- Colorectal cancer
- Pancreatic/Appendiceal cancer (including pseudomyxoma peritonei or PMP)
- Ovarian cancer
- Stomach cancer
- Peritoneal mesothelioma
- Primary peritoneal cancer
Peritoneal Surface Malignancy Treatment
Peritoneal Surface Malignancy FAQ | Jonathan Greer, M.D.
Surgical oncologist Jonathan Greer discusses peritoneal surface malignancy, a tumor that has spread from a primary organ to the abdomen — more specifically, the lining of the abdominal cavity (or peritoneum) — and treatment options.
HIPEC: What You Need to Know | Fabian Johnston, M.D.
Surgical oncologist Fabian Johnston discusses cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC), a highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery and has been shown to be effective against primary peritoneal and other types of cancer.
Due to recent advances in surgical techniques, we are now able to provide more treatment options for certain late stage cancers than ever before. A technique called tumor debulking, or cytoreductive surgery (CRS), and hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to be an effective treatment option for certain patients with peritoneal surface malignancy.
This complex surgical procedure is a two-step process:
- Surgically removing any visible tumor or cancer (CRS)
- Delivering heated chemotherapy drugs into the abdomen (HIPEC)
The first phase of treatment, CRS, involves removing any visible tumors in the abdomen, which may include involved organs.The extent of surgery will be determined by the amount of tumor in your abdomen. Surgeons carefully balance the risks and benefits of organ removal with your cancer treatment and overall health, and will discuss this with you extensively prior to surgery.
During the second phase of treatment, a heated chemotherapy solution is circulated in the abdominal cavity to treat any cancer cells that may remain.The combination of heat and chemotherapy delivered directly to your abdomen in the operating room is believed to be more effective than surgery alone for certain patients with peritoneal disease because it can access and kill more cancer cells than can be found with the naked eye.
Recent studies have shown that CRS/HIPEC is beneficial for certain patients with late-stage gastrointestinal cancers and ovarian cancer.The procedure can potentially prolong life and also improve quality of life for patients. Since the chemotherapy is delivered as a one-time dose directly into the abdomen, the traditional side effects of oral or intravenous chemotherapy drugs may be avoided; however, many patients do still require intravenous chemotherapy before or after surgery.
Quality of Care
A multidisciplinary team of health care professionals will carefully review your medical records and meet with you to determine if this operation may be an effective treatment for you. Two factors are critical for successful outcomes: First, careful patient selection to determine who may benefit the most with the least amount of risk, and second, performance of this operation at a busy national cancer center, such as The Johns Hopkins Hospital, by professionals experienced in the care of complex cancer patients.
Frequently Asked Questions about Peritoneal Surface Malignancy Treatment
At this time, most CRS/HIPEC is performed through an open incision, extending from the bottom of your sternum to your pubic bone. We work closely with our anesthesia colleagues to minimize discomfort after surgery.
Two to three months is the average time that it takes for most patients to feel back to normal.
- Fatigue is common as the body recovers from this complex surgery and gradually improves with daily activity and rest periods as needed.
- Nausea is managed with medications and gradually advancing your diet from liquids to solid foods.
- Pain is managed with intravenous or epidural medications and, later, oral medications to achieve control.
- Loss of appetite is common and gradually improves by eating small frequent meals.
- Hair loss is temporary and usually improves with good nutrition and time.
- As with all major surgery, there are the standard risks of bleeding, infection and the effects of anesthesia. Most are minor, but some require further stay in the hospital for management.
- Other surgical risks depend on the degree of organ removal and will be discussed with you at your preoperative visit.
Be prepared to stay in the hospital 10–14 days. On average, patients are released on approximately day 8 or 9.
The one-time dose of chemotherapy delivered into the abdomen at an elevated temperature causes the following:
- Bowels to temporarily slow down
- Changes in lab results such as white blood cell and platelet counts
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Meet Our Experts
Our multidisciplinary team consists of surgeons, oncologists, advanced practice providers, radiologists, anesthesiologists, nurses, nutritionists and social workers who are all dedicated to providing holistic care based on the best evidence to improve patient outcomes and the quality of life for people diagnosed with peritoneal carcinomatosis.
Nettles, Brenda Smith DNP, ACNP-BC
Nurse Practitioner Johns Hopkins University School of Medicine, Baltimore, Maryland