"Cgsolomong"~Info 4U re Ovarian Cancer & hyperthermic intraperitoneal chemotherapy (HIPEC)

LorettaMarshall
LorettaMarshall Member Posts: 662 Member
edited March 2018 in Ovarian Cancer #1

Hello “Cgsolomong”

First of all, allow me to place your posting of February 27, 2018, in a new topic line all your own.  You have responded to a line of questions in a post that is now 10 years old.  It started back in 2008, and has been read by over 38,000 people.  So if you continue to go back there, you may not find many that are still posting.  So in order to “find you” more easily, it would be good if you place any questions and comments you have under this new heading.  Then we can keep a chronological discussion going dedicated to your wife’s cancer.  That is the best way for us to keep up with your comments and questions.   So I am taking the liberty of placing your short letter here, and then making my comments below. 

https://csn.cancer.org/comment/1619019#comment-1619019

“My wife was diagnosed on Jan 6, 2018 w Ovarian Cancer stage 3C

 This news broke us hard, and just a month after my dad died. It has been really rough. My wife started with CA 125 of 1250, the 1 st chemo did a good job and brought it down to 550, after 2nd Chemo it is in 86, so we are confident that for the 3rd she will get below 35. She is Platinum sensible and hopefully she gets a strong reduction of the tumor by the Cito reduction surgery commIng up on early April.

Then she will get a new treatment as 1st step for the surgery called HIPEC, which consists in giving her warm Chemo bathing her organs for 90 minutes, and then cleaning it up, this attacks also from the outside and not only from the blood stream, so the idea is to take out any small tumor that t(El human eye cannot see, therefore increasing chances of not getting it again. This procedure seems to have a great effect on Survival Rates, taking it from 37% up to 60% average, so it does increases the chances of removing the whole thing once and for all.  Anyway  3 chemos more will come after as maintenance and then the terrible waiting for the results. 

Good luck to you all.”

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My comments here:

Those of us who have “booked a room in Heartbreak Hotel” certainly know about the grief you are suffering, first from your father’s death in December 2017 and now your wife’s Ovarian Cancer diagnosis on January 6, 2018.  And though I’m not a mind reader, but most people I think equate eventual death with the word “cancer”.  That’s not always so, but if there is one word that brings “fear” into our hearts, it’s to hear that someone has been diagnosed with cancer.  However, there are miracles and the Lord has given me two miracles I do believe. 

For one, my husband was diagnosed with advanced stage Esophageal Cancer in 2002, and has been through all the pre-op (neoadjuvant) surgery, and post-op recovery, and is still cancer free as of today.  That is a miracle because most Esophageal Cancer patients are only diagnosed in the last stage where surgery is NOT an option, and death follows most often soon thereafter.  So I’ve been through all the stages of shock, but not disbelief or denial.  That’s because I’ve always known that none of us are immune from cancer.  I’ve know the “thrill of victory” of having him still be alive today.  And I give credit to my Lord for that.  Contrary to what others may choose to believe, while I know that God can and does heal many, He isn’t obligated to do so.  (And I’m not here to challenge anyone else’s beliefs, just telling you where I come from as it relates to my own Stage IV diagnosis.)

And then in November of 2012, I was diagnosed with terminal cancer, right from the “get-go.”  You can read more “about me” if you care to, by clicking on the picture of my husband and me which was taken December 2016.  We both have birthdays on the same day, that being February 12th.  So now I’m 79 and he is 81!  And I often tell people we are now back to adding a “half” to our years.  So if you ask me how old I am later this year, I would tell you 79 and “a half.”  That’s not normally how a woman would tell her age, if she would tell it at all.  But my husband and I are both elated and thankful to still be alive.  So both of us have been on “both sides of the cancer fence” as caregivers and cancer patients.  For that reason we believe we can be a help to others who follow after us.  Both of us have buried our moms and dads, so we know how their departure affects our lives.  They live on in our hearts because we carry with us many of their same traits and treasure the legacy of love they left with us.

That said, I will now comment on your wife’s cancer diagnosis—Ovarian Cancer Stage 3C.  When a person is “platin resistant”, it means that their bodies do not respond to the “platin” drugs.  You have described her as “platin sensible” and I think you mean “platinum sensitive”, based on the reduction in her CA-125 numbers.  She is responding well to whatever platin drug it is.  Carboplatin and Paclitaxel (Taxol) are the two chemo agents that I am taking.  They are usually the drugs prescribed first (most often) for Ovarian cancer patients since that combination has shown to be the most effective for the greatest number of OC patients.  That doesn’t mean that “all” have responded well.  If they are “platin resistant”, meaning that when tested the tumor markers have not been reduced that much, then another alternative med is prescribed.  So can I “assume” that she is taking Carboplatin?  Whatever it is, she is doing fantastic. 

Now you say, “Anyway  3 chemos more will come after as maintenance and then the terrible waiting for the results.”

 Yes, it “terrible” WAITING for the results.  We all know what you mean by that.  You know how the chemotherapy has affected your wife.  Very few of us have smooth sailing.  Often it’s quite debilitating.  And we may even despair at times when side effects seem intolerable.  But yet we keep the “end result” in mind and push on hoping to read the results of the final scans and see that it was all worth it after all.

 I may be a bit confused.  Is she going to have 3 more additional treatments PRIOR to her Cytoreductive Surgery?  Or is the surgery next on the schedule and then 3 more chemo treatments AFTER that?  HIPEC is given at the end of the Cytoreductive surgery (CRS), so I’m thinking she isn’t going to have 3 additional chemo treatments after the surgery, or is she?  Just trying to get a clear picture of the chronological order of things.

 My own chemo regimen consists of 6 treatments of Carbo/Taxol three weeks apart.  So am I to assume that this is the same regimen for your wife?  My oncologist usually orders a CT scan after the 3rd week to check my progress.  If I am doing well in reduction rate of tumor markers, then he will proceed to the last 3.  If I am not responding well, he will suggest using some other chemo combo.  So once again I think that your wife is most likely going to have 3 more treatments.  And then, she will be scheduled to have CYTOREDUCTIVE  Surgery (CRS) in early April.  Then again you’re there and I am not. 

 My own experience is that I first had a 6-treatment of chemotherapy pre-op (neoadjuvant) chemotherapy in the Spring of 2013.  Then on July 1, 2013, I had Cytoreductive Surgery.  At that time I had all “non-essential” organs removed.  That included removal of my fallopian tubes, ovaries, gallbladder, spleen, omentum and parts of my small intestines.  Now for me this was NOT meant to be curative, since I was already Ovarian Stage IV meaning multiple tumors were in many places in my peritoneal cavity.  The object was to remove as much cancer as possible and to prevent metastasis (spread) to new places.  In my case, I had previously had my uterus and appendix removed years back.  If I still had those, they would have been removed as well. 

 At the time of my surgery, Dr. Bartlett discussed HIPEC as a possibility.  I was hopeful that I would get to have that “warm chemo bath”.  However, this would be a determination he would have to make during surgery.  And when I recovered from the surgery, I learned that he had not chosen to use the HIPEC procedure.  I regretted that because I knew that clinical trials have shown that those patients who receive HIPEC do have longer survivals.  And that’s what we all want.  However, I had and still have great confidence in Dr. David Bartlett from the University of Pittsburgh Medical Center (UPMC) and I have to “go with his wisdom” on that.  I can’t see what he saw inside my body.  Each patient’s cancer situation will determine the specific treatment they will undergo. 

 I told my husband today—“I’m going to wear my “handicap placard” to Sunday School and tell them “I’ve outlived my 5-year handicap sticker”.  It expired today, February 28, 2018.  I’ve been issued another one.  And if your wife is as “fatigued” as I am, you will do well to ask for a handicap sticker, if you don’t already have one.  It’s a simple form that you fill out, have her doctor sign it, and send it in to the state.   

 So my hope for your wife is that her chemo regimen, the Cytoreductive Surgery and the HIPEC treatment will give your wife renewed health and vigor.  I’m sure all who have read your letter are wishing the both of you great success. 

Loretta (Peritoneal Carcinomatosis/Ovarian Cancer Stage IV)

 P.S.  Below you will see a multitude of references relative to Ovarian Cancer and videos about how the “Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is utilized.  And don’t be afraid to ask your doctors any and ALL questions that you have on your mind.  There are no “stupid questions.”  You’ve never “been here” before, and you are not expected to know everything about this cancer.  Basically, I’ve included the info from the University of Pittsburgh Medical Center (UPMC) because Dr. David Bartlett is my surgeon from there.  Not all hospitals are equipped and staffed to perform the HIPEC center.

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 1.      http://www.practiceupdate.com/c/30185/2/0/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_onc&elsca4=oncology&elsca5=newsletter&rid=MTYyNDA5MzQwNDg1S0&lid=10332481

Published in Oncology - Journal Scan / Research · October 08, 2015

“Hyperthermic Intraperitoneal Chemotherapy Plus Cytoreductive Surgery Improves Ovarian Cancer Survival

European Journal of Surgical Oncology TAKE-HOME MESSAGE

  • The authors performed a systematic review and meta-analysis to evaluate the safety and efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery (CRS) in patients with epithelial ovarian cancer (EOC). HIPEC+CRS+chemotherapy was associated with improved 1-year survival compared with CRS+chemotherapy, which continued up to year 8. There were no differences in morbidity and mortality between groups, and HIPEC+CRS+chemotherapy resulted in similar 1-, 3-, and 5-year survival rates among patients with primary and recurrent EOC. Completeness of cytoreduction was positively correlated with survival.
  • Overall survival in patients with either primary or recurrent EOC is improved by adding HIPEC to CRS and chemotherapy...

PURPOSE - Emerging evidence suggests that hyperthermic intraperitoneal chemotherapy (HIPEC) with cytoreductive surgery (CRS) shows a survival benefit over CRS alone for patients with epithelial ovarian carcinoma (EOC). This systematic review and meta-analysis will assess the safety and efficacy of HIPEC with CRS for EOC.

DESIGN - Searches of five databases from inception to 17/02/15 was performed. Clinical outcomes were synthesised, with full tabulation of results.

RESULTS - A total of 9 comparative studies and 28 studies examining HIPEC+CRS for primary and/or recurrent EOC were included.

Meta-analysis of the comparative studies showed HIPEC+CRS+chemotherapy had significantly better 1-year survival compared with CRS+chemotherapy alone (OR: 3.76, 95% CI 1.81-7.82).

The benefit of HIPEC+CRS continued for 2-, 3-, 4-, 5- and 8-year survival compared to CRS alone (OR: 2.76, 95% CI 1.71-4.26; OR: 5.04, 95% CI 3.24-7.85; OR: 3.51, 95% CI 2.00-6.17; OR: 3.46 95% CI 2.19-5.48; OR: 2.42, 95% 1.38-4.24, respectively). Morbidity and mortality rates were similar. Pooled analysis of all studies showed that among patients with primary EOC, the median, 1-, 3-, and 5-year overall survival rates are 46.1 months, 88.2%, 62.7% and 51%. For recurrent EOC, the median, 1-, 3-, and 5-year overall survival rates are 34.9 months, 88.6%, 64.8% and 46.3%. A step-wise positive correlation between completeness of cytoreduction and survival was found.

CONCLUSION - The addition of HIPEC to CRS and chemotherapy improves overall survival rates for both primary and recurrent EOC.”

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2.      https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/staging.html

“Ovarian Cancer Stages

After a woman is diagnosed with ovarian cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer's stage when talking about survival statistics.

Ovarian cancer stages range from stage I (1) through IV (4). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more. Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

One of the goals of surgery for ovarian cancer is to take tissue samples for diagnosis and staging. To stage the cancer, samples of tissues are taken from different parts of the pelvis and abdomen and examined in the lab.

How is the stage determined?

The 2 systems used for staging ovarian cancer, the FIGO (International Federation of Gynecology and Obstetrics) system and the AJCC (American Joint Committee on Cancer) TNM staging system are basically the same.

They both use 3 factors to stage (classify) this cancer :

  • The extent (size) of the tumor (T): Has the cancer spread outside the ovary or fallopian tube?  Has the cancer reached nearby pelvic organs like the uterus or bladder?
  • The spread to nearby lymph nodes (N): Has the cancer spread to the lymph nodes in the pelvis or around the aorta (the main artery that runs from the heart down along the back of the abdomen and pelvis)? Also called para-aortic lymph nodes.
  • The spread (metastasis) to distant sites (M): Has the cancer spread to fluid around the lungs (malignant pleural effusion) or to distant organs such as the liver or bones?

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage.

The staging system in the table below uses the pathologic stage (also called the surgical stage). It is determined by examining tissue removed during an operation. This is also known as surgical staging. Sometimes, if surgery is not possible right away, the cancer will be given a clinical stage instead. This is based on the results of a physical exam, biopsy, and imaging tests done before surgery. For more information see Cancer Staging.

The system described below is the most recent AJCC system effective January 2018. It is the staging system for ovarian cancer, fallopian tube cancer, and primary peritoneal cancer.

Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand…”

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3.      http://www.upmc.com/Services/regional-perfusion/treatment/hipec/Pages/default.aspx?

​Hyperthermic Intraperitoneal Chemoperfusion (HIPEC) Treatment

Many tumors too advanced for surgical removal remain confined to a single organ or region of the body. Hyperthermic intraperitoneal chemoperfusion (HIPEC) is a surgical technique that we use to treat these types of tumors.

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4.      https://www.youtube.com/watch?v=UeDDYt_5-Gw

Cancer Treatment: Heated Intraperitoneal Chemotherapy (HIPEC)

 Nucleus Medical Media – Feb. 6, 2014 - Hyperthermic intraperitoneal chemotherapy, or HIPEC, is a treatment option for patients with advanced cancers that have spread to the abdominal cavity or peritoneum.  First, the doctor performs an operation to remove all visible tumors from the abdominal cavity. Then, the HIPEC is administered, which is a heated chemotherapy treatment aimed at killing any remaining cancer cells that cannot be seen.  (3:50 minutes) animated video

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5.       https://www.youtube.com/watch?v=ot3YAxpOLR0

HIPEC Shows Promise for Treatment of Abdominal Cancers

 Published on Apr 5, 2013 - David Bartlett, MD, vice chairman for surgical oncology and gastrointestinal services at UPMC, discusses HIPEC as an approach that may improve the long term survival of patients diagnosed with abdominal cancers when used in conjunction with other cancer therapies. (3.56 minutes)

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6.      https://www.youtube.com/watch?v=OHK23AWoG0Q&t=116s

Dr. David Bartlett discusses the HIPEC program at UPMC (6:29 Minutes)

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7.      https://www.youtube.com/watch?v=bdNtah1mpg4

Published on Sep 17, 2012 - UPMC physician's assistant discusses HIPEC pre-operative workup, orders and consent forms (3:00 minutes)

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8.      https://www.youtube.com/watch?v=6lqnl-3WP7Y

HIPEC Procedure - Hyperthermic Intraperitoneal Chemotherapy

Published on Sep 14, 2015 - A novel procedure called hyperthermic intraperitoneal chemotherapy (HIPEC) combines surgery, heat and chemotherapy, creating a powerful treatment that can dramatically improve the quality of life, and sometimes even extend it, for patients with these types of cancer. (4:45 minutes)

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9.      http://www.upmccancercenter.com/cancer-care/surgical-oncology/koch-regional-cancer-therapy-center/treatments/hipec?&gclid=COKrsOvtyNMCFV6BswodqugDQg

“Hyperthermic Intraperitoneal Chemoperfusion (HIPEC) Treatment

Many tumors too advanced for surgical removal remain confined to a single organ or region of the body. Hyperthermic intraperitoneal chemoperfusion (HIPEC) is a surgical technique that we use to treat these types of tumors.

What Can I Expect During Hyperthermic Intraperitoneal Chemoperfusion?

In HIPEC, our surgeons may first debulk, or partially remove, the tumor prior to treating.

    • Afterwards, the surgeon makes two small incisions and inserts tubes:
      • One to pump the heated chemotherapy solution into your body.
      • One to circulate the fluid back to the heating equipment.
    • Once the treatment begins, the temperature in the chest cavity rises to between 105 and 107.6 F (40.6 and 42 C).
    • The chemotherapy solution circulates for several hours to kill the cancer cells.
    • The pump is turned off to allow the treated region to cool to normal temperature.
  • Then the surgeon removes the tubes and temperature probes, closes the incisions, and sends you to recovery…”
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10.  https://www.youtube.com/watch?v=bqJiyMEMamk

HIPEC Patient Education Video Series - Introduction

 HIPEC Treatment - Published on Sep 17, 2012 - Dr. David Bartlett discusses the HIPEC program at UPMC (2:00 minute video intro)

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11.  https://www.youtube.com/watch?v=VRfU-oOBNGU

Specialty Care Centers at UPMC Cancer Centers

Uploaded on May 17, 2011- Dr. David Bartlett explains how UPMC Cancer Centers streamlines cancer care. (2:55 minutes)

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12.  https://www.youtube.com/watch?v=mJ4rdhhboVs&t=185s

HIPEC Patient Education Video Series - Patient Selection

Published on Sep 17, 2012 - Dr. Herbert Zeh discusses HIPEC Patient Selection at UPMC – (4:43 Minutes)

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13.  https://www.youtube.com/watch?v=eiAu-LHQHoY&t=672s

Dr. David Bartlett HIPEC Webinar - HIPEC Treatment - Uploaded on Jan 27, 2012 – (24:58 minutes)

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14.  https://www.youtube.com/watch?v=MSeqsc-2WFM

HIPEC Patient Education Video Series - Cytoreductive Surgery

Published on Sep 17, 2012 – Dr. James Pingpank discusses the operative technique for debulking and cytoreductive surgery at UPMC (10:06 Minutes)

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15.  https://www.youtube.com/watch?v=GCABswECFYg&t=250s

Published on Sep 17, 2012 - Dr. Steven Ahrendt (my doctor who monitored my recovery from Cytoreductive Surgery) discusses post-operative issues and follow up care – (18:15 minutes)

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16.  https://www.youtube.com/watch?v=ATJ-2bLz14c&t=235s

HIPEC Patient Education Video Series – Anesthesia

Published on Sep 17, 2012 - Dr. Larry Maher discusses the role of anesthesia in the HIPEC procedure at UPMC (11:24 minutes)

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17.  https://www.youtube.com/watch?v=NHNoeMxqnro

Published on Sep 17, 2012 - A UPMC nurse practitioner discusses Perioperative care (4:24 minutes)

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18.  https://www.youtube.com/watch?v=uI2GYjxM8_o

HIPEC Patient Education Video Series - Operating Room Nursing & Perfusion

Published on Sep 17, 2012 - A UPMC clinical specialist discusses the operating room nursing and perfusion aspects of HIPEC (18.09 minutes)

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19.  https://www.youtube.com/watch?v=J6DpWGEKQ3g

Uploaded on May 17, 2011- Dr. David Bartlett discusses treatment options for cancer that has advanced beyond surgical treatment.

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20.  https://www.youtube.com/watch?v=eiAu-LHQHoY

This is a 24 – minute video by Dr. David Bartlett explaining which types of cancer benefit from HIPEC. 

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21.  https://www.youtube.com/watch?v=OHK23AWoG0Q

Dr. David Bartlett discusses the HIPEC program at UPMC-A 6 minute video by Dr. Bartlett explaining HIPEC.

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22.  https://www.youtube.com/watch?v=l65xOD7nPbc

Published on Jan 22, 2014-Hyperthermic (or Heated) Intraoperative Peritoneal Chemotherapy (HIPEC) is used to treat cancers that have spread to the lining of the abdominal cavity, such as those of the appendix, colon, stomach, and ovaries.

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23.  https://www.youtube.com/watch?v=UeDDYt_5-Gw

Published on Feb 6, 2014-Hyperthermic intraperitoneal chemotherapy, or HIPEC, is a treatment option for patients with advanced cancers that have spread to the abdominal cavity or peritoneum.  First, the doctor performs an operation to remove all visible tumors from the abdominal cavity. Then, the HIPEC is administered, which is a heated chemotherapy treatment aimed at killing any remaining cancer cells that cannot be seen.

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24.  http://www.hipec.com/

4:38 minute video explaining HIPEC treatment for Peritoneal Cancer

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25.  http://www.hipec.com/peritoneal-cancer/treatment-options/

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26.  http://www.hipec.com/hipec/

Treatment Centers around the globe.

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27.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3076138/

Intraperitoneal therapy for peritoneal cancer

 _________________End of references – mostly relative to UPMC HIPEC program___________________________

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