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Peritoneal Stripping

wanttogetwellsoon
Posts: 147
Joined: Apr 2011

My doctors have said that they might contemplate releasing some of my adhesions as they are dense and take my peritoneum out by stripping it.

Does anyone else here have any knowledge of this process and how difficult is the operation?

Thanks everyone...:)

Sue

Tina Brown's picture
Tina Brown
Posts: 1054
Joined: Nov 2009

I have never heard of this and will be interested to hear how it goes

Tina x

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi: As I understand the question, it is the "stripping" that is the surgery? The two doctor team that does the HIPIC thing in Calgary start with complete stripping of the peritoneum hoping to remove not only the visible tumours but also the microscopic ones. It takes about 10-17 hours. They follow this with the chemo bath internally using their hands to "wash" everything. As I also understand it, the peritoneum is only a cell or two in depth which makes stripping a tricky technique and why it takes so long to perform. Have I got this right?
Cheryl

wanttogetwellsoon
Posts: 147
Joined: Apr 2011

That's what I thought. The peritoneum I'm told is the largest area of the body even after the skin. I hadn't realised the operation would take so long but now I know it's not an easy operation. I'll probably have more information in about four weeks when I have the results of my 3 month scan so I'll let you know. Thanks for letting me know. :)

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi: I would certainly check on exactly what your operation will entail. Myself, I don't really understand the difference between the two or are they in fact the same operation, just different words to describe it. I know I see "debulking" in the ovarian cancer literature and stripping in the peritoneum/gastro literature. Any one out there know? Thanks!
Cheryl

AussieMaddie's picture
AussieMaddie
Posts: 345
Joined: May 2011

I've not heard of stripping the peritoneum, but Cheryl, if it takes 10-17 hours, there's not way I can ever see them doing it on me.

AT my morbidly obese size, I'd be lucky to recover from a one hour procedure.

Somehow, I don't think it will be an issue for me.

Good luck Sue on your experience of stripping of the peritoneum. If you can't find answers here, I'd google "stripping the peritomeum" to find some answers. The other obvious place is to ask your oncologist.

For now, I'm just waiting on results..

AussieMaddie

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi all: See my findings (and confusion) under Surgeries.
Cheryl

wanttogetwellsoon
Posts: 147
Joined: Apr 2011

It sounds like a difficult procedure doesn't it? I know the peritoneum is the biggest surface of the body including the skin. It's not very thick so I'm told. I have dense adhesions so, if the chemo helps in getting the inflammation down, I'm not sure if my doctor will say that the organs need releasing anyway. I usually find things easy(ish) to understand but the whole abdomen thing is hard for me and partly, I think it's because I'm so emotionally involved. I'll let you all know soon as I have a scan in two weeks to check how the first three chemos have gone and then see my doctor the week after that. :)

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi: Keep us posted on this one. Ditto for me re what's all in there and why there are different procedures for different kinds of peritoneum cancers. I should get the results of my MRI scan of the peritoneum soon, hopefully, to see if the new chemo regime is doing any kind of a job at all.
Cheryl

wanttogetwellsoon
Posts: 147
Joined: Apr 2011

Hi Cheryl...
I hope things go well with the MRI. I'll be keeping all fingers and toes crossed for you. :)

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi: Thanks! The lung CT was clear (monitoring some apparently old lesions from an exposure at some time in the past to something nasty like TB or something creeping out in places I've worked in like the Arctic or the Amazon or even labs). Still awaiting the MRI results.
Cheryl

AussieMaddie's picture
AussieMaddie
Posts: 345
Joined: May 2011

Hi Cheryl,

great news about the CT scan that was clear. Now hoping that the MRI goes the same way..
Take great care,
AussieMaddie
xxx

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi: Well, these results were not so good but not terrible either. No change in size or number of cancerous nodules on the peritoneum (but oncologist had hoped for some reduction and even elimination) and no evidence of any cancers anywhere else (that is very good news). But I have a mammo biopsy tomorrow so we'll see how that goes! Thanks for the wishes!
Cheryl

AussieMaddie's picture
AussieMaddie
Posts: 345
Joined: May 2011

Good luck with that ((( hugs )))

wanttogetwellsoon
Posts: 147
Joined: Apr 2011

Cheryl...
Just wondering why you're having the mammo biopsy. Can the breasts affected? I hadn't realised that ... or am I barking up the wrong street? :)

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daBeachBum
Posts: 164
Joined: Apr 2011

Cheryl,

I'm sorry that you didn't find any shrinkage in your nodules. Overall though your results seemed pretty promising to me. I hope the next time around you get the news you want!

I got a similar report back about my osmental caking remaining unchanged on my CT scan, but my doctor was very happy with the results. If she is OK with it, then I will be too. I figure if she is smart enough to work at Penn, I will trust what she says.

Best of luck on the mammo biopsy!

Ray

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westie66
Posts: 642
Joined: Jun 2010

Hi: thanks, all. Yes, no change is better than growth. And who knows, there may have been shrinkage when comparing each nodule to what it was a year ago. I need a "map" of these critters with location and start size (being the good geographer that I am!).
Re the mammo biopsy. I don't think they are related as I have had call backs on my mammograms for years. But it is possible. The biopsy was interesting to say the least and not something I want to repeat! Get those results in 10 days. My dog Charlotte just got sprayed by a skunk in the backyard so have to go and clean her up (she stinks!) - not sure how as I'm not supposed to lift anything for 2 weeks. But must be done.
Cheryl

Sadee
Posts: 1
Joined: Jul 2011

I had been reading up on peritoneal cancer earlier tonight as it is one of several cancers my mother has just been diagnosed with. I came across a website with the info I believe you are looking for in the HIPEC surgery at www.hipectreatment.com .

westie66's picture
westie66
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Joined: Jun 2010

Hi: There is only one place that does it here in Canada and that is in Calgary (Wally Temple). They had a program on it on the news the other night and it looks very promising indeed - less traumatic than the stripping surgery. Has anyone had this treatment without the debulking or stripping? Has it worked? There were a lot of very positive testimonials on the newscast.
Cheryl

wanttogetwellsoon
Posts: 147
Joined: Apr 2011

Hi Cheryl..
I've heard that for certain types of cancer, intra peritoneal chemo can be much more effective than conventional chemo because it gets straight to where it needs to. It's like giving the peritoneum a bath. Unfortunanately, I have so many adhesions that the organs are stuck together and, even if the surgeons thought it possible to cut the adhesions to release them, it would be unlikely that the chemo would reach every nook and cranny. The treatment must offer hope though to many people, mustn't it? :)

westie66's picture
westie66
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Joined: Jun 2010

Yikes! trying to visualize organs stuck together - sounds awful! I'm not sure what my chances of getting the treatment would be given only one place in Canada does it. To me, it makes sense - get the chemo to where it needs to be, particularly as the peritoneum nodules are not connected to the blood system. How painful can a procedure like that be? (Well, it is always worse than it sounds!).
Cheryl

wanttogetwellsoon
Posts: 147
Joined: Apr 2011

Hi Cheryl....
I hadn't realised that the nodules aren't connected to the blood system by direct means. I think the cells travel through the body (if they ever do) via the lymph nodes. And, yes, it does seem sensible that the drug can get to where it's needed. I think the surgeons use the chemo bath when they take away the uterus etc. during debulking surgery, but I've heard that they can also put in a port on the abdomen and administer the drugs that way post debulking. It does sound as if it could be a painful procedure, but I'm not sure if it is or not. The drug is a lot more effective though and it can't be worse than what we've been through already, can it?
Take good care Cheryl. :)

abrub's picture
abrub
Posts: 1531
Joined: Mar 2010

tho it sounds awful. If they give you Emla cream or another numbing agent, you don't feel the needle going into your belly at all. Then you lie there for a couple of hours while they infuse the chemo. You roll around for an hour (change sides every 15 minutes) to spread the chemo around, and you go home. Most people feel bloated after. My husband and I used to go for walks after (and I bought myself the sexiest dress I ever owned on a chemo afternoon! Husband was thrilled!) That said, I did have residual meds (see below) still fogging my mind for a few hours, tho I didn't realize it. (No driving involved - we went to NYC for the IP.)

Due to other reasons, I had to be pre-medicated with IV ativan and dilaudid for the IP chemo. The IV was much more painful than the needle in the belly port. (No one else I know who had the IP chemo like I did, post-op via belly port, needed the IVs - I was just "special".)

At the end, the belly port was removed in an outpatient setting, with local anesthetic, and I was sent home.

My port did rub my diaphragm a bit, which made me gasp occasionally, not in pain, just a reflexive gasp. It startled people, but once the port was gone, the gasping stopped. It also made me more prone to hiccups.

However, the IP chemo was definitely easier to tolerate than the systemic.
Alice

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi Alice: So, it is done once or over a period of days or regularly over a longer period?
Cheryl

abrub's picture
abrub
Posts: 1531
Joined: Mar 2010

Cheryl,
It is a 3 day cycle, repeated every 2 weeks for X number of cycles (I was supposed to have 8 cycles.) The first cycle is started 24-48 hours post-op.

Day 1: 2 liters of chemo is infused in your belly, over about 2 hours.
Days 2 & 3: 1 liter each day is infused into your belly over about 1 1/2 hours.

The chemo is left to resorb on its own. It is not run through and drained. After the infusion, you roll from side to side every 15 minutes for an hour to ensure that your belly gets fully treated.

I only completed 5 cycles, as the level of pain indicated that I had developed a chemical peritonitis (very rare). The damage was confirmed when my surgeon did my hernia repair last year, and found that an erstwhile clean belly, while still clear of cancer, was now "a spider-web of massive adhesions" (his words.) Probably residual scar tissue from "chemical burns".

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi again: And I assume it is done only after the stripping? Which would be out for me as I can't get the stripping. Do you know of anyone that has had the intra-peritoneal chemo without the peritoneal stripping?
Cheryl

MFDM
Posts: 3
Joined: Aug 2011

Hi everybody -- I've been lurking on these boards for a while now since my mother has stage four peritoneal cancer. I joined just now and got an account because I wanted to make sure you all saw Andrew Pollack's article in today's New York Times. Here's a link (I don't know if the paste will work very well, but it's on the front page of nyt.com right now):
http://www.nytimes.com/2011/08/12/business/heated-chemotherapy-bath-may-be-only-hope-for-some-cancer-patients.html?hp

I found the article very informative about the procedure, the risks, the cost, etc.

Very best to all of you--
MFDM

Tina Brown's picture
Tina Brown
Posts: 1054
Joined: Nov 2009

Thanks for the link I found it very interesting. I live in the Uk so not too sure whether it is offered over here. I've been told my cancer is "sand like" and surgery would be futile.

Tina x

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi Tina and all: In Canada you don't appear to be able to get the internal heated chemo bath without the stripping surgery which doesn't make too much sense to me but there it is. I have heard of people getting the surgery with nodules on the peritoneum and omentum which also worked for the "sand like" almost microscopic invasions as they remove the peritoneum and omentum and other things to make sure they get it all. But I have also heard that the little cancers "text message" each other to start spreading when treated. Not sure I believe that but anything is possible with cancer! I think someone on this discussion board (or maybe it was the colon cancer board) described their peritoneum cancer as like an exploded dandelion head and she had surgery for it. That was in the States though. An interesting topic to me because not sure what we'll try if the oxaliplatin/irenotcan/leucovin/5FU cocktail doesn't work! The nodules won't respond to a cocktail with taxol in it because they originated from the gallbladder.
Let us know hwat your ultrasound shows, Tina. I had ultrasound for an "unusual" ovary - it was done internally - and it was just a cyst.
Cheryl

Tina Brown's picture
Tina Brown
Posts: 1054
Joined: Nov 2009

My ultra-sound did include a TV (Trans vaginal) probe. That is how they were able to see the abnormal ovary. I am seeing my oncologist Thursday 18th (tomorrow) and hopefully get some sort of plan of action. Will post as soon as I know.

Tina xx

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi Tina: Please let us know!
Good luck!
Cheryl

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