The Ever-evolving Cancer Surgery in Women

Treatment of gynaecological cancers is ever evolving and the survival rates has improved significantly over last decade because of better surgical techniques and development of chemotherapy drugs. The advancement of medical technologies has greatly impacted the treatment and outcomes in gynaecological cancers. One such technology that has become part of any advanced gynae oncology unit is Hyper thermic intraperitoneal chemotherapy (HIPEC)

IN WHICH WAY HIPEC HELPS IN CANCER:

HIPEC has shown significant benefit in treatment of advanced ovarian cancers (stage III & IV). Although largely used in ovarian cancers HIPEC is also showing promising results in advanced colon, appendiceal and stomach cancers as well.

WHAT DOES HIPEC MEAN:

HIPEC is the application of chemotherapy drugs directly into the abdominal cavity at higher temperatures. This is done using a highly specialised recirculating machine which ensures that all quadrants of abdominal surfaces are evenly exposed to the right amount of chemotherapy at the right temperature hence achieving a uniform antitumor effect thus eliminating the tumour completely from the abdomen.

How is HIPEC Advantageous:

• Allows use of higher doses of chemotherapy.
• Minimises the side effects of chemotherapy drugs.
• Improves absorption of chemotherapy drugs
• improved median survival for stage III ovarian cancers

Does it mean I don’t need surgery?

Myth- that HIPEC is a form of chemotherapy alone and that it does not involve surgery. 

Fact- HIPEC is part of an extensive surgical procedure called cytoreductive surgery (CRS) and peritonectomy.  CRS is complex 6 to 8 hours long surgery which involves the meticulous removal of all visible tumour form the abdominal cavity. Once optimal cytoreduction has been achieved the HIPEC is administered for 90 minutes using a highly specialised equipment. HIPEC improves survival only in the presence of a very good cytoreductive surgery.

Does getting a HIPEC mean I don’t need conventional chemotherapy:

HIPEC works best if all the tumour is removed in CRS. Preoperative chemotherapy significantly decreases the tumour burden and greatly increase the surgeon’s chances of achieving the optimal cytoreduction.