Treatment of Ovarian cancer with CRS and HIPEC - hyperthermic intraperitoneal chemotherapy

Ovarian cancer can occur at any period of life, but it is often diagnosed in patients of 40-50 years of age. In terms of incidence, ovarian cancer ranks second in gynecologic oncology with a significant prevalence of advanced forms (75-80%).

Content

1. Overview
2. Symptoms
3. Diagnostics
4. Treatment
5. Where can I undergo CRS and HIPEC treatment abroad?
6. The cost of treatment abroad
7. How can I undergo CRS and HIPEC treatment abroad?

Overview

The problem of an ovarian cancer diagnosis is one of the most urgent in modern medicine. Its relevance is due to the undoubted increase in mortality from this pathology, that was noted in recent decades in many countries of the world.

The majority (75-87%) of ovarian cancer patients are admitted for treatment at advanced stages of the disease, at which the 5-year survival rate does not exceed 10%. Poor prognosis of ovarian cancer is due to both the absence of specific signs of the disease and the late treatment of patients.

Symptoms

In most cases, even with advanced forms of the pathology when the cancer process spreads through the body, medical signs may include loss of appetite, weakness, nausea, and an increase in the volume of the abdomen. Clinical manifestations of the advanced forms of the disease are more pronounced than ones of the early forms. In such cases, there is abdominal bloating, especially in the upper section of the abdomen, and satiety from small portions of food, which is due to the large volume of the tumor which creates difficulties in food passing. As the tumor grows, the volume of the abdomen increases, shortness of breath develops, and a feeling of fullness arises.

With advanced forms of ovarian cancer, the menstrual cycle is disrupted, dysfunctional uterine bleeding occurs, the amount of urine decreases, and constipation occurs.

Diagnostics

The asymptomatic development of ovarian cancer at the early stages of the disease forces clinicians to develop more advanced methods of cancer detection and to single out a group of patients with increased risks. Judgments about the significance of anamnestic data in patients with ovarian cancer are heterogeneous, but summarizing them, one can find medical signs preceding the development of a tumor in the form of endocrine hormonal disorders that can manifest as:

• Later onset of menstruation
• Infertility
• Diabetes mellitus
• Early or late menopause
• Obesity
• Myoma
• Endometriosis

It should be emphasized that the risk of ovarian cancer development increases if patients have a combination of 2 or 3 signs. Therefore, in presence of risk factors, every woman should have preventive examinations at least 2 times a year. This allows detecting ovarian cancer at an early stage of the disease.

The information about a history of chronic inflammation of the uterine appendages or surgery for a benign ovarian tumor is particularly important. It is known that with unilateral removal of a benign ovarian tumor, the appearance of ovarian cancer in another ovary is very likely. Information about tumor diseases in the family is also important. All of these details should be clarified in order to recognize ovarian cancer early.

To make the diagnosis, the patients are examined using ultrasound scanning of the pelvis. The advantage of the ultrasound method in the diagnosis of ovarian cancer is its high information content, simplicity, speed, harmlessness, painlessness, the possibility of repeated carrying out, and objective documentation.

The search for tumor markers is of great importance in the diagnosis of ovarian cancer. These are specific biological substances that are produced by the tumor and can be determined by biochemical or immunological methods. Concerning ovarian cancer, the most important is the associated antigen CA-125. The level of CA-125 above 35 U/ml is found in almost 80% of patients with ovarian cancer.

Treatment

For ovarian cancer, surgery is necessary. It allows establishing the stage of the disease and removal of the tumor. And not only the tumor that has grown in the ovary or fallopian tube in the lower abdomen, but also any cancer cells that have spread outside the pelvic region are subject to removal. Surgeons try to remove as much of the affected tissue as possible so that by the beginning of the chemotherapy course the patient has only a small number of pathological cells.

With ovarian cancer, the goal of any surgery is to remove affected tissues from the abdomen and any other areas where cancer has spread. Another purpose of the surgery is to find the organs and structures affected by cancer. It is on this basis that doctors determine the stage of the disease.

Patients often hear the term "staging surgery". It indicates the surgery required to obtain information. The doctor performs a surgery, which usually removes both ovaries along with the fallopian tubes, and also performs a hysterectomy (removal of the uterus and cervix).

Cytoreductive surgery (CRS) is surgery performed to remove the maximum volume of affected tissues. Additionally, the lymph nodes are excised, which is called lymphadenectomy. It is necessary to remove the lymph nodes of the abdominal cavity, which are located near the large blood vessels that carry blood to the heart and back. The lymph nodes along these blood vessels are most often at risk in metastatic ovarian cancer, so doctors remove them during surgery. If, as a result, tumor cells are found in the removed lymph nodes, doctors can establish the stage of development of the pathology.

When doctors perform such surgery as a part of the therapy in young women, they make every possible effort to preserve ovarian function and fertility. For example, only one fallopian tube and one ovary can be removed, while the other ovary along with the fallopian tube remains in place (if it is healthy at the time of the surgery).

CRS in combination with HIPEC therapy has shown the greatest effectiveness in the treatment of ovarian cancer. Other cancer treatments using CRS and HIPEC is also effective. 

Hyperthermic intraperitoneal chemotherapy is one of the most innovative methods of treatment of advanced cancer, which is also known as HIPEC or hot chemotherapy. Today, chemotherapy HIPEC is the only type of therapy in medicine that can extend the life of patients with ovarian cancer by 20-50% when other methods are ineffective.

Many types of oncology that develop in the intra-abdominal organs can affect the peritoneal cavity. This indicates that cancer has progressed significantly. In this case, intravenous chemotherapy is usually not effective enough because the drugs simply do not reach the peritoneal cavity. The only efficient treatment in this case is intraperitoneal chemotherapy which allows drugs to target tumor lesions directly.

Hyperthermic intraperitoneal chemotherapy is a three-step treatment. First of all, a cytoreductive surgery is performed, during which doctors remove all affected tissues and organs (colon, ovaries, gallbladder, part of the stomach). After that, while the patients are still under the action of general anesthesia in the operating room, it is the turn of hyperthermic intraperitoneal chemotherapy.

Cytoreductive surgery takes 6-10 hours. It is performed by experienced surgeons, and, if necessary, also by gynecologists-oncologists. At the same time, HIPEC requires long and thorough preparation, extensive experience, and well-coordinated work of a whole team of medical specialists. Radiologists, medical oncologists, pathologists, nuclear medicine specialists, nutritional experts, anesthesiologists, and nurses are also involved in patient care.

About 3.5 liters of chemotherapy drugs are injected into the peritoneal area. Their temperature is 41-43 degrees. The solution circulates for 1.5 hours, penetrating all areas and affecting the tumor cells remaining after a patient is treated surgically. The fluid is then pumped out and the abdominal cavity is closed. Cytoreductive surgery and HIPEC may also be complemented by systemic chemotherapy.

However, in some cases, hyperthermic intraperitoneal chemotherapy (HIPEC) can be performed without surgery. Drugs can be injected into the abdominal cavity laparoscopically, through catheters.

Positive effects of HIPEC for ovarian cancer treatment include:

• The drug’s even distribution over the entire inner surface of the abdominal cavity, delivering high doses of the drug directly to malignant neoplasms
• The therapeutic effect of chemotherapy drugs increases due to heating
• Better penetration of the medical substances into the affected tissues and their ability to destroy the malignant cells left after surgery
• The drug does not affect healthy organs located outside the abdominal cavity, which reduces the risk of side effects development (those noticed after a patient is treated with conventional chemotherapy)

Besides, HIPEC can be used to treat ascites (fluid accumulation in the abdominal cavity), which often develops in patients with advanced cancer. This pathological process causes bloating and leads to the spread of cancer cells in the peritoneum up to the diaphragm.

Cytoreductive surgery with HIPEC, however, is not used in patients with metastases outside the abdominal cavity (cranial, pulmonary, and bone metastases). Also, HIPEC is not used in patients with multiple, inoperable liver metastases.

HIPEC is a very complex treatment that carries higher risks compared to side effects after a tumor is treated with standard surgical procedures. Most often, patients experience temporary deterioration of gastrointestinal function. During the surgery, there is also a risk of hemorrhage, kidney failure, clots in the lungs or brain, and bone marrow damage. In this case, the mortality risk is about 0-7%.

However, given the complexity of the disease and the high mortality risks of this pathology, the surgery is more preferable. Cytoreductive surgery in combination with HIPEC and systemic chemotherapy is currently the only treatment that can prolong the patient's life and improve its quality.

Where can I undergo CRS and HIPEC treatment abroad?

Health tourism is becoming more and more popular these days, as medicine abroad often ensures a much better quality of ovarian cancer treatment.

The following hospitals show the best success rates in ovarian cancer treatment with CRS and HIPEC:

1. University Hospital Tuebingen, Germany
2. Memorial Sisli Hospital Istanbul, Turkey
3. Medicana International Istanbul Hospital, Turkey
4. University Hospital Ulm, Germany
5. Rambam Health Care Campus Haifa, Israel

You can find more information about the hospitals on the Booking Health website.

The cost of treatment abroad

The prices in hospitals listed on the Booking Health website are relatively low. With Booking Health, you can undergo ovarian cancer treatment with CRS and HIPEC abroad at an affordable price.

The cost of HIPEC ranges from €51.818 to €92.416 and depends on the type of cancer, the extent to which it has spread and the level of the hospital.

You also need to consider the cost of possible additional procedures and follow-up care. Therefore, the ultimate cost of treatment may differ from the initial price.

To make sure that the overall cost of treatment is suitable for you, contact us by leaving the request on the Booking Health website.

How can I undergo CRS and HIPEC treatment abroad?

It is not easy to self-organize any treatment abroad. It requires certain knowledge and expertise. Thus, it is safer, easier, and less stressful to shift some responsibility onto a medical tourism agency.

As the largest and most transparent medical tourism agency in the world, Booking Health has up-to-date information about ovarian cancer treatment and other cancer treatments using CRS and HIPEC in the best hospitals in the world. Therefore, we will help you select the right clinic taking into account your wishes for treatment.

We want to help you and take on all the troubles. You can be free of unnecessary stress, while Booking Health takes care of all organizational issues regarding the treatment. Our services aimed at undergoing ovarian cancer treatment with CRS and HIPEC safely and successfully.

Medical tourism can be easy! All you need to do is to leave a request on the Booking Health website and our manager will contact you shortly.

Authors: 

The article was edited by medical experts, board-certified doctors Dr. Vadim Zhiliuk and Dr. Nadezhda Ivanisova. 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