Conditions That May Be Treatable With IHPP

Intraoperative Hyperthermic Peritoneal Perfusion (IHPP) can improve the quality of life and increase the lifespan of some patients with certain advanced abdominal or gynecological cancers. At University Hospital, Dr. Lawrence Harrison, a surgical oncologist, performs IHPP on carefully selected patients that, based on the type of cancer and its location, have the best likelihood of a positive outcome with the treatment. He most commonly uses IHPP on patients with one of the following conditions, which are described in more detail below: gastric cancer, colorectal cancer, ovarian cancer, pseudomyxoma peritonei, peritoneal mesothelioma, and peritoneal cancinomatosis. Another criteria for IHPP treatment is that the tumor must be confined to the belly, or peritoneal cavity. By definition, IHPP follows surgery to remove as much of the tumor as possible.

	CT scan of patient with pseudomyxoma peritonei (as indicated by the yellow arrow).
	Intraoperative picture of pseudomyxoma peritonei. The tumor coats the lining of the abdomen with a jelly-like substance.

Gastric Cancer: Cancer of the stomach, or gastric cancer, occurs when malignant cells form in the stomach’s lining. In the United States, about 25,000 new cases of gastric cancer are diagnosed each year. There are many symptoms associated with gastric cancer, including indigestion, nausea, and stomach pain.

Traditional treatments: Surgery is the most common treatment for gastric cancer. Depending on how far the cancer has spread, the surgeon will remove part or all of the stomach ( a procedure known as a gastrectomy) and often the adjacent lymph nodes. Systemic chemotherapy, where the drug travels throughout the body, has not proven effective for patients with advanced cases of gastric cancer. Radiation is sometimes used to kill cancer cells.

Colorectal Cancer: Colorectal cancer is the third most common cancer in the United States. According to the American Cancer Society, in 2003, an estimated 150,000 new cases of colon or rectal cancer were diagnosed. Most colorectal cancers are adenocarcinomas, which originate in the lining of the colon and the rectum.

Traditional treatments: Surgery is the most common treatment for both colon and rectal cancers; however, sometimes tiny cancer cells are left behind following surgery. Radiation can be used to destroy residual cancer or, in cases where surgery is not possible, to reduce the size of the tumor. Chemotherapy is often used after surgery when the cancer has spread to other organs. Radiation and chemotherapy can also be used as palliative treatment.

Ovarian Cancer: In 2003, about 25,000 new cases of ovarian cancer were diagnosed in American women, according to the American Cancer Society. The symptoms of ovarian cancer are often vague—indigestion, pelvic or abdominal pain or swelling, and a “full” feeling—and because of this, is often not diagnosed until the advanced stages. The most common type of ovarian cancer affects the organ’s outer epithelial layer; rarer ovarian cancers include stromal tumors, which involve the connective tissue around the ovaries, and germ-cell tumors, which develop from the ovaries’ egg-producing cells.

Traditional Treatments: Surgery is the usual treatment, whether removing the cancerous part of an ovary or the ovary itself. Systemic chemotherapy is sometimes used after surgery to kill any remaining cancer cells.

Pseudomyxoma Peritonei: Pseudomyoxma peritonei, or PMP, is a very rare cancer that begins as a polyp in the appendix or ovary. Over time, the polyp bursts through the wall of the appendix, and a jelly-like mucous spreads through the peritoneum, the lining of the abdominal cavity. Slow growing and often initially misdiagnosed, PMP is sometimes described as a “borderline malignancy.”

When PMP symptoms are present, they mimic those of other, more common conditions: a swollen abdomen (sometimes referred to as “jelly belly”); infertility in women; and digestive problems. PMP is often diagnosed after other conditions are ruled out.

Traditional Treatment: In very early stages of PMP, an oncologist might recommend “watchful waiting.” More typically, PMP is not diagnosed until it is well advanced. There are two main surgical options: a procedure to remove as much of the tumor as possible or a more aggressive approach involving tumor removal and a peritonectomy, in which the peritoneum (the abdominal lining) is stripped at mucous-containing sites. Chemotherapy taken intravenously or by mouth usually is ineffective at reaching the cancer cells.

Peritoneal Mesothelioma: Mesothelioma is a malignant cancer associated with exposure to asbestos. Its most common form, pleural mesothelioma, affects the lining of the lungs. Peritoneal mesothelioma, a cancer of the abdominal lining, or peritoneum, has an incidence rate of 1: 1,000,000 people, making it a very rare disease. It is also a very fast-progressing and often fatal condition. The symptoms of peritoneal mesothelioma include loss of both appetite and weight, abdominal swelling, and ascites, a build-up of fluid in the abdomen.
Traditional Treatment: Systemic chemotherapy is used to treat peritoneal mesothelioma, but the benefits are typically not long lasting.

Peritoneal Carcinomatosis: Tumors known as peritoneal carcinomatosis can develop from cancers of the digestive tract or from the peritoneum. Patients typically experience a great deal of pain from severe ascites, a build-up of fluid in the abdomen, or a blockage in the intestine.

Traditional Treatment: Like other cancers that affect the peritoneum, peritoneal carcinomatosis has, in the past, been difficult to treat with systemic chemotherapy. Surgery alone can actually dislodge cancer cells within the peritoneum and cause them to re-implant elsewhere.

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