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IntraPeritoneal (IP) Chemo

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

I was asked, so I'll share what I know and what I experienced.

I had metastatic appendix cancer. I had major cytoreductive surgery and colon resections (yes, plural - I'm reconnected in 3 places) followed by 5 3-day cycles bi-weekly of IP chemo, starting the day after surgery.

My IP chemo cocktail contained FUDR, which is a form of 5FU, at a strength of at least 300x stronger than what they can give you systemically, since it is only minimally absorbed by the bloodstream when administered intraperitoneally.

The dose of 5FU was diluted in 2 liters of a carrier for the day one infusion. Days 2 and 3 were each of one liter of chemo solution. All was left in me to resorb - a total of 4 liters every other week. After each day's infusion, I spent an hour rolling from side to side (every 15 minutes changing side) to distribute the chemo. Most people feel bloating and perhaps nausea from the pressure from this; I had pain, and developed the very rare complication of chemical peritonitis. Thus, I had only 5 cycles of a planned 8.

With the Heated IP Chemo (HIPEC), they usually use mitomycin or oxaliplatin in the chemo bath which is circulated through your peritoneal cavity during surgery, and then drained off. It is sometimes followed by subsequent IP chemo over the next few days while you are still in the hospital (different drs have different protocols.)

The protocol I had is the only one that I know of that occurs over several months.

I do know that IP chemo is also done for Ovarian cancers, tho the chemo agents and protocols are a bit different.

I'll try to answer any questions as best I can.

Alice

tanstaafl's picture
tanstaafl
Posts: 963
Joined: Oct 2010

Thanks, Alice. I noticed you mentioned special IP hardware. Its description and placement surgery will be all news for us.

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

A belly port for IP chemo is very much like a mediport/portacath for systemic chemo, in that it provides an easy access to get the chemo where it needs to go. However, unlike a systemic chemo chest port, an IP port has a tube running from it that ends in the peritoneal cavity, not in a vein. It also usually has holes along the tube to help the chemo disperse (like those watering hoses.)

Emla cream works wonders on it, and it is accessed just like any other port. The difference is that it is not "connected" on the other end, but just allows chemo to fill your belly. It can be placed during laparascopic surgery (which is what we'd hoped I would have.) However, my surgeon found more cancer during the laparascopic exploration, and switched to a laparatomy for full cytoreduction/debulking. The port was placed via a separate clean incision, just below my ribs. Tho some people don't bother ever having it removed, mine was bothering me, irritating my diaphragm and making me gasp and hiccup. It was removed in office under local.

For HIPEC, tubes and drains are placed. I don't know how the post-op IP chemo is handled; whether the equivalent of PICC lines are left in the belly, or whether that chemo is left in or drained out like the HIPEC is. I do know that the IP chemo I have is left in, and eventually resorbed.

I'll answer any questions that people have.

Alice

k44454445's picture
k44454445
Posts: 494
Joined: Jul 2012

thank you for the info as i will have hipec or someother type of ip chemo after surg. i have my #12 out of 12 chemo tx ( folfiri plus avastin) dec 31. some new year eve i will have!!! then 3 wks later a pet. i have an appt with an onc surg for feb 5th to discuss options. i wish i could avoid surg but as of now my onc said there will be surg. i might have questions later so thank you for the invite for future questions.
judy

pete43lost_at_sea's picture
pete43lost_at_sea
Posts: 3915
Joined: Nov 2010

I may have this one day, so thanks heaps.
interesting.

hugs,
Pete

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