By Mark Sherman, M.D., & Cheryl Olson, M.D., Scripps Memorial Hospital La Jolla
Two of cancer’s biggest foes-heat and chemotherapy-have joined forces to create a powerful weapon in the battle against abdominal cancer, a life-threatening form of cancer long considered virtually untreatable in its advanced stages.
Why is abdominal cancer so challenging? There are several reasons. Only about 10-20 percent of abdominal cancers are diagnosed in the earlier stages; the rest are found much later, after cancer cells have spread along the inner lining of the abdomen, known as the peritoneum. At this stage, it is not possible to remove all of the cancer cells surgically. Nor is conventional chemotherapy effective, because treatments taken orally or delivered through the veins are too diluted to have significant value by the time they reach the abdominal cavity. So cancer often persists despite treatment.
Enter the newest approach, called Intra-Peritoneal Hyperthermic Chemotherapy or IPHC (or ), which applies chemotherapy chemicals directly to the cancerous cells by bathing the entire lining of the abdomen with a heated chemotherapy solution.“Intra-peritoneal” means that the treatment is delivered directly to the abdominal cavity; “hyperthermic” means that the solution is heated. IPHC is performed after the surgeon has removed as much of the tumor as possible; the heated chemotherapy solution comes into direct contact with the cancer cells that remain in the lining at higher concentrations than oral or intravenous therapies. Moreover, heat alone kills cancer cells; combined with chemotherapy, heat enhances the effect of the treatment.
Clinical studies have proven that IPHC can be significantly more effective than surgery alone in treating advanced abdominal cancers. In one study of patients whose cancer had spread from the small intestine to the abdominal lining, those who received IPHC in addition to surgery and other treatments survived an average of 45.1 months. Patients in the same study who did not have IPHC survived just 3.1 months.
Depending on the individual, IPHC can significantly improve the patient’s length and quality of life or may even be a cure. In any case, it offers renewed hope to patients whose cancer was previously considered untreatable.
Who Is Eligible for IPHC?
The best candidates for IPHC have advanced gastrointestinal cancer, including cancers of the stomach, appendix, large intestine, small intestine and ovaries, that is untreatable by any other method. The cancer must be confined to the abdominal cavity, and since the treatment takes several hours following surgical removal of the tumor, patients must be able to undergo a lengthy surgical procedure. The risks of IPHC are similar to those of conventional surgery.
If a patient is a good candidate for IPHC, the surgeon will first perform an exploratory procedure to confirm the diagnosis and determine whether IPHC is truly the right approach. After removing as much of the tumor from the surfaces of the abdomen as possible, the surgeon will introduce the heated fluid containing a chemotherapy drug called Mitomycin-C into the abdominal cavity (in some cases, other chemotherapy drugs may be used as well). The heated solution circulates in the abdominal cavity for about two hours, and then is drained from the patient’s body.
The entire operation lasts from four to eight hours; afterward, patients typically spend a day or two in the Intensive Care Unit (ICU) to monitor recovery, followed by another week or so in the hospital to fully recover.
Drs. Sherman and Olson are general surgeons at Scripps Memorial Hospital La Jolla.