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Peritoneal Cancer and HIPEC Archive Questions

Below are Dr. Hanna’s answers to Peritoneal Cancer and HIPEC questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 20.

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Q : 1

How long should a patient follow up with an oncologist after the diagnosis of a mucinous tumor of uncertain malignant potential of the appendix?

Given that the incidence of these tumors is very low, there are no guidelines. I personally would recommend a follow up of up to 10 years.

Q : 2

I was diagnosed with appendix cancer. The appendix didn't rupture, so a partial cecectomy was all that was needed. Nine months later, a complex, solid 4.3 cm mass was detected on my right ovary. Is it possible that this could be related to the appendix cancer? My current oncologist says no.

Possibly, but it could also be a primary ovarian neoplasm. You should have a colonoscopy before any surgery, which is likely needed depending on your age and other factors.

Q : 3

Other than the surgical procedure itself, what kind of therapy or rehab is involved with HIPEC?

Often patients will receive adjuvant systemic chemotherapy. If the patient is de-conditioned, physical and occupational therapy will be required. Nutritional supplements are also needed.

Q : 4

I read an article by Dr. Sugarbaker (Limited survival in the treatment of carcinomatosis from rectal cancer, Dis Colon Rectum, Dec 2005) that stated cytoreduction with HIPEC worked less well for rectal cancer mets to the peritoneum than for colon cancer. Specifically, median survival for rectal patients with a complete cytoreduction was 17 months versus 35 months for colon cancer. No rectal patients survived longer than 29 months. What's your opinion? Is HIPEC worth it for rectal cancer patients? The study was very small.

It depends on the volume and location of recurrent disease as well as patient performance and completeness of cytoreduction. Also back then, we did not have the effective chemotherapy we use today. You should be evaluated to determine if it would benefit you.

Q : 5

I have been diagnosed with cancer of the appendix, but my doctor said it hasn't spread yet. Would I be a candidate for the HIPEC?

If your cancer spreads beyond the appendix, you should be evaluated as a candidate for the HIPEC procedure. You should speak with your doctor about other, more specific, treatment options for your condition.

Q : 6

Do you recommend a HIPEC treatment for a patient with linitis plastica stage IV without having surgery? Doctors in Canada rejected the patient.

HIPEC is unlikely to add any benefit.

Q : 7

What are the patient requirements for HIPEC? My father is 71 with stage IV colon cancer and peritoneal tumors. No surgery has been performed. He has been on chemo for almost 16 months and in general has stabilized.

We would need to evaluate the patient. Generally the disease should be localized in the peritoneal cavity.

Q : 8

My brother has non-urachal primary adenocarcinoma of the bladder. He underwent a successful cystectomy with neobladder. The surgery report indicated that two of the 17 surrounding lymph nodes had cancer. His PET scan was clear in November and he started systemic chemo. In February, a CT scan showed 4 lymph nodes with growths in the thoracic region. The largest (1 cm) was biopsied and proved to be the same type of cancer, signet ring. Could tumor debulking with heated chemo be an option?

If there is no disease in the abdomen, neither debulking nor HIPEC are indicated. For the thoracic nodes, systemic chemo is an option.

Q : 9

Can HIPEC treatment be successfully used to treat 3rd stage rectal cancer?

Yes. We will be happy to review the case for recommendation.

Q : 10

My brother is only 45-years-old and was diagnosed 2 months ago with signet ring cell adenocarcinoma from the colon. The doctors are saying he has peritoneal carcinamatosis and it is inoperable. He has no other organs involved, but he does have a pleural effusion that is not associated with the cancer. He is currently on FolFox 6 and it seems to be working, however we don't know if this can cure his disease. Do you think he would be a candidate for the surgery with the heated chemo? His oncologist states there is not much success rate with this surgery, but the doctors here don't have a wealth of knowledge about this type of cancer. Do you think it could be beneficial?

Yes, he could be a candidate for the surgery with heated chemo. The current chemotherapy he is receiving will not cure him. His oncologist is unaware of the results of this therapy. Please call my office 410-328-7320 for information.

Q : 11

What is the likelihood that HIPEC will cause infertility in women of childbearing age?

Currently, there is not a lot of information available as most female patients who have this procedure are menopausal or have their ovaries removed as a part of the cytoreductive surgery. If there is true concern, then you may want to consider ova harvesting and freezing.

Q : 12

My wife had HIPEC with debulking about 8 weeks ago. She has lost weight and has had difficulty gaining it back since the surgery. She still takes medication for abdominal pain and sometimes has significant cramping/discomfort after eating. Is this to be expected after this length of time? She will be undergoing more chemo (5FU) next week and I am concerned about undergoing chemo while still feeling the after effects of the surgery.

This is not unexpected given the nature of the HIPEC procedure. It is very important that your wife keeps up with her nutrition and is eating a proper diet.

Q : 13

Is the HIPEC treatment experimental or is it FDA approved? Do you take volunteers or what is the cost? My husband has stage 4 stomach cancer and is doing chemo right now but it's not working.

It is not experimental and we do not take volunteers. Cost is dependent on the extent of the surgery, but most insurances will cover the procedure. It can be done for stomach cancer only if there is limited disease and good performance status. If interested in consultation, please call my office 410-328-7320 to schedule appointment.

Q : 14

Under what circumstances would it be advisable to have conventional IV neoadjuvant chemotherapy prior to cytoreductive surgery and HIPEC? Under what circumstances would it be advisable to skip neoadjuvant chemo and go straight to cytoreductive surgery and HIPEC? The patient in question has colon cancer that has spread to the omentum, but has not metastized outside of the peritoneal cavity.

Both approaches are acceptable. It really depends on the understanding of the biology of your tumor, prior chemo or not, and what type, extent of disease,etc. The main advantage of neoadjuvant chemo is to determine if your tumor is responsive to this chemo to be continued after the surgery.

Q : 15

My mother has metastatic peritoneal sarcoma. Doctors told us that we can't do a surgery, only chemotherapy. Is the HIPEC procedure an option for her? Thank you.

Yes, HIPEC can be helpful, but it will depend on the volume and distribution of her disease.

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