The spread of cancer cells to the abdominal membrane and organs and structures in the abdominal cavity is called peritoneal carcinomatosis. Cancer may spread to a limited area within the abdominal cavity, or it may become more widespread and involve the entire abdomen. Unfortunately, peritoneal carcinomatosis is an indicator of advanced cancer disease, and if it cannot be treated, the patient's life expectancy decreases significantly.
The growth of cancer cells may also cause dysfunction in other organs in the abdomen. It causes complaints such as nausea, vomiting, inability to eat, weight loss, and abdominal swelling, especially as a result of narrowing and obstruction in the intestines.
How is peritoneal carcinomatosis treated?
The majority of patients are often in advanced stages. and they present with widespread disease, and after this stage, treatment options are limited to chemotherapy.
First, the cancerous areas in the abdomen are cleared of cancer with a comprehensive and specialized surgery. If necessary, organs affected by cancer are also removed. In this surgery, the abdominal membrane, part of the small intestines, large intestines, spleen, uterus and ovaries in women can often be removed. Then, the invisible cancer cells in the abdomen are targeted and hot chemotherapy (HIPEC) is applied to destroy them.
Each patient undergoes surgery (cytoreductive surgery). and can it be treated with hot chemotherapy (HIPEC)?
After the information about the patient and the disease is evaluated in detail by the council consisting of General Surgery, Oncology, Radiology, Nuclear Medicine, Pathology and Gynecology specialists who are experienced in this field, the treatment is completed. The shape is decided.
For which cancers that spread to the abdominal lining is it applied?
Large intestine (colon and rectum)
Celestial intestine (appendix)
Ovary
Uterus (endometrium)
Pseudomyxoma peritonei
Mesothelioma
Primary peritoneal carcinomatosis
Although it is not very common, it can also be applied in the spread of breast, stomach, pancreatic and some other cancers to the abdominal membrane.
What is hot chemotherapy - HIPEC?
Surgery It is an integrated treatment. Intra-abdominal spread by surgery After the cancer is cleared, hot chemotherapy (HIPEC) is applied to destroy invisible cancer cells.
Through a special device, the medicine specifically determined for the patient is injected into the patient's abdominal cavity in serum heated to approximately 42 degrees, at the appropriate dose calculated for that patient.
To make an analogy using less medical terms:
Let's think of cancer that has spread within the abdomen as a dirty dinner plate. We can compare the scraping of food residues from the plate and washing it thoroughly with tap water to the removal of intra-abdominal cancer through surgery. Then, placing this plate in the dishwasher and washing it with hot water and dishwashing detergent to remove invisible microbes can be likened to killing invisible cancer cells with hot chemotherapy – HIPEC application.
Why do chemotherapy hot? Is it applied?
Heat not only increases the penetration of the chemotherapy drug into the cancer cell, but also has the effect of killing cancer cells. For this reason, hot chemotherapy – HIPEC is applied with a temperature of approximately 42 degrees, which is defined as medical hyperthermia.
How long is it applied?
In the operating room, while the patient is asleep under anesthesia, 30 -It is applied in 90 minutes.
If I do not have surgery, is it possible to apply only hot chemotherapy?
Hot chemotherapy – Chemotherapy drugs given with HIPEC are at most 2-3 sizes in size. It can enter into mm cancers. For this reason, applying only hot chemotherapy - HIPEC without surgically removing larger cancerous areas will not be sufficient.
However, in some patients who cannot be treated with surgery, in case of extensive fluid - ascites in the abdomen, hot chemotherapy - HIPEC can be applied with open or laparoscopic surgery to reduce this fluid.
What is the difference from intravenous chemotherapy?
Intravenous chemotherapy can reach the organs through the vascular network and is effective. However, since most of the cancerous areas in the abdominal membrane and abdominal cavity do not have their own vascular structure, they are connected to the vascular network. Distributed chemotherapy cannot reach them sufficiently. When the dose is increased to reach more, it causes side effects in many organs and structures, especially the liver, kidneys and bone marrow. However, with the application of hot chemotherapy – HIPEC, the effect of chemotherapy is much higher than when chemotherapy is given intravenously, as the chemotherapy is heated and administered directly into the abdominal cavity and onto the cancerous cells. Since chemotherapy is less absorbed from the abdominal cavity and passes to the organs, the side effects are less than the same dose of chemotherapy given intravenously. For these reasons, the dose of chemotherapy that can be given when intra-abdominal warm chemotherapy – HIPEC is applied is planned to be higher than when given intravenously.
My disease surgery (cytoreductive surgery) and heat chemotherapy – not suitable for HIPECbut is there an option other than intravenous chemotherapy to delay the progression of my intra-abdominal disease?
In selected patients, PIPAC(Pressurized IntraPeritoneal Aerosol Chemotherapy) - pressurized aerosol chemotherapy can be applied to delay the progression of cancer in the abdomen, postpone the development of complaints such as intestinal obstruction and abdominal swelling - ascites, and prolong the patient's lifespan. This method is applied in the operating room while the patient is under anesthesia. The patient's abdomen is reached by making two 5-10 mm holes in the patient's abdomen using the laparoscopy method, and chemotherapy is administered by forming an aerosol under pressure with the help of a special device.
We wanted to explain this method with an analogy to make it easier for our patients to understand: Applying chemical pesticides to very large areas by spraying them under pressure to kill insects and flies in gardens. Here, applying the chemotherapy drug in the form of pressure and aerosol increases its penetration into cancerous tissues.
Is hot chemotherapy – HIPEC only a therapeutic method? Can it also be applied as a preventive/preventive method?
In patients with colon and stomach cancer, although the disease spread into the abdomen - peritoneal carcinomatosis is not detected during the first surgery, some patients develop it in later years than others. It is predicted that the risk of intra-abdominal recurrence of the disease and the development of peritoneal carcinomatosis may be higher.
The risk of developing peritoneal carcinomatosis will be high in patients with the following characteristics:
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Intestinal obstruction or intestinal perforation due to cancer
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During surgery, fluid called ascites is detected in the abdominal cavity
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The pathology report shows that the cancer is pT4 and involves the lymph nodes
In these patients who are at high risk for peritoneal carcinomatosis, hot chemotherapy - HIPEC can be applied for precautionary purposes during cancer surgery or a certain period of time after the surgery, before peritoneal carcinomatosis develops.
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