Key Takeaways
- HIPEC (hyperthermic intraperitoneal chemotherapy) delivers heated chemotherapy directly into the abdominal cavity to target cancer cells left behind after surgery.
- It is usually performed right after cytoreductive surgery, which removes as much visible cancer as possible from the abdomen.
- Not every patient qualifies. Good candidates generally have cancer confined to the abdomen, are healthy enough for major surgery, and often have the epithelioid cell type.
- For selected patients, surgery with HIPEC may help control the disease and extend survival, but it is not a guaranteed cure.
- Risks include infection, bleeding, digestive and kidney complications, and a demanding recovery that can take weeks or longer.
- Patients who aren’t eligible still have options, including systemic chemotherapy, immunotherapy, clinical trials, and supportive care.
- Peritoneal mesothelioma is linked to asbestos exposure, and those diagnosed may have legal options. Call 800-505-6000 for a free case review.
A diagnosis of peritoneal mesothelioma can leave patients and their families with many questions about treatment. One option doctors may discuss is HIPEC, a specialized procedure that delivers heated chemotherapy directly into the abdominal cavity. For certain patients, this treatment may be combined with surgery to remove visible cancer.
Understanding what HIPEC involves, who may qualify, and what recovery can look like can help patients have more informed conversations with their medical team.
What Is HIPEC?
HIPEC stands for hyperthermic intraperitoneal chemotherapy. It is a treatment that delivers heated chemotherapy medication directly into the abdominal cavity to target cancer cells that may remain after surgery.
Peritoneal mesothelioma develops in the peritoneum, the thin layer of tissue that lines the abdomen and covers many of the organs inside it. Because this cancer can spread along surfaces within the abdominal cavity, doctors may consider treatments that target the affected area directly.
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HIPEC is usually performed immediately after cytoreductive surgery, which is an operation to remove as much visible cancer as possible. Once the surgeon has removed the visible tumors, a heated chemotherapy solution is circulated throughout the abdominal cavity. The solution is then drained before the operation is completed.
According to the National Cancer Institute’s explanation of HIPEC, this approach is designed to treat cancer cells that may remain after the visible tumors have been removed.
How Does HIPEC Work?
HIPEC combines surgery with regional chemotherapy. Rather than delivering chemotherapy through the bloodstream alone, the procedure brings chemotherapy medication directly into the area where the cancer is located.
Although the exact process varies by hospital and treatment plan, the procedure generally follows several steps.
- The surgeon removes visible cancer.
The first step is cytoreductive surgery. During this operation, the surgeon removes as much visible tumor tissue as possible from the lining of the abdomen and affected surfaces. Depending on where the cancer has spread, some nearby tissues or portions of organs may also need to be removed.
- Heated chemotherapy is circulated through the abdomen.
After removing visible tumors, the surgical team circulates a heated chemotherapy solution throughout the abdominal cavity using specialized tubing. The medication comes into direct contact with the abdominal surfaces where microscopic cancer cells may remain.
Heating the chemotherapy may help increase its cancer-killing effects. The goal is to target remaining cancer cells in the area treated by surgery.
- The chemotherapy solution is drained.
After the medication has circulated for a set period, the team drains the solution from the abdomen. The surgical team then completes the operation and begins the patient’s postoperative care.
HIPEC is performed under general anesthesia and is part of a major surgical procedure. The entire operation can take several hours, depending on the extent of the cancer and the work required to remove it.
Who May Be Eligible for HIPEC?
HIPEC is not appropriate for every person diagnosed with peritoneal mesothelioma. Doctors consider several factors before recommending this treatment, including the extent of the cancer, its cell type, the patient’s overall health, and whether surgeons believe they can remove most or all visible disease.
Patients who may be considered for cytoreductive surgery and HIPEC generally have cancer that is primarily confined to the abdominal cavity and are healthy enough to undergo an extensive operation.
The cancer’s subtype can also influence treatment decisions. For example, some patients with epithelioid peritoneal mesothelioma may be better candidates for surgery than patients with certain other cell types. However, eligibility depends on the complete clinical picture rather than one factor alone.
Because peritoneal mesothelioma is rare, patients may benefit from consulting a cancer center with experience treating this disease. A specialist can review imaging, pathology results, and other medical information to determine whether surgery with HIPEC is a reasonable option.
The National Cancer Institute’s mesothelioma treatment guidance discusses how doctors select patients for this combined treatment approach.
What Are the Potential Benefits of HIPEC?
One potential benefit of HIPEC is that it allows chemotherapy to be delivered directly into the abdominal cavity after visible tumors have been removed. This may help treat microscopic cancer cells that cannot be seen during surgery.
For appropriately selected patients, combining cytoreductive surgery with HIPEC may help control the disease and extend survival. However, outcomes vary considerably, and the treatment is not a guaranteed cure. Peritoneal mesothelioma may return even after extensive surgery and chemotherapy.
Doctors must weigh potential benefits against the risks of a major operation. The decision to pursue HIPEC should reflect the patient’s diagnosis, overall health, treatment goals, and personal preferences.
It is also important to understand that HIPEC is a specialized treatment for certain cancers affecting the abdominal cavity. It is not the same procedure used to treat pleural mesothelioma, which develops in the lining surrounding the lungs.
What Are the Risks and Side Effects of HIPEC?
Because HIPEC involves extensive surgery and chemotherapy, patients may experience side effects during recovery. The specific risks depend on the patient’s health, the chemotherapy medication used, and the extent of the operation.
Possible complications include:
- Infection: As with other major surgeries, infection can develop during recovery.
- Bleeding: Surgery may cause blood loss, and some patients may require a transfusion.
- Digestive complications: Patients may experience changes in bowel function or complications involving the intestines.
- Kidney problems: Certain chemotherapy medications can affect kidney function, so the medical team monitors patients closely.
- Blood cell changes: Chemotherapy may affect blood cell counts, increasing the risk of infection, fatigue, or bleeding.
- Fatigue and pain: Recovery from extensive abdominal surgery can take time and may involve discomfort, reduced energy, and changes in appetite.
Some patients may need additional treatment after recovering from surgery. Others may require ongoing monitoring to check for signs that the cancer has returned.
Before making a decision, patients should ask their care team to explain the risks associated with their particular situation, how complications will be managed, and what recovery may involve.
What Is Recovery Like After HIPEC?
Recovery after cytoreductive surgery and HIPEC can be demanding. Patients generally remain in the hospital for monitoring and support while their bodies recover from surgery.
During this time, the medical team may manage pain, monitor kidney function and blood counts, and help patients gradually resume eating, drinking, and moving around. Some people may need additional assistance with daily activities after leaving the hospital.
The length of recovery varies. It depends on the extent of surgery, whether complications occur, and the patient’s overall health before treatment. Returning to normal activities may take weeks or longer, and some patients need additional support at home.
Follow-up appointments are an important part of care. Doctors use these visits to monitor recovery, evaluate treatment results, and determine whether further treatment or surveillance is needed.
Patients and caregivers should discuss discharge instructions, medication schedules, nutrition, activity restrictions, and warning signs that require medical attention before leaving the hospital.
Are There Other Treatment Options for Peritoneal Mesothelioma?
Yes. HIPEC is one potential treatment approach, but it is not the only option. The best treatment plan depends on how far the cancer has spread, its subtype, the patient’s overall health, and whether surgery is appropriate.
Other treatment options may include:
- Systemic chemotherapy: Medication travels through the bloodstream to treat cancer cells throughout the body.
- Immunotherapy: Certain medications help the immune system recognize and attack cancer cells.
- Targeted therapy: In some circumstances, treatment may be guided by specific molecular features of the cancer.
- Clinical trials: Research studies may provide access to treatments being evaluated for peritoneal mesothelioma.
- Supportive care: Treatment for pain, abdominal fluid buildup, digestive problems, and other symptoms can help improve comfort and quality of life.
Some patients may receive treatments before or after surgery. Others may be advised to pursue nonsurgical treatment if an extensive operation is unlikely to provide enough benefit or would pose too great a risk.
The American Cancer Society’s guide to mesothelioma treatment provides additional information about treatment approaches and the factors doctors consider when developing an individual care plan.
Questions to Ask Your Doctor About HIPEC
If your medical team has mentioned HIPEC, preparing questions before your appointment can help you better understand your options.
Consider asking:
- Am I a potential candidate for cytoreductive surgery and HIPEC?
- What is the goal of treatment in my specific situation?
- How much of the visible cancer do you expect to remove?
- Which chemotherapy medication would be used?
- What are the most significant risks for someone with my health history?
- How long might I need to stay in the hospital?
- What support will I need during recovery?
- Could I benefit from a second opinion or a clinical trial?
- What other treatments are available if surgery is not recommended?
It may also be helpful to bring a family member or trusted person to appointments. They can help take notes, remember questions, and discuss the information with you afterward.
Understanding Your Options After a Peritoneal Mesothelioma Diagnosis
HIPEC is a specialized treatment that combines heated chemotherapy with surgery to remove visible cancer. For certain people with peritoneal mesothelioma, it may offer an opportunity to control the disease and improve outcomes. However, it is an intensive procedure with significant risks, and it is not suitable for everyone.
Learning about available treatments and speaking with experienced specialists can help patients make decisions that reflect their medical needs and personal goals. Every diagnosis is different, so treatment recommendations should be based on an individualized medical evaluation.
Peritoneal mesothelioma is also associated with asbestos exposure. People diagnosed with this disease who have a history of occupational, household, or other asbestos exposure may have questions about how that exposure occurred and whether they have legal options.
The Halpern Law Firm represents individuals and families affected by mesothelioma and asbestos-related illnesses in Pennsylvania. Those who have questions about a potential asbestos-related claim can contact the firm to discuss their circumstances. Call (800) 505-6000, or fill out our contact form.
Medical disclaimer: This article is for informational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Patients should consult a qualified healthcare professional about their individual diagnosis and treatment options.
Frequently Asked Questions
What does HIPEC stand for?
HIPEC stands for hyperthermic intraperitoneal chemotherapy. “Hyperthermic” means the chemotherapy is heated, and “intraperitoneal” means it is delivered directly into the abdominal cavity rather than only through the bloodstream.
How long does HIPEC surgery take?
Cytoreductive surgery with HIPEC is a major operation that often takes several hours, and in some cases much of the day. The total time depends on how widely the cancer has spread and how much tissue the surgeon needs to remove before the heated chemotherapy is circulated.
How hot is the chemotherapy used in HIPEC?
The chemotherapy solution is typically warmed to a few degrees above normal body temperature, generally in the range of about 105 to 109 degrees Fahrenheit (roughly 41 to 43 degrees Celsius). Heat may help the medication penetrate tissue and increase its effect on remaining cancer cells.
Is HIPEC a cure for peritoneal mesothelioma?
HIPEC is not considered a guaranteed cure. For carefully selected patients, cytoreductive surgery combined with HIPEC may help control the disease and extend survival, but outcomes vary and the cancer can return. Regular follow-up care is used to monitor for recurrence.
Who is a good candidate for HIPEC?
Candidates generally have cancer that is mostly confined to the abdominal cavity, are healthy enough for an extensive operation, and have disease that surgeons believe can be largely removed. Cell type matters too: patients with epithelioid peritoneal mesothelioma are often better surgical candidates. A specialist at an experienced cancer center can review imaging and pathology to make that determination.
How long is the hospital stay after HIPEC?
Hospital stays after cytoreductive surgery and HIPEC commonly last one to two weeks or longer, depending on the extent of surgery and whether complications occur. Full recovery and return to normal activities can take several weeks to a few months.
Can HIPEC be used to treat pleural mesothelioma?
No. HIPEC is designed for cancers within the abdominal cavity, such as peritoneal mesothelioma. Pleural mesothelioma develops in the lining around the lungs and is treated with different surgical and medical approaches.
What if I am not eligible for HIPEC?
Patients who are not candidates for surgery still have options, including systemic chemotherapy, immunotherapy, clinical trials, and supportive care to manage symptoms such as abdominal fluid buildup and pain. A second opinion from a mesothelioma specialist can also help confirm whether surgery is truly off the table.
Is peritoneal mesothelioma caused by asbestos?
Asbestos exposure is the primary known cause of peritoneal mesothelioma. Asbestos fibers that are swallowed or inhaled can lodge in the lining of the abdomen and, decades later, lead to cancer. Exposure often occurred at work, but family members of workers can also be exposed through fibers carried home on clothing.
Can a mesothelioma claim help with the cost of treatment like HIPEC?
People diagnosed with peritoneal mesothelioma after asbestos exposure may be entitled to compensation through lawsuits and asbestos trust funds, which can help cover medical expenses, lost income, and other costs. In Pennsylvania, filing deadlines generally run from the date of diagnosis, so it is important to act promptly. Call The Halpern Law Firm at 800-505-6000 or request a free case review.
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