A treatment for ovarian cancer that has been around since the 1970s, IP, or intraperitoneal chemotherapy (also known as “belly bath chemo”) is a procedure done by inserting a catheter into the patients’ belly to deliver chemotherapy. “It makes a lot of sense,” says Dr. Beth Karlan, director of the Women’s Cancer Program at Cedars-Sinai Medical Center. “We have said that ovarian cancer tends to spread within the abdominal cavity, [so] why not put chemotherapy in the abdominal cavity, right next to the cancer cells.”
The treatment, done post-operatively, which also includes some chemo being delivered through an IV, allows for a higher dose of chemotherapy, so that more cancer cells can be killed. This type of targeted treatment is crucial for those cancers that are particularly difficult to treat. Ovarian cancer (like colorectal or gastric cancer) often spread to the lining surfaces of the abdominal cavity. Traditionally, chemotherapy for these cancers has had a low rate of success.
The last large study on the IP regimen showed a median survival rate of more than five years for women with advanced ovarian cancer. The IP method, however, is known to have significant side effects, which can include more nausea, pain and fatigue. Karlan admits that the IP approach is a more difficult procedure to get through.
Since that study, additional therapies have been discovered. “There are now newer ways to give the chemo, equivalent to the IP approach,” enthuses Dr. Karlan. HIPEC—heated intraperitoneal chemotherapy—is one of them. One of the most important advances in ovarian surgery treatments over the past 30 years, the procedure is done during the same surgery that an ovarian cancer patient would have to remove all visible tumors in the peritoneal cavity.
For HIPEC to be successful, it is important that the surgeon has been able to remove (or debunk) the tumors that have been left behind to a size of less than 1 cm, as HIPEC is unable to penetrate a tumor larger than 1 cm in diameter. Once the appropriately-sized cancer cells have been taken out, the doctor usually makes two small incisions—one to pump the heated solution into the abdomen and the other to circulate the solution back out. She then continually circulates the sterile, heated chemotherapy solution (which has also been referred to as a heated chemotherapy organ “bath”) throughout the cavity. The heated bath can take anywhere from 90 minutes to two hours, and, while women still need additional chemotherapy treatments after surgery, HIPEC allows for higher doses of chemotherapy to be administered and enhances the effectiveness of the treatment. Since, during surgery to debunk a tumor, cancer cells may break off and still be present in the body, the HIPEC method can seek these cells out: it is better absorbed by tumors and those microscopic cancer cells that may still remain in the abdomen.
Furthermore, the treatment seems to be well tolerated by women, with no additional side effects. Because HIPEC delivers chemotherapy directly to the abdomen, it is considered a good option for cancers that have originated or spread to the abdominal cavity, allowing for a greater concentration of the drug exactly where it is needed, without exposing other parts of the body. HIPEC can be used for a wide range of cancers, including appendix, colorectal, mesothelioma, stomach, peritoneal, and, of course, ovarian cancer.
The results thus far have been very promising. According to Reuters Health, women who underwent an experimental procedure at eight hospitals in the Netherlands two years ago typically survived 45.7 months, compared to 33.9 months for women who just received the tumor-removal surgery and conventional therapy. Dr. Karlan observes, “that one big dose of the heated chemo seems to add survival benefits for patients.”
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Dr. Beth Karlan is a gynecologic oncologist at UCLA Medical Center in Santa Monica, California. Read More
A treatment for ovarian cancer that has been around since the 1970s, IP, or intraperitoneal chemotherapy (also known as “belly bath chemo”) is a procedure done by inserting a catheter into the patients’ belly to deliver chemotherapy. “It makes a lot of sense,” says Dr. Beth Karlan, director of the Women’s Cancer Program at Cedars-Sinai Medical Center. “We have said that ovarian cancer tends to spread within the abdominal cavity, [so] why not put chemotherapy in the abdominal cavity, right next to the cancer cells.”
The treatment, done post-operatively, which also includes some chemo being delivered through an IV, allows for a higher dose of chemotherapy, so that more cancer cells can be killed. This type of targeted treatment is crucial for those cancers that are particularly difficult to treat. Ovarian cancer (like colorectal or gastric cancer) often spread to the lining surfaces of the abdominal cavity. Traditionally, chemotherapy for these cancers has had a low rate of success.
Read More The last large study on the IP regimen showed a median survival rate of more than five years for women with advanced ovarian cancer. The IP method, however, is known to have significant side effects, which can include more nausea, pain and fatigue. Karlan admits that the IP approach is a more difficult procedure to get through.
Since that study, additional therapies have been discovered. “There are now newer ways to give the chemo, equivalent to the IP approach,” enthuses Dr. Karlan. HIPEC—heated intraperitoneal chemotherapy—is one of them. One of the most important advances in ovarian surgery treatments over the past 30 years, the procedure is done during the same surgery that an ovarian cancer patient would have to remove all visible tumors in the peritoneal cavity.
For HIPEC to be successful, it is important that the surgeon has been able to remove (or debunk) the tumors that have been left behind to a size of less than 1 cm, as HIPEC is unable to penetrate a tumor larger than 1 cm in diameter. Once the appropriately-sized cancer cells have been taken out, the doctor usually makes two small incisions—one to pump the heated solution into the abdomen and the other to circulate the solution back out. She then continually circulates the sterile, heated chemotherapy solution (which has also been referred to as a heated chemotherapy organ “bath”) throughout the cavity. The heated bath can take anywhere from 90 minutes to two hours, and, while women still need additional chemotherapy treatments after surgery, HIPEC allows for higher doses of chemotherapy to be administered and enhances the effectiveness of the treatment. Since, during surgery to debunk a tumor, cancer cells may break off and still be present in the body, the HIPEC method can seek these cells out: it is better absorbed by tumors and those microscopic cancer cells that may still remain in the abdomen.
Furthermore, the treatment seems to be well tolerated by women, with no additional side effects. Because HIPEC delivers chemotherapy directly to the abdomen, it is considered a good option for cancers that have originated or spread to the abdominal cavity, allowing for a greater concentration of the drug exactly where it is needed, without exposing other parts of the body. HIPEC can be used for a wide range of cancers, including appendix, colorectal, mesothelioma, stomach, peritoneal, and, of course, ovarian cancer.
The results thus far have been very promising. According to Reuters Health, women who underwent an experimental procedure at eight hospitals in the Netherlands two years ago typically survived 45.7 months, compared to 33.9 months for women who just received the tumor-removal surgery and conventional therapy. Dr. Karlan observes, “that one big dose of the heated chemo seems to add survival benefits for patients.”
Learn more about SurvivorNet's rigorous medical review process.
Dr. Beth Karlan is a gynecologic oncologist at UCLA Medical Center in Santa Monica, California. Read More
