Guide to Hipec Advanced Chemotherapy Treatment Destroy Cancer
Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a targeted cancer treatment used after surgery to deliver heated chemotherapy directly into the abdomen. Learn how it works, which cancers it can treat, who is eligible, and what to expect before, during, and after the procedure.
Introduction
HIPEC combines surgery and heated chemotherapy to target cancer within the abdomen while minimising whole-body
exposure.
If you or a loved one has been told that cancer has spread inside the abdomen, you may have heard about HIPEC—short for hyperthermic intraperitoneal chemotherapy. Unlike standard chemotherapy that travels through the bloodstream, HIPEC delivers warmed chemotherapy directly into the abdominal cavity at the end of a specialised operation. This concentrates the treatment where the cancer is located and reduces exposure to the rest of the body.
This guide explains how HIPEC works, which cancers it may benefit, who is suitable, what happens during and after the procedure, and what evidence shows about outcomes and risks. It also covers recovery, costs, and how to choose an experienced centre.
Consult a Top Oncologist for Personalised Advice
What Is HIPEC and How Is It Different from Standard Chemotherapy?
HIPEC is a two-stage treatment combining surgery to remove visible tumours and the circulation of heated
chemotherapy within the abdomen.
How HIPEC Works
HIPEC is performed immediately after cytoreductive surgery (CRS). During CRS, surgeons remove visible cancer
deposits from the lining of the abdomen and affected organs where possible. Once this is complete, heated chemotherapy is circulated inside the abdominal cavity for 30–120 minutes. The temperature is maintained at around 41–43°C to help the drug penetrate tumour tissue and destroy heat-sensitive cancer cells.
Why Heating and Direct Delivery Are Important
Heating enhances chemotherapy absorption and impairs the ability of cancer cells to repair damage. Delivering the
drug directly into the abdomen allows a higher concentration at the disease site, while overall body exposure remains
lower than with intravenous chemotherapy.
HIPEC vs Intravenous Chemotherapy
The main differences lie in drug location (local versus systemic), timing (single intraoperative session versus multiple
treatment cycles), and purpose (focused regional control versus ongoing systemic management). HIPEC is typically
used in conjunction with systemic therapy before and/or after surgery.
Which Cancers Can HIPEC Treat?
HIPEC is used in specific cancers where disease is confined to the lining of the abdomen and complete tumour removal
is achievable.
Colorectal Cancer with Peritoneal Metastases
In some patients whose colorectal cancer has spread only within the abdomen, CRS with or without HIPEC may
extend survival compared with systemic therapy alone. Outcomes depend on the ability to achieve complete tumour
removal.
Ovarian Cancer
For stage III ovarian cancer undergoing interval debulking after chemotherapy, adding HIPEC has been shown to
improve both recurrence-free and overall survival without significantly increasing side effects. It may also be considered in certain recurrent cases at specialist centres.
Appendix Cancer and Pseudomyxoma Peritonei
HIPEC is a key component of treatment for low-grade appendiceal mucinous tumours and pseudomyxoma peritonei.
When complete tumour clearance is achieved, long-term control and, occasionally, cure are possible.
Peritoneal Mesothelioma and Gastric Cancer
HIPEC can prolong survival in peritoneal mesothelioma and is used selectively in some cases of gastric cancer
involving the peritoneum, usually within clinical trials.
When HIPEC Is Not Appropriate
HIPEC is not recommended when cancer has spread widely outside the abdomen, when complete tumour removal is
not feasible, or when a patient is unfit for major surgery.
Who Is a Candidate? Selection, Scoring, and Work-Up
Careful patient selection determines whether HIPEC is safe and beneficial.
Peritoneal Cancer Index (PCI)
The PCI measures the amount and distribution of tumour within the abdomen, with scores ranging from 0 to 39. Lower
scores generally indicate a better prognosis.
Completeness of Cytoreduction (CC) Score
After surgery, the CC score records how much visible disease remains. A CC-0 or CC-1 score (no visible or very small
residual disease) is linked with the best outcomes.
Fitness for Major Surgery
HIPEC procedures are lengthy and complex. Pre-operative assessment includes heart and lung evaluation, nutritional
status, and blood tests for kidney and liver function.
Multidisciplinary Review
Potential candidates should be reviewed by a multidisciplinary team, including surgeons, oncologists, radiologists, and
anaesthetists. This ensures suitability and coordination of systemic and surgical treatments.
Inside the Operating Room: Step-by-Step HIPEC and CRS
The operation involves two major stages—tumour removal followed by heated chemotherapy perfusion.
Cytoreductive Surgery (CRS)
Surgeons remove visible tumour deposits from the peritoneum and affected organs such as the omentum, bowel, spleen,
or ovaries. The goal is complete or near-complete removal of all visible cancer.
Perfusion Techniques
Once surgery is complete, heated chemotherapy is circulated within the abdomen. Two main methods are used:
- Closed technique: The abdomen is temporarily closed to maintain temperature and prevent exposure.
- Open (“Coliseum”) technique: The abdomen remains open and covered by a sterile sheet, allowing manual stirring for even drug distribution.
The chemotherapy is maintained at 41–43°C for 30–120 minutes, depending on the drug used.
Commonly Used Drugs
Mitomycin C, cisplatin, and oxaliplatin are frequently used agents, selected according to cancer type, previous
treatments, and kidney function.
Completion of the Procedure
After perfusion, the fluid is drained, the abdomen rinsed, and any surgical reconstructions finalised before the patient is
moved to recovery or intensive care for monitoring.
Benefits and Outcomes: What the Evidence Shows
Results depend on cancer type, surgical completeness, and centre experience.
Ovarian Cancer
Adding HIPEC to surgery after chemotherapy in stage III disease improves recurrence-free and overall survival,
without major increases in complications.
Colorectal Cancer
In selected patients, surgery to remove all visible disease offers meaningful survival. The added benefit of HIPEC varies
according to drug regimen and disease characteristics.
Pseudomyxoma Peritonei and Peritoneal Mesothelioma
Patients undergoing complete cytoreduction and HIPEC at specialised centres can achieve long-term survival, with
some remaining disease-free for years.
Quality of Life
Although recovery can be prolonged, most patients regain their baseline quality of life over time, particularly when
rehabilitation protocols are followed.
Risks, Side Effects, and Recovery Timeline
HIPEC carries surgical and chemotherapy-related risks that vary with the extent of treatment.
Surgical Risks
Possible complications include bleeding, infection, bowel leakage, blood clots, and delayed bowel function.
Chemotherapy-Related Effects
Side effects may include temporary reductions in blood counts, kidney strain (especially with cisplatin), and local
inflammation. Hair loss and severe nausea are less common than with standard intravenous chemotherapy.
Recovery Timeline
Hospital stays usually last 7–14 days. Recovery at home involves gradual improvement in appetite and energy over 4–8
weeks. Early movement and nutrition support enhance recovery.
At-Home Monitoring
Patients should observe wound healing, temperature, bowel habits, and pain levels. If fever, persistent pain, or vomiting
occurs, prompt medical advice is required. Online consultations through Apollo 24|7 can provide accessible support
and coordination with oncology teams.
Alternatives, Add-Ons, and Clinical Trials
Other intraperitoneal chemotherapy methods and ongoing studies are exploring new approaches.
Systemic Chemotherapy
Most patients receive chemotherapy before and/or after CRS and HIPEC to treat disease outside the peritoneum and
evaluate tumour response.
EPIC and NIPEC
Early Postoperative Intraperitoneal Chemotherapy (EPIC) and Normothermic Intraperitoneal Chemotherapy (NIPEC)
deliver chemotherapy directly into the abdomen either immediately after surgery or in cycles. These are used in selected
cases or within trials.
Emerging Techniques
Pressurised Intraperitoneal Aerosol Chemotherapy (PIPAC) is a minimally invasive approach used mainly in research
for patients not suitable for CRS/HIPEC.
Clinical Trials
Patients with borderline eligibility or less-common tumour types may be offered enrolment in clinical trials to access
novel treatments or protocols. Online medical consultation platforms such as Apollo 24|7 can assist in coordinating
referrals or second opinions.
Costs, Insurance, and Choosing a HIPEC Centre
Outcomes are influenced by surgical expertise, institutional experience, and coordinated care.
High-volume centres tend to have better results and fewer complications. Patients should ask about case numbers,
expected recovery times, and centre-specific outcomes. Financial discussions should take place early to clarify insurance
coverage, hospital costs, and post-operative support services.
Living Well After HIPEC
Recovery focuses on nutrition, physical rehabilitation, and regular medical monitoring.
Nutrition
Patients should aim for adequate protein intake through small, frequent meals and appropriate supplements. A
temporary low-residue diet may be recommended after bowel surgery.
Physical Activity
Gradual walking and gentle exercises help restore strength and prevent complications.
Mental Health and Support
Emotional fatigue is common. Psychological support and survivorship clinics can aid adjustment and coping.
Follow-Up Care
Regular check-ups, blood tests, and imaging scans monitor recovery and detect recurrence. Apollo 24|7 offers
convenient home sample collection for follow-up laboratory tests when travel is difficult.
Return to Work
Most patients can resume light duties within 6–8 weeks, with heavier activity deferred until medically advised.
Myths vs Facts About HIPEC
Clarifying misconceptions about what HIPEC can and cannot achieve.
- Myth 1: HIPEC Cures All Advanced Cancer
- Fact: HIPEC is effective only for disease confined to the peritoneal cavity. It does not treat cancer in distant organs.
- Myth 2: HIPEC Replaces Systemic Chemotherapy
- Fact: Systemic chemotherapy is still needed to treat microscopic or distant disease before or after HIPEC.
- Myth 3: Higher Temperatures Work Better
- Fact: Temperature is carefully controlled. Excessive heat increases risk without improving results.
- Myth 4: One Negative Study Means HIPEC Never Works
Fact: Outcomes depend on cancer type, completeness of surgery, and drug regimen. Evidence of benefit is strongest in
specific conditions such as ovarian cancer and pseudomyxoma peritonei.
Conclusion
HIPEC delivers heated chemotherapy directly to the abdominal cavity following surgical removal of visible cancer. It aims to destroy residual microscopic disease while reducing systemic side effects. Success depends on cancer type, tumour extent, and surgical completeness.
For ovarian cancer undergoing interval surgery, HIPEC has demonstrated a survival advantage. In colorectal peritoneal metastases, complete tumour removal remains the most critical factor, while the additional benefit of HIPEC varies by case. In appendiceal tumours and peritoneal mesothelioma, CRS combined with HIPEC often forms part of standard care at experienced centres.
Choosing a centre with expertise, understanding your PCI score, and planning post-operative recovery are essential steps. If symptoms persist or complications arise after surgery, consult a doctor online with Apollo 24|7 or schedule an in-person follow-up. With comprehensive care and appropriate selection, HIPEC can provide an important option in the management of advanced peritoneal cancers.
Consult a Top Oncologist for Personalised Advice
Consult a Top Oncologist for Personalised Advice
Dr. Sanchayan Mandal
Medical Oncologist
17 Years • MBBS, DrNB( MEDICAL ONCOLOGY), DNB (RADIOTHERAPY),ECMO. PDCR. ASCO
Kolkata
MCR SUPER SPECIALITY POLY CLINIC & PATHOLOGY, Kolkata
Dr. Anindita Ray
Oncologist
7 Years • MBBS, MD ( Radiation Oncology )
Kolkata
MCR SUPER SPECIALITY POLY CLINIC & PATHOLOGY, Kolkata
Dr. Rupam Manna
Radiation Specialist Oncologist
4 Years • MBBS MD(RADIO THERAPY)
Barasat
Diab-Eat-Ease, Barasat
Dr.sanchayan Mandal
Medical Oncologist
17 Years • MBBS, DrNB( MEDICAL ONCOLOGY), DNB (RADIOTHERAPY),ECMO. PDCR. ASCO
Kolkata
Dr. Sanchayan Mandal Oncology Clinic, Kolkata
Dr Sunita Samleti
Oncologist
18 Years • M.D. (Pathology)- TN Medical College, Mumbai University, Mumbai, Mar 2005 M.B.B.S. Grant Medical College, Mumbai University, Mumbai, Oct 1999
Chinagadila
Apollo Hospitals Health City Unit, Chinagadila
Consult a Top Oncologist for Personalised Advice
Dr. Sanchayan Mandal
Medical Oncologist
17 Years • MBBS, DrNB( MEDICAL ONCOLOGY), DNB (RADIOTHERAPY),ECMO. PDCR. ASCO
Kolkata
MCR SUPER SPECIALITY POLY CLINIC & PATHOLOGY, Kolkata
Dr. Anindita Ray
Oncologist
7 Years • MBBS, MD ( Radiation Oncology )
Kolkata
MCR SUPER SPECIALITY POLY CLINIC & PATHOLOGY, Kolkata
Dr. Rupam Manna
Radiation Specialist Oncologist
4 Years • MBBS MD(RADIO THERAPY)
Barasat
Diab-Eat-Ease, Barasat
Dr.sanchayan Mandal
Medical Oncologist
17 Years • MBBS, DrNB( MEDICAL ONCOLOGY), DNB (RADIOTHERAPY),ECMO. PDCR. ASCO
Kolkata
Dr. Sanchayan Mandal Oncology Clinic, Kolkata
Dr Sunita Samleti
Oncologist
18 Years • M.D. (Pathology)- TN Medical College, Mumbai University, Mumbai, Mar 2005 M.B.B.S. Grant Medical College, Mumbai University, Mumbai, Oct 1999
Chinagadila
Apollo Hospitals Health City Unit, Chinagadila
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Frequently Asked Questions
1) Is HIPEC a cure for peritoneal cancer?
HIPEC can control disease and prolong survival, particularly in pseudomyxoma peritonei and selected ovarian or mesothelioma cases. Cure depends on cancer type, tumour spread, and the success of surgery.
2) What is the Peritoneal Cancer Index (PCI)?
The PCI measures how extensively cancer has spread within the abdomen. Lower scores generally predict better outcomes.
3) How long is recovery after HIPEC?
Hospitalisation usually lasts 7–14 days. Most patients recover normal activity within 4–8 weeks, depending on surgical extent.
4) Does HIPEC replace intravenous chemotherapy?
No. Systemic chemotherapy remains important to treat microscopic or distant disease alongside HIPEC.
5) What are the main side effects of HIPEC?
Risks include infection, bleeding, bowel leaks, and temporary effects on blood counts or kidney function. Contact a healthcare professional or Apollo 24|7 if any concerning symptoms occur.