The Leading Treatment for Cancers of the Abdomen: CRS/HIPEC
I was told that I needed to get my things in order because I only had 6 months to live. That was 7 years ago. CRS/HIPEC changed my life forever
Gary Young, survivor
Cytoreductive Surgery & HIPEC
What is Cytoreductive Surgery?
Cytoreductive surgery is the aggressive removal or destruction of all or most of the visible tumors in the abdomen. Performing cytoreductive surgery requires the surgical expertise of an experienced surgeon. The length of the surgery depends on the amount of disease that is present. The surgery is often long, averaging between 7-10 hours, sometimes longer, to ensure a thorough inspection and complete removal of all tumors throughout the abdomen.
The goal of cytoreductive surgery is to remove all visible tumors. In medical terms, this is called a “complete cytoreduction” and is measured using the completeness of cytoreduction score (CC-score). A completeness of cytoreduction score of 0 (CC-0, no visible disease remaining) or 1 (CC-1, only small nodules <2.5 mm remaining) is considered a “complete cytoreduction” and is associated with the best survival. In some cases, the amount and location of the tumors may make it impossible to remove it all, and obtaining a complete cytoreduction is not possible. When this happens, a palliative or incomplete cytoreduction may be offered to alleviate symptoms or your surgeon may recommend a different treatment, such as systemic chemotherapy.
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Even if your surgeon is able to remove all visible disease, it is possible that very small tumors and microscopic cancer cells remain. In order to prevent microscopic cancer cells from maturing into new cancerous cells, while in the operating room, the cytoreductive surgery is immediately followed by Hyperthermic (or heated) Intraperitoneal Chemotherapy (HIPEC). CRS/HIPEC is the most effective treatment for advanced cancers with peritoneal spread.
What is Hyperthermic Intraperitoneal Chemotherapy (HIPEC)?
HIPEC is used in conjunction with cytoreductive surgery and refers to the procedure of heated chemotherapy being circulated into the abdomen for 90 minutes to destroy non-visible or microscopic tumor cells. The chemotherapy solution is heated to a temperature of 42 degrees Centigrade (107.5 degrees Fahrenheit) to treat any microscopic residual disease. Heat helps kill the cancer cells and also enhances the effect of some chemotherapy drugs.
Diagram courtesy of ThermaSolutions, Inc.
How is HIPEC done?
Following the cytoreductive surgery, several catheters (tubes) are inserted in the abdomen. The tubes are attached to a specialized HIPEC perfusion machine that moves the heated chemotherapy solution into the abdominal cavity and then back out for a constant flow. This method allows the heated chemotherapy to reach all corners of the abdominal cavity and treat the cancer cells that could potentially form new tumors.
Studies have shown HIPEC to be considerably more valuable than traditional surgery alone for cancers of the abdominal cavity. Used in conjunction with cytoreductive surgery, HIPEC can improve survival and quality of life for patients who otherwise have been told there are no other treatment options. In most instances, HIPEC offers better results than systemic chemotherapy due to the timing of the drug administration and the direct contact of the higher concentration of chemotherapy with the cancerous cells. While many patients can benefit from HIPEC treatment, some patients will not be candidates for this procedure.