HIPEC (Hyperthermic Intraperitoneal Chemotherapy) & IP (Intraperitoneal Chemotherapy) Specific repl

 

October 10, 2015

 

Dear “myljon3@yahoo”

          Since reading your entry, I decided to look up some references regarding the Intraperitoneal Chemo treatments.  I am addressing this letter to you in particular but decided to put it on a separate entry so others could access the info as well, if they are not familiar with it.  Anyone anticipating surgery, or having just been diagnosed with Ovarian Cancer or Peritoneal Carcinomatosis may find it useful.

          I was first diagnosed with Peritoneal Carcinomatosis in November of 2012.  First I went to my regular GP thinking I might have a hernia since I felt a small “lump” on the left side of my abdomen.  He just examined my abdomen with a touch of his hands and concurred that it was most likely had a hernia.  He asked if I wanted to just wait a while and see if things improved.  Before I could answer he said, “I can tell by the look on your face that you don’t want to wait.”  So he made arrangements for me to see a surgeon.  However, a week later I experienced some sharp groin pain and general abdominal discomfort that lasted for 3 days so I went to the Emergency room.  After going through the routine questions and examination, they gave me a CT.

           The physician handed me a copy of my CT scan. Since my husband is a 15-year survivor of Esophageal Cancer, Stage III (3N1M0).   (That is a miracle for which we thank the Lord.)  I immediately recognized familiar cancer terms.   Bottom line—my symptoms were actually cancer—not a hernia.  The doctor showed me my scan on a computer screen, and pointed out multiple tumors floating around in the peritoneal fluid in my abdomen.  From there I began an informative search on the web to find out what this cancer was all about.

           Since my husband had successful surgery with the latest laparoscopic procedure for Esophageal Cancer, (MIE), we contacted his surgeon, Dr. James Luketich, Chief of Thoracic Surgery, at the University of Pittsburgh Medical Center, (UPMC) for advice and a second opinion.   He in turn, referred me to his associate, Dr. David Bartlett.  We sent my records there and made an appointment for possible exploratory surgery in December 2012.  At that time a PET/CT scan revealed that the cancer was also in my ovaries.  Moreover, the tumors were too large and too numerous to do Cytoreductive surgery at that time.  I was told to come home, undergo chemotherapy treatment, and then another consultation would be in order. 

          So my chemo treatments of Carboplatin/Taxol began the early part of 2013.  Thankfully, the tumors were reduced to an operable level, so surgery took place at Passavant Hospital, one of many hospitals at the University of Pittsburgh Medical Center, on July 1, 2013.  For anyone who has had Cytoreductive surgery, no explanation is necessary.  I should say that at age 36, and I am now 76, I had a hysterectomy but only my uterus was removed.  My Ovaries and Fallopian tubes were left intact.  My gynecologist told me recently that many physicians now believe that Ovarian cancer actually begins in the Fallopian tubes, so from now on he is going to remove everything when he performs a hysterectomy.

           In hindsight, I would concur with that completely (take out everything!)  So if you know anyone who is contemplating having a hysterectomy, they might want to consider having everything removed.  Anyway, my doctors at University of Pittsburgh Medical Center (UPMC) concluded that most likely this cancer began in my ovaries and then spread to the peritoneal fluid in my abdomen. (Sometimes the primary cancer isn’t determined before it shows up in the Peritoneal fluid.)  So now I just go by the diagnosis, Ovarian Cancer Stage IV.  And yes, that’s terminal at some point, but my times are in the Lord’s hands, and I am making the best use of doctors and medicines HE has blessed us with here in America. 

          Needless to say, after the Cytorductive (debulking) Surgery was performed, I was completely “wiped out”, perhaps I should have said “cleaned out!”  Doctors said they would remove “non-essential organs”.  With that they removed my Gall Bladder, Spleen, Ovaries, Fallopian tubes, Omentum, and resectioned my Intestines.  Had I had an appendix, that would have been removed as well, but I had Appendicitis at age 12, so that saved me one snip! 

          When going into surgery, I fully expected to have the HIPEC Chemotherapy as part of my surgery.  We had discussed it as a possibility.  Not until I came out from under the effects of the surgery did I know that Dr. Bartlett opted NOT to perform the additional chemo treatment.  Naturally I wasn’t going to ask for a do-over! J I went in trusting his judgment and am content to be in as good a shape as I am today.  However, other patients that I met while there did have the Cytoreductive (CRS) surgery plus the HIPEC treatment.  So obviously it isn’t a “given” that each patient will be treated the same. I am certain that the “specific diagnosis” and the condition of the patient will determine the treatment process.   Moreover, I was happy to be eligible to be a “surgical candidate at age 74. One surgeon I consulted with prior to my UPMC consultation indicated they didn’t like to perform this surgery on any one over age 60. L

          So I was relieved to consult with UPMC.  I trust Dr. Bartlett’s judgment, and am so impressed with the University of Pittsburgh Medical Center.  They are one of the best hospitals in the country, and on the cutting edge of technology.  Therefore, when I search the web for info, I first consult UPMC to see what they have to say about any given procedure.  So several references below my name are from UPMC and NIH and may serve as a starting point for your inquiry regarding Intraperitoneal Chemotherapy (IP). 

          Since recovering from my surgery in July of 2013, I had enjoyed a good state of health until June of this year, 2015.  Severe abdominal distress akin to childbirth happened on two occasions.  I visited the Emergency room twice.  My oncologist said that the pain I was describing to him was most likely symptomatic of Intestinal blockage.  So after a PET/CT scan showed several new tumors and “increased nodularity along my intestinal wall”, I began a second series of chemo treatments of Carboplatin & Taxol, and completed my last session on September 25, 2015.  I am scheduled for a CT exam to show final results, but an interim CT scan showed a reduction in my CA 125 count and a lessening in the size of the tumors.  My treatments were given via my medi-port once every 3 weeks for a series of 6 treatments. 

          And yes, once more my hair fell out. (No big deal, it will grow back!)  I just told my husband that there were some good things about being bald.  I can ride down the road with the windows down, and not worry about the wind messing up my hair.  It also saves him 15 minutes every time he has to take me somewhere because I don’t have to “comb” my hair.  It began to fall out two weeks after the first treatment.  The side effects of TAXOL were hair loss, among more serious side effects.  I save money on hairdressers too.  For Halloween, I can always put on hoop earrings and masquerade myself as “MR. CLEAN!”  I believe that laughter is a part of the recovering and coping process and it puts those around me at ease.  I’m not making light of this cancer, but I am not living in the den of despair either.  The peace that God gives me allows me to live with and above the circumstances, and for that I am so thankful.

            Well, “myl” this serves as my “Hello greeting.”  And below are my references that will give you an idea of what Intraperitoneal Chemotherapy is all about.  Both HIPEC (hyperthermic intraperitoneal chemotherapy) as well as IP (Intraperitoneal Chemotherapy) is explained.   As for your husband not liking to hear you talk about “recurrence”, he may not like it but you are the one living in this very “real world” of potential recurrences. But he is hurting in his own special way.  I always said, “When my husband has cancer, I have cancer.”  So your husband’s  love for you may cloud his perspective shall we say?  No husband, or wife, for that matter, wants to think too far into the future about the difficulties that cancer brings.   “TODAY” your husband is not “losing” you, and he wants it to stay that way.  I can understand that.   However, you are wise to be realistic about it all and yet not let it rob you of the joys you share together TODAY!   

            As for your question—“Can you tell me, with that marker, (8.0) how long it usually takes for it to return?” I don’t think there is one definitive answer to that question.  I believe that depends on each individual’s case.  Anything below 35 is considered in a normal range, as I understand it.  My CA125 was never higher than 200 and is now down to 21.  But as for “things to come”, I ask the Lord to give me HIS peace for today, and not let me “dwell” on the things “down the road” that may or may not occur.   

          Yes, some of these entries are “eye openers” as to how our sisters are suffering.  It is wise to research this cancer.  But for now, with Stage IV, I have enough to deal with one day at a time.  And for the foreseeable future, I hope to have some more good days.  Living “days to come” before they arrive will produce nothing but despair, and rob us of the special relationships we have with our loved ones in the “here and now.”  This letter comes with a special prayer that you will have many good days for a long time to come.

Loretta

P.S.  These are references you might want to research. You can read them and expand your own personal research of course.  But as you read them, remember that TODAY is where you are right now.  I am so glad you are doing well at the moment.  Don’t miss it.  After reading them, put this info on the back burner of your mind and don’t go there till you have to.  J

          Incidentally, I make no pretense here.  Parts of these references I can understand when I read them, and parts are way “above my paygrade.”  However, I have often printed out references and taken them to my oncologist and asked him to explain it to me.  You might want to do the same.  The distinction between the heated treatment (HIPEC) and (IP), as I understand it, seems to be that the “Hyperthermic  Intraperitoneal Chemotherapy” is administered during the surgical procedure, before adhesions have had a chance to form.  (It is a heated chemo treatment.)  This provides a better penetration of the tumors.  But please ask your doctor for a professional opinion, and as always, anything you read on these discussion links should be discussed with your doctor.  Patients are encouraged to share their experiences, but not to “prescribe treatments”. 

          The Intraperitoneal Chemotherapy (IP) is administered at various times through a port in the abdomen, and can take a long time to administer. And its effectiveness will vary depending on the size of the tumors and whether or not the patient’s condition warrants that type of treatment.    It doesn’t seem to penetrate large tumors so effectively.  But this is just MY understanding and I am not a doctor.  Since it is the weekend, I cannot ask my oncologist.  However, if my understanding is not correct, I will come back and clarify things.  I did talk to Dr. Sugarbaker’s office but they were not as encouraging as was UPMC.  My age was one factor.  However, they said they would “take a look at my records” before making a determination as to whether I was a good candidate for their type of treatment.  That’s when I called UPMC, and they were very receptive to my plight. 

1.  http://www.surgicaloncology.com/pc.htm

Sugarbaker Oncology Associates - Specialty Section for the Treatment of Peritoneal Carcinomatosis from Colorectal and Ovarian Cancer

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2.  http://www.cancercenter.com/discussions/blog/moving-toward-a-new-standard-of-care-in-treating-peritoneal-carcinomatosis

 

3.  http://www.upmc.com/locations/hospitals/magee/services/magee-womens-cancers/gynecologic-cancer-program/treatment/Pages/ip-chemotherapy.aspx

 

​“Intraperitoneal (IP) Chemotherapy for Gynecologic Cancer - Intraperitoneal (IP) chemotherapy is a regional chemotherapy procedure in which surgeons insert a port in your abdomen to deliver chemotherapy.  Because the chemotherapy is confined to your abdomen, side effects to healthy tissue are minimal.

  IP chemotherapy may be an ideal treatment for gynecologic tumors if they are: Confined to the abdomen or Too advanced to remove surgically

Hyperthermic Intraperitoneal Chemoperfusion (HIPEC) - HIPEC circulates heated chemotherapy through your abdomen, raising the temperature to between 105 and 107.6 F (40.6 and 42 C).  Heating the chemotherapy can increase the penetration into the layers of the cells in the abdomen…”

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4.  http://www.upmc.com/patients-visitors/education/cancer-chemo/Pages/ip-chemotherapy-ovarian-cancer.aspx

 

“IP Chemotherapy for Ovarian Cancer - About This Treatment - Intraperitoneal, or IP chemotherapy, is a treatment for ovarian cancer where chemotherapy is put inside your abdomen. This treatment may or may not be combined with chemotherapy that is given in your vein (IV). A port will be placed under your skin and over your ribs to give this chemotherapy into your abdomen.  During an IP chemotherapy treatment, you will lie flat on a bed while chemotherapy runs into your abdomen over a few hours…”

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5.  http://www.upmcphysicianresources.com/ovariancancer

 

“…Our gynecologic oncologists have used IP chemotherapy since 1995 to treat patients on an outpatient basis. In the past, IP chemotherapy was hard for women to tolerate, and only 40 percent of them completed it. At UPMC, our physicians have made modifications and improvements that diminish side effects, enhance a woman’s quality of life, and enable 90 percent of patients to finish their therapy.  

A typical IP chemotherapy patient:

 

Is over 50 years old.

Has Stage 2 or Stage 3 ovarian cancer, which has spread in a “snow globe” — or exfoliation — fashion from the ovaries and surrounding adnexal tissue into the abdominal cavity, contaminating other organs, such as the diaphragm, spleen, small and large bowel, and stomach.

 

• Has advanced gynecologic tumors that can’t be removed surgically.

 

 

6.  http://www.ncbi.nlm.nih.gov/pubmed/20644370

 

7.  http://www.ncbi.nlm.nih.gov/pubmed/22080886

 

 

8.  http://www.ncbi.nlm.nih.gov/pubmed/22571746

"Secondary cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent epithelial ovarian cancer: a multi-institutional study…Peritoneal Surface Malignancy Program, Department of Surgery, National Cancer Institute, Milan, Italy. marcello.deraco@istitutotumori.mi.it

 

Abstract - OBJECTIVE: To assess the efficacy and morbidity and mortality of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in recurrent epithelial ovarian cancer (EOC)…

CONCLUSIONS: - Patients with recurrent EOC treated with CRS and HIPEC showed promising results in terms of outcome. The combined treatment strategy could benefit subsets of patients wider than that defined for conventional secondary debulking surgery without HIPEC. These data warrant further evaluation in randomized clinical trials…”

 

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