liters. The average flow rate is 700 ml 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. It drains and the surgical wound is sutured.
When treating peritoneal cancer, HIPEC has significant advantages over systemic chemotherapy when 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 tumor tissues.
Where can one get treatment?
To treat cancer, patients often go to Germany. This country achieves phenomenal success in the fight against malignant tumors. It successfully performs cytoreductive surgical procedures, uses intraperitoneal chemotherapy. Here is a list of the best clinics abroad where patients can undergo treatment:
Helios Clinic Krefeld. The Department of Abdominal and Minimally Invasive Surgery is responsible for performing cytoreductive surgery with intraperitoneal chemotherapy here. The department shows excellent results in the treatment of abdominal cancers. The cost of treatment is about 40 thousand euros.
Charite University Hospital. It 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. It 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 of one of German clinics. Booking Health will help you in organizing treatment in the best clinics abroad. Our services and benefits:
- Selection of the best clinic specializing in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.
- Treatment cost reduction up to 50% by eliminating coefficients for foreign patients.
- Possibility to undergo treatment at the dates convenient for you.
- Establishment of communication with doctors and administration before the start of treatment and after the end of the program.
- Preparation of a treatment program without repeating previously completed examinations.
- Monitoring of the program at all its stages.
- Funds management and return of unspent funds.
- Organization of additional examinations.
- Assistance in purchasing and transmission of medicines.
Booking Health will provide you with high level of service. We will book a hotel and airline tickets for you, help you complete the necessary paperwork, meet you at the airport and take to the clinic by car.
Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko
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