Extending the Lives of Stage 4 Cancer Patients

HIPEC procedure treats cancers that have spread to the abdomen

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

When someone is said to have "advanced cancer" that means the cancer has spread beyond where it started. Stage 4 is the most advanced cancer — there is no stage 5.

Now, individuals with certain advanced cancers have a reason to be optimistic. A procedure is available that can extend life beyond what traditional therapies offer.

This treatment is called hyperthermic intraperitoneal chemotherapy, or HIPEC for short.

In a nutshell, the two-part procedure begins with what's called "debulking" surgery to clear cancer from the abdominal cavity. Then heated chemotherapy is circulated throughout the abdomen to kill any remaining cancer cells.

Unlike traditional chemotherapy given through a vein, patients don’t experience traditional side effects such as hair loss with HIPEC.

dailyRx News spoke with one of the nation’s leading HIPEC experts, Richard Berri, MD, director of Surgical Oncology at St. John Hospital and Medical Center's Van Elslander Cancer Center in Grosse Point, Michigan.

dailyRx News:  What types of cancer is the HIPEC procedure used for?

Dr. Berri: Patients we treat have stage 4 metastatic cancer that has spread to the abdominal or peritoneal cavity. Patients who are eligible for evaluation are any patients who have tumors of the appendix, ovary, colon, rectum, stomach or small intestine. It also treats primary tumors of the peritoneum (abdomen) — peritoneal mesothelioma.

dailyRx News:  Who would make a good candidate for HIPEC?

Dr. Berri: Any patient who has had these tumors that have spread to the abdominal cavity should at least be evaluated by a surgical oncologist to determine if they are a potential candidate for this treatment.  

Most of my patients have already been treated for cancer and have had surgery or multiple surgeries, chemotherapy and radiation. Many have had extensive treatment.

dailyRx News:  So prior treatment does not exclude them as candidates for HIPEC?

Dr. Berri: That’s right. Previous treatment — even extensive treatment — would not exclude someone from undergoing this surgery and the HIPEC intervention.

dailyRx News:  Who would not be a good candidate for evaluation?

Dr. Berri: A patient who has been told by their doctor that the cancer has spread beyond the peritoneal cavity such as to the lung would be excluded from this treatment.

Also, the patient has to be strong enough to tolerate another surgery. If their day-to-day functioning isn’t very good, they most likely aren’t good candidates. So, for example, if they’re in a wheelchair or they can’t take care of their daily activities — bathing, dressing, etc. — or they can’t walk or are extremely weak or cannot eat or drink, then in most cases, these people are not going to be eligible for this type of surgery and this kind of intervention.

dailyRx News:  How is someone evaluated for this treatment?

Dr. Berri: First, they can call me and talk to me directly. I’ll answer any questions they may have. They can set up an appointment for this consultation through hipectreatment.com.

The next step is they come and visit our center. We take a detailed medical history of all that they’ve had done in the past, what conditions they’ve had and all the treatments they had for their current condition. We do a thorough review of all their prior history — reviewing all of their records, their previous pathology [lab] reports, operative reports, etc.

I talk with them about the risks and benefits of the procedure. Then their case is presented at our Multidisciplinary Tumor Board conference so as a group we can make a consensus recommendation as to whether the patient is a good candidate for surgery.

dailyRx News: Describe the procedure.

Dr. Berri:  The intent of the surgery is to explore the abdomen and find any sign of disease and to see if it’s removable. If we think we can remove all the disease, we proceed.

The surgery sometimes involves removing organs. I always tell patients that if I have to remove multiple organs and multiple structures, the intent is not to interfere dramatically with their function after surgery. So I will not do anything or go to the extent where I think it’s going to drastically change the patient’s quality of life and their functional status after they recover.

After I’ve removed all the disease, I then put in fluid that has chemotherapy within it. We close the patient’s abdomen and circulate the fluid that has chemotherapy in it that’s heated by the machine that allows it to circulate. The fluid and chemotherapy circulates for 90 minutes.

People ask if the chemotherapy we use has the same side effects as traditional chemotherapy in the vein and the answer really is “no” — it does not have the same side effects such as hair loss.

Then we reopen the patient and remove the fluid and the chemotherapy. If we’ve removed anything or taken anything apart that we need to repair, we do that and then close the abdomen.

dailyRx News: How long does the entire procedure last?

Dr. Berri: The surgery can last for anywhere from 4 to 15 hours. How long it takes depends on what we find during the surgery.
dailyRx News: Talk about the recovery.

Dr. Berri: Usually, they’re in the intensive care unit for 24 to 48 hours. The day after surgery, we expect them to be up and moving and walking. We have a whole team of nurses and people who will help them with their post-operative recovery. They leave the hospital an average of 8 days after the surgery. Then recovery at home lasts between six and eight weeks.

After recovery, patients can resume their normal activities and enjoy a good quality of life.

dailyRx News: How does this procedure impact survival?

Dr. Berri: In patients, for example with cancer of the appendix, who have the debulking surgery and HIPEC, we’ve seen 10-year survival rates of 50 to 70 percent.  That’s a type of tumor that really responds to this therapy and is almost standard indication for this procedure.

Other tumors — such as colon tumors — we’ve seen survival rates of five years that are quite routine. In colorectal cancers treated with standard chemotherapy, the survival rate is about two years. And that’s improved from the past, which is good. So for patients who may not be candidates for this surgery, there’s still hope with chemotherapy alone.

dailyRx News: What would you like patients to know about this procedure?

Dr. Berri: If you’ve been told you have a tumor of the GI [gastrointestinal] tract or of the abdominal cavity and it has spread, at the least you should inquire about this possible treatment. If felt appropriate by the surgeon or the doctors taking care of you, then you really should, at the very least, be evaluated by someone who offers this treatment to see if you are eligible and to see if they can help you.

It’s very, very worth it to explore all of your treatment options. As medicine continues to evolve and even for patients who have stage 4 metastatic disease, we still have many options to treat them to extend their lives — and this is one of them. Awareness and the ability to communicate and talk about these options and be evaluated is extremely important.

Learn more

To find out more about this procedure, visit the links below.

We’d like to thank Dr. Berri for taking time to visit with us and share his insights about this exciting advance in cancer therapy.

Review Date: 
August 6, 2013