Your abdomen holds some of your body’s most important organs, like your stomach, liver and bladder. The space around these organs is called the peritoneal cavity, and it’s covered by a thin, protective layer called the peritoneum. When cancer affects this lining, it's called peritoneal carcinomatosis, peritoneal surface malignancy (PSM) or peritoneal cancer.
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Peritoneal cancer starts in the lining of your abdomen, called the peritoneum. It can either begin there or develop when cancer from another part of your body spreads to this area.
We understand that this news can feel like a heavy weight to bear, but you don't have to carry it alone. We'll be there for you every step of the way, even as you undergo treatment for your pre-existing cancer.
We are dedicated to your care, which is why we are one of the few programs in the Boston area to offer a breakthrough treatment for peritoneal cancer called hyperthermic intraperitoneal chemotherapy (HIPEC). This advanced treatment combines surgery with heated chemotherapy delivered directly to your abdomen, which means fewer side effects than traditional chemotherapy.
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Treatments
Peritoneal cancer can be challenging to treat, but when cancer is found on the surface of your organs and has not spread to your bloodstream, you may be a candidate for cytoreductive surgery with HIPEC.
This treatment is completed in 2 phases:
- First, we’ll remove all visible tumors through cytoreductive surgery, leaving only microscopic cancer cells behind.
- Next, we’ll deliver a heated chemotherapy solution directly into your abdominal cavity to kill any microscopic cancer cells.
The body only absorbs a small amount of this chemotherapy, allowing doctors to use higher doses without risking side effects that can stem from traditional chemotherapy.
About 1-2 weeks after your HIPEC treatment, we'll meet with you again to check on your progress. This is also a good time to talk with your dietitian about how nutrition can help your healing process.
Monitoring your response to treatment
We recommend follow-up lab tests to see how your body is responding to treatment. These tests look for specific tumor markers, which can be found in your blood, urine, or tissues. Tumor markers are often made by cancer cells, and doctors use them to check how well your treatment is working or if the cancer has come back. We suggest doing these tests every 3 months for the first 2 years after your surgery and then every 6 months from years 3 to 5.
We might also recommend getting a regular CT scan for up to 5 years after your treatment. If your tumor markers go up at any time, your doctors may ask for additional tests to figure out why and design a further treatment plan.
FAQs
How long is the hospital stay following HIPEC surgery?
Our patients typically remain in the hospital for 10-12 days following the HIPEC procedure. Even after you return home, our care teams will keep working with you and your loved ones to ensure that all your home care needs are met. This includes coordinating a visiting nurse, physical therapist and occupational therapist as needed.
What is the HIPEC surgery recovery process?
After cytoreductive surgery with HIPEC, some patients may feel fatigued for 2-3 months. While you should take time to rest and recover, it’s also important to move around and stay as active as possible. Activity can help you fight fatigue and prevent possible surgical complications, such as blood clots forming in your legs and pneumonia.
Recovery is a long road that's best taken day by day. Set short- and long-term goals and try your best to continue doing activities that you enjoy most.
Is nutrition important during recovery?
Nutrition plays an important role in maintaining health and wound healing. Your care team will include a dietitian. They will monitor your nutrition before and after surgery to make sure your body is getting all the calories it needs.
Sometimes, this might involve additional help with a treatment like total parenteral nutrition (TPN). If that’s the case, your dietitian will work with you to create a customized formula and post-treatment plan.
What are the possible risks of HIPEC?
After cytoreductive surgery with HIPEC, the most common complications are bleeding and infection, which can occur with any surgery.
Other less common complications include:
- Blood clots: They can form in the legs and travel to other parts of the body, such as the lungs.
- Caloric deficits: This can happen if you aren’t able to consume enough calories after surgery. If this happens, you’ll receive intravenous nutrition to help keep up your caloric needs.
- Openings or leaks: An enterocutaneous fistula (an opening between the intestines and the abdominal skin) or an anastomotic leak (a leak that may occur when sections of the intestines are surgically reconnected) are less common risks, but still possible.
- Partial or complete organ removal: This might be necessary if your tumor cannot be separated from an organ’s surface. Organs that might be affected include the:
- Omentum (fatty layer that surrounds organs and absorbs tumor cells)
- Gallbladder
- Spleen
- Part of the small or large intestine
- Peritoneum (membrane that lines the abdominal cavity and covers the abdominal organs)
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