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Peritoneal Surface Malignancy and HIPEC
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As one of the top-ranked medical centers in the U.S., UT Southwestern Medical Center provides the latest groundbreaking care for patients diagnosed with advanced cancer.
In addition to being the only National Cancer Institute (NCI)-designated comprehensive cancer center in North Texas, Harold C. Simmons Comprehensive Cancer Center is one of the very few centers to have a multidisciplinary Peritoneal Surface Malignancy (PSM) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Program in the U.S.
With ongoing research in basic, translational, and clinical trials, we deliver the best cancer care available today and push to discover new treatments for patients with advanced cancers that spread in the belly cavity.
NCI designation means we offer patients the ability to participate in the broadest range of clinical trials, with access to potential therapies not available at other facilities.
Our team of world-renowned PSM experts work tirelessly to address the unique needs of patients diagnosed with advanced or metastatic cancer that spread in the belly cavity. Through a multidisciplinary approach, our specialists lead and design the very best personalized treatment plans and therapies targeting a patient’s specific disease. In fact, UT Southwestern is considered one of the best hospitals for treating peritoneal cancer in the nation.
What Is Peritoneal Surface Malignancy?
Peritoneal surface malignancy (PSM) represents a wide range of benign or malignant tumors that have spread within the abdominal cavity.
These tumors can arise from the lining of the abdominal cavity known as the peritoneum. It can also originate from the appendix, colon, rectum, stomach, and ovaries. PSM often represents an advanced stage of cancer.
How Is PSM Treated?
For the best outcome in patients diagnosed with PSM, experts at UT Southwestern often use a combination of standard chemotherapy with a surgical procedure commonly called cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy HIPEC.
CRS and HIPEC are part of an aggressive surgical treatment protocol delivered in three phases:
- Phase one: Surgical exploration to determine how much cancer has spread within the abdominal cavity and the precise location of tumors.
- Phase two: CRS is an abdominal surgery during which the surgeons remove all macroscopic or visible tumors in the abdomen.
- Phase three: HIPEC occurs immediately following CRS. In HIPEC, heated chemotherapy is directly delivered into the abdomen to eliminate any microscopic or invisible cancer cells.
Why Do We Assess the Abdominal Cavity During the Surgery?
Directly examining the abdominal cavity is the only way to clearly determine the volume and location of the tumors. Because these tumor implants are very small, even computed tomography (CT) or magnetic resonance imaging (MRI) scans have difficulty “seeing” them.
This assessment can be performed most of the time by a small incision surgery or laparoscopic surgery.
What Is Cytoreductive Surgery (CRS)?
CRS is performed through an incision on the abdomen where all visible cancerous and diseased tissue is precisely removed.
What Is a HIPEC Procedure?
Following CRS, our surgical oncology specialists carefully place catheters into the abdominal cavity and deliver heated, cancer-fighting chemotherapy into the abdomen. The chemotherapy is allowed to circulate inside the abdomen at 42°C (107.6°F) for 100 minutes. Following the treatment, the chemotherapy solution is completely removed from the abdomen.
The UT Southwestern team of surgical oncologists will work with patients to determine the best treatment for them based on their specific cancer, location, and severity of disease.
Who Is CRS and HIPEC For?
Unfortunately, not all patients with peritoneal cancer can undergo HIPEC surgery or experience the benefits this treatment can offer. Patients who wish to undergo HIPEC should consider several factors, including:
- Origin of the peritoneal cancer: Where did the peritoneal cancer start, or which organ did the cancer originate from?
- Extent of the disease: The volume of cancer, often referred by our specialist as peritoneal cancer index (PCI) score, is used to determine how advance the cancer is in the belly cavity. In general, a high PCI score means a worse prognosis. However, there are exceptions, especially for a condition called low grade appendiceal neoplasm. Also, the location of the tumor implants is important. Sometimes, the tumor is in a spot where a safe operation cannot be performed.
- Patient performance status: HIPEC is a very long, extensive, and complex surgery. Patients must be in good health to tolerate the surgery and regain full recovery. Age alone might not be a limiting factor for HIPEC – “physiological age” is more important than “calendar age,” as we have safely performed HIPEC on otherwise fit and healthy patients over 70 years old.
- Cancer outside of the abdominal cavity: Heated chemotherapy used in HIPEC can treat cancer only inside the abdominal cavity. HIPEC works by the chemotherapy making direct contact with the tumor. If there are visible cancers outside of the abdomen (for example, in the lungs, bones, or brain), HIPEC is usually not considered. Other areas where HIPEC cannot treat include cancer inside the abdominal organs, such as the liver and pancreas.
What Are the Advantages of the HIPEC Procedure?
If a patient is a candidate for HIPEC procedure, there are many benefits to this type of targeted treatment versus traditional chemotherapy through an IV, including:
- A single treatment: Unlike intravenous chemotherapy, HIPEC is delivered once directly into the abdomen immediately following CRS. This means patients don’t need to make several trips for ongoing treatment over a period of weeks or months.
- Fewer side effects: HIPEC directly attacks the cancer cells in the abdomen instead of filtering through the entire body like traditional chemotherapy infusion. And because the solution is washed away, the ongoing toxic impact of the medicine is reduced.
- More effectively eliminates cancer cells: HIPEC is a powerful, concentrated, cancer-fighting treatment that washes throughout the abdomen. And because the medicine is heated, it works more quickly and effectively to destroy any cancer cells that may linger after surgery.
- Improved outcomes: Research shows that this type of highly directed treatment has significantly extended survival for many patients with peritoneal metastasis.
The goal of HIPEC is to control the cancer, symptoms and prevent cancer from returning.
Patients who may benefit from this targeted chemotherapy technique include those diagnosed with:
- Appendiceal cancer
- Colorectal cancer
- Gastric (stomach) cancer
- Peritoneal mesothelioma
- Ovarian cancer
For some with a peritoneal tumor, HIPEC may lead to a cure for their cancer. Others with a chronic peritoneal condition may choose HIPEC to manage their disease, relieve symptoms, and improve quality of life. Patients may receive a single HIPEC treatment or an additional treatment at a later time, depending on the peritoneal cancer type, location, and progression.
A Partnership Approach to Care Throughout a Cancer Journey
Moving forward after a cancer diagnosis can be physically, emotionally, and spiritually daunting. That’s why the UT Southwestern Medical Center specialists and sub-specialists are committed to helping our patients every step of the way throughout a cancer journey.
As a patient within the UT Southwestern Medical Center multidisciplinary PSM program, treatment begins with an on-site, thorough evaluation and treatment review with our multidisciplinary team of experts from medical oncology, surgical oncology, radiation oncology, and more.
Together, the patient and this team of cancer experts discuss the diagnosis and determine the best personalized treatment options, from surgery and treatment through recovery and beyond.
We also help patients navigate the resources and services available at UT Southwestern. Through our exceptional affiliations and collaborations on campus and throughout Central Texas and beyond, we can help patients, their family members, caregivers, and friends find meaningful programs and initiatives designed to educate, support, and address concerns and needs.
If you’ve been diagnosed with peritoneal cancer, would like a second opinion or would like to speak with a peritoneal disease specialist, please call 214-645-4673 to make an appointment.
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