These new techniques can be a game changer for cancer patients
A 65-year-old hypertensive lady with Carcinoma Ovary post three cycles of chemotherapy was admitted to BLK Cancer Centre. Carcinoma is a type of cancer in the epithelial cells of the abdominal cavity. Cancer in each of the abdominal organs had spread to abdominal surfaces and the peritoneum. This kind of spread is called peritoneal carcinomatosis and traditionally, considered an incurable disease with a life expectancy of not more than few months. Despite undergoing chemotherapy, her disease was present with nearly two litres of ascites (abnormal accumulation of fluids in the abdomen) and thickened omentum and peritoneum which are the fatty lining covering stomach, large intestines and other abdominal organs containing lymph nodes.
On a complete and detailed investigation, it was observed that the carcinoma involving the peritoneum, included metastasis (spread) of cancer of the appendix, cancer of the colon and rectum, cancer of the ovaries, and cancer of the stomach. After going through the complete history of the patient, the team came to a conclusion of performing multiple surgeries. Surgery was performed to remove her uterus, cervix, ovaries, fallopian tube, omentum, lymph nodes, cecum and colon. This was done using the innovative technique known as Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and she is living a normal life.
“Because heated chemotherapy can penetrate only at a very limited distance in the tumour tissue, it is imperative to remove all visible and palpable tumour deposits before HIPEC is delivered. Surgery for removal of tumour deposits in the abdomen is known as cytoreductive surgery. Cytoreductive surgery is a complex surgical procedure, during which some organs are resected or removed,” Dr Kapil Kumar, HOD, Surgical Oncology, BLK Cancer Centre.
This includes various surgeries:
- Total Abdominal Hysterectomy (TAH) – It is a surgical procedure done for the removal of uterus along with cervix. It is done in extreme cases like cancer when non-surgical treatments fail.
- Bilateral Saplingo Oopherectomy (BSO) – This surgical procedure is done for removal of both ovaries and the fallopian tube. It is usually performed along with TAH when the cancer cells have spread completely and a more casual term is used Ovariohysterectomy (TAH-BSO).
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- Lymphadenectomy - lymph node dissection is the surgical removal of one or more groups of lymph nodes. It is almost always performed as part of the surgical management of cancer. The patient also undergoes pelvic and para-aortic lymph node dissection.
- Omentectomy - Surgery to remove part or all of the omentum, an enlarge apron of fatty tissue containing veins, arteries, lymphatics. The omentum attaches to and nourishes the stomach and the entire colon.
- Peritonectomy – It is the most common surgical procedure for peritoneal mesothelioma patients. The goal of the surgery is to remove the cancerous part of the lining of the abdominal cavity.
- Extended Right Hemicolectomy - Open right hemicolectomy is a procedure that involves removing the cecum, the ascending colon, the hepatic flexure (where the ascending colon joins the transverse colon), the first one-third of the transverse colon, and part of the terminal ileum, along with fat and lymph nodes.
How much time is required to perform CRS?
The surgery mostly takes a minimum of 10-12 hours before the patient is ready for HIPEC. The duration depends on the severity of the carcinoma and the spread.
This type of complex surgery requires special equipment and high surgical skills. CRS is an aggressive removal of all or most visible tumours in the abdomen and preventing the growth of microscopic cells which are left behind. After completion of the resection of all tumour tissue, the HIPEC procedure is performed.
HIPEC vs traditional chemotherapy
Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is installed via a machine which circulates Chemotherapy solution in the peritoneal cavity at 42 degree Celsius for 60-90 minutes. During the HIPEC procedure, a machine will continuously circulate a heated sterile solution containing a chemotherapeutic agent throughout the peritoneal cavity of the patient, for one to one and half hours and kills the remaining cancer cells. The HIPEC procedure also improves drug absorption and effect with minimal exposure to the rest of the body. In this way, the normal side effects of chemotherapy can be avoided. It is being performed in selected centres across India including BLK Cancer Centre and abroad.
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The patient makes steady post-operative progress and can be discharged within two weeks. The patient can then undergo their remaining chemotherapy procedures. With this latest and innovative technology, the patient’s quality of life improves and her chances of survival are very much on the cards.
Most commonly treated diseases are pseudomyxoma peritonei, mesothelioma, colon and rectal cancer, appendiceal cancer, gastric cancer, ovarian cancer, and primary peritoneal cancer.
The HIPEC procedure, when combined with CRS, has proven to be an effective therapy that has improved survival outcomes. BLK Cancer centre has now treated many peritoneal cancer patients in the recent times with this innovative technology.