Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Message from Dr. Ajay Simha
A cancer diagnosis involving the lining of the abdomen can be challenging for patients and their families. When cancer spreads to the peritoneum, patients naturally have concerns about whether surgery is possible, the extent of treatment, recovery and the available options for controlling the disease.
Hyperthermic intraperitoneal chemotherapy (HIPEC) is a specialized form of regional chemotherapy delivered directly into the abdominal cavity during surgery. It is generally performed after cytoreductive surgery (CRS), which aims to remove visible tumour deposits.
I am Dr. Ajay Simha, Consultant Surgical Oncologist (Cancer Surgeon), and this page provides an overview of HIPEC, including when it may be considered, how patients are evaluated, the role of cytoreductive surgery, the treatment process, recovery and commonly asked questions.
What Is Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
What is Hyperthermic Intraperitoneal Chemotherapy (HIPEC)?
HIPEC is a specialized cancer treatment in which heated chemotherapy is delivered directly into the peritoneal cavity during surgery. The treatment is usually performed after the surgeon has removed as much visible tumour as possible through cytoreductive surgery. A chemotherapy solution is then warmed and circulated inside the abdominal cavity through specially placed tubes.
When is HIPEC Recommended?
HIPEC may be considered for carefully selected patients with cancer that has spread to the peritoneal surfaces and where adequate cytoreductive surgery can potentially be achieved.
The decision depends on several factors, including:
- Type and origin of the primary cancer
- Extent and distribution of peritoneal disease
- Peritoneal Cancer Index (PCI) or other assessment of tumour burden
- Involvement of the small bowel, mesentery or other critical structures
- Presence or absence of disease outside the peritoneal cavity
- Response to previous chemotherapy
- Patient’s age and general health
- Nutritional status and physical fitness
- Ability to achieve complete or near-complete cytoreduction
- Expected benefits and risks of major surgery and HIPEC
HIPEC is not suitable for every patient with peritoneal metastases. Careful patient selection is essential because CRS and HIPEC can involve complex and extensive abdominal surgery.
Evaluation of Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
A detailed evaluation is performed before considering CRS and HIPEC to determine the extent of peritoneal disease and assess whether the patient can safely undergo the treatment.
Imaging investigations such as contrast-enhanced CT, MRI, PET-CT or other appropriate scans may be performed to evaluate the distribution of tumour deposits and identify disease outside the abdominal cavity.
The original biopsy and pathology reports are reviewed to confirm the primary cancer and understand its biological characteristics.
The results are discussed by the cancer treatment team to determine whether cytoreductive surgery with HIPEC is appropriate.
Treatment Options for Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Treatment for peritoneal surface malignancy depends on the primary cancer, stage, extent of disease and patient’s overall health. Treatment may involve surgery, systemic chemotherapy and other cancer therapies.
Cytoreductive surgery is an essential component when HIPEC is planned. The surgeon removes visible tumour deposits from the peritoneal surfaces and, when necessary, affected portions of organs or other tissues. The goal is to achieve complete or near-complete removal of visible disease whenever this can be done safely. HIPEC is generally delivered after the cytoreductive portion of the operation has been completed.
Chemotherapy may be given before or after surgery as systemic treatment depending on the primary cancer and individual treatment plan. HIPEC itself is a form of regional chemotherapy in which the anti-cancer drug is delivered directly into the abdominal cavity. The specific chemotherapy drug and treatment protocol depend on the cancer and institutional treatment approach.
Radiation therapy uses high-energy radiation to destroy cancer cells. Its role varies according to the primary cancer and location of disease. It may be recommended in selected situations but is not routinely used as the main treatment for peritoneal surface disease.
Immunotherapy helps the body's immune system recognize and attack cancer cells. It may be recommended for selected cancers based on tumour type, stage and specific molecular or immune characteristics. Its use is considered separately from HIPEC as part of the overall cancer treatment plan.
Targeted therapy uses medicines designed to act on specific molecular changes or pathways involved in cancer growth. For selected cancers, molecular testing may help determine whether targeted treatment is appropriate before or after CRS and HIPEC.
Supportive Care
Supportive care is an important component of treatment for patients undergoing CRS and HIPEC. Because the treatment can involve major abdominal surgery, optimizing nutrition, physical fitness and overall health before treatment can help patients prepare for recovery.
Nutritional Support
Nutritional support is particularly important for patients undergoing CRS and HIPEC. Peritoneal cancer can cause reduced appetite, weight loss, abdominal discomfort and nutritional deficiencies. A personalized nutritional plan may therefore be recommended before treatment and continued during recovery. Nutritional monitoring helps identify deficiencies and supports healing and recovery following major surgery.
Physiotherapy
Physiotherapy and physical conditioning may help patients prepare for major surgery and support recovery afterward. After CRS and HIPEC, early mobilization, breathing exercises, muscle strengthening and gradual progression of physical activity may form part of the rehabilitation plan.
Surgical Approaches for Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
HIPEC is performed as part of a carefully planned surgical procedure. The technique and extent of treatment depend on the type and distribution of the cancer.
The first stage of CRS-HIPEC involves removal of visible tumour deposits from the abdominal cavity. The surgeon examines the peritoneal surfaces and removes tumour deposits from affected areas. Depending on the extent of disease, portions of organs or other tissues may also need to be removed.
The aim is to achieve the greatest possible tumour clearance while maintaining patient safety.
Recovery after CRS and HIPEC can be longer than after many routine abdominal operations because the treatment may involve extensive cytoreductive surgery and intraperitoneal chemotherapy.
HIPEC can also cause treatment-related side effects, and the risks depend on the chemotherapy drug used, treatment duration and the patient's overall condition.
Dr. Ajay Simha provides individualized evaluation and surgical treatment planning for patients with selected peritoneal surface malignancies who may benefit from CRS and HIPEC. Treatment decisions are based on the primary cancer, extent of peritoneal disease, patient's overall health and the possibility of achieving meaningful tumour clearance safely.
Frequently Asked Questions
HIPEC stands for hyperthermic intraperitoneal chemotherapy. It is a form of regional chemotherapy in which heated anti-cancer medicine is circulated directly inside the abdominal cavity, usually after visible tumour has been removed through cytoreductive surgery.
HIPEC is used to treat microscopic cancer cells that may remain within the abdominal cavity after cytoreductive surgery. The chemotherapy is delivered directly to the peritoneal surfaces rather than primarily through the bloodstream.
No. HIPEC is considered only for selected patients. The decision depends on the type of primary cancer, extent and distribution of peritoneal disease, patient's overall health and whether adequate cytoreductive surgery can be achieved safely.
CRS, or cytoreductive surgery, involves removing visible tumour deposits from the abdominal cavity. HIPEC is the subsequent delivery of heated chemotherapy directly into the abdomen to treat microscopic residual cancer cells.
Dr. Ajay Simha provides personalized evaluation and surgical treatment planning for patients with selected peritoneal surface malignancies who may be candidates for CRS and HIPEC.