What Is Intraperitoneal (Intra-Abdominal) Heated Chemotherapy? How Is It Given and What Are Its Side Effects?

Intraperitoneal (intra-abdominal) chemotherapy is a treatment for cancers in the abdomen. It delivers chemotherapy drugs directly into the peritoneal (abdominal) cavity, which contains the liver, stomach and intestines.

During intraperitoneal chemotherapy, specialists administer chemotherapy drugs and fluids into the peritoneal cavity. This allows them to give higher doses of the necessary drugs while minimizing side effects in the rest of the body.

Cancer specialists may recommend intraperitoneal chemotherapy for people with ovarian, stomach, colon, rectal, pancreatic or appendix cancers.

There are 3 types of intraperitoneal chemotherapy: HIPEC (heated chemotherapy), PIPAC (pressurized aerosol chemotherapy) and intraperitoneal chemotherapy given on an outpatient basis. Although these methods are discussed in detail below, this article focuses mainly on HIPEC.

What Is Intraperitoneal Chemotherapy?

Intraperitoneal chemotherapy is a cancer treatment in which specialists infuse chemotherapy drugs directly into a person's peritoneal cavity. With conventional intravenous (IV, into a vein) administration, chemotherapy drugs do not always reach the areas affected by cancer and may therefore be ineffective in treating abdominal cancers. With intraperitoneal chemotherapy, the drugs go directly to the cancer site and can penetrate deeper into any tumors.

Which Patients Are Suitable for Intraperitoneal Chemotherapy?

Intraperitoneal chemotherapy appears effective against tumors of millimeter size (2.5 mm or smaller). Surgeons must therefore remove all tumors they can reach during surgery before starting intraperitoneal chemotherapy. Effective clearance of abdominal tumors is one of the most important factors determining its success. Operations performed for this purpose are called cytoreductive surgery procedures.

There are 3 types of intraperitoneal chemotherapy:

1. Hyperthermic IntraPEritoneal Chemotherapy (HIPEC): This is also called intra-abdominal heated chemotherapy. It is given once after surgery. In HIPEC, after surgical tumor clearance, the chemical contents delivered into the abdomen are heated to 42-43°C, and treatment lasts 1 – 2 hours. After this initial treatment, specialists usually recommend systemic chemotherapy through a vein. However, depending on the cancer's location and stage, the person may undergo further intraperitoneal treatments. The scientific evidence for HIPEC is stronger than for the other two methods below.
2. Intraperitoneal chemotherapy: In this method, chemotherapy is not heated and is administered at set intervals in outpatient chemotherapy centers, like conventional chemotherapy.
3. PIPAC: PIPAC involves delivering diluted aerosolized chemotherapy under pressure inside the abdominal cavity. Peritoneal carcinomatosis represents end-stage disease in many cancers, particularly cancers of abdominal organs and the peritoneum (abdominal lining), and most patients with widespread cancer involvement of the peritoneum die within six months. Platinum-based systemic chemotherapy is an effective option in many cancers that have metastasized to the peritoneum, but poor overall performance, recurrence, chemotherapy resistance and treatment side effects are major problems for these patients. However, some patients with peritoneal carcinomatosis have good general performance and a life expectancy of more than a few months, so the search continues for palliative treatments that could improve both survival and quality of life. One treatment tested in recent years is the surgical method called PIPAC (Pressurized IntraPeritoneal Aerosol Chemotherapy). Although it has become popular in recent years, the scientific evidence is weak or conflicting.

The HIPEC procedure is illustrated below:

Which Cancers Are Treated With Intraperitoneal Chemotherapy?

Intraperitoneal chemotherapy may be effective for people with cancer in the abdomen. These cancers include:

• Ovarian cancer (cancer of the female ovaries)
• Colorectal tumors, colon and rectal cancers
• Stomach cancer
• Appendix cancer

How Does Intraperitoneal Chemotherapy Work?

During tumor debulking surgery, surgeons place a catheter attached to a port that provides access to the abdominal cavity. Depending on which part of the peritoneal cavity is targeted, the access port is attached below the ribs and near the pelvis (groin area).

During treatment, specialists inject chemotherapy drugs into the port, and the drugs spread through the abdomen.

The Intraperitoneal Chemotherapy Process

Intraperitoneal chemotherapy can be given as an inpatient or outpatient procedure. HIPEC (postoperative heated chemotherapy) is performed only in an operating room. The number of treatments and types of drugs may differ from person to person depending on the cancer type. Doctors will explain what will happen during treatment.

Before Intraperitoneal Chemotherapy

Some people may feel unwell after treatment. Before starting any chemotherapy, it is therefore important to know that the person receiving treatment can get home safely.

• People can wear loose, comfortable clothing to help minimize discomfort associated with bloating.
• Eating light meals the evening before and the morning of treatment may also help.
• Depending on how long treatment will take, patients can bring snacks and drinks into the treatment room.

During Intraperitoneal Chemotherapy

People receiving intraperitoneal chemotherapy need to lie down during treatment, but they can walk to the bathroom when necessary.

Specialists mix most chemotherapy drugs with a saline solution that travels into the abdominal cavity through the access port and catheter. Healthcare staff access the port under the skin with a needle. They may tape the needle in place. Once the fluid reaches the abdomen, people are usually asked to change position or turn from one side to the other every 15 minutes. This helps distribute chemotherapy drugs through the area and allows them to reach as many organs as possible.

After Intraperitoneal Chemotherapy

After intraperitoneal chemotherapy, specialists usually recommend resting, drinking plenty of fluids to avoid dehydration, and eating small, regular meals.

People should check the access site regularly and contact specialists if there is any redness or swelling.

Once the incision made for the port has healed, most people can bathe and carry out daily activities normally.

What Are the Side Effects of Intraperitoneal Chemotherapy?

Some of the most common side effects of intraperitoneal chemotherapy, such as bloating or needing to urinate more often, may be caused by excess fluid in the abdomen.

Other common side effects of chemotherapy include:

• Nausea and vomiting
• Fatigue
• Constipation or diarrhea
• Difficulty concentrating
• Reduced appetite
• Mood changes

When Should You Contact a Doctor?

Everyone responds differently to chemotherapy, but certain warning signs require medical attention. Contact a specialist if the following symptoms occur after intraperitoneal chemotherapy:

• Pain, swelling or leakage around the access site
• Nausea or vomiting lasting more than 24 hours
• A fever of 38 °C or higher
• Diarrhea lasting more than 24 hours
• Severe constipation
• Persistent or severe abdominal pain
• Reduced appetite for more than 24 hours (inability to eat or drink)

Summary

Intraperitoneal chemotherapy is a treatment for cancers in the abdomen. In this method, chemotherapy drugs in a saline solution are delivered directly into the abdominal cavity and reach all areas. Specialists generally recommend intraperitoneal chemotherapy after surgery to reduce or remove tumors, because it works more effectively against smaller tumors.

Intraperitoneal chemotherapy may cause side effects such as bloating and needing to urinate more frequently. A person who feels unwell, has a fever or has pain at the application site should contact a specialist immediately.

For some cancers, studies show that people receiving hyperthermic intraperitoneal chemotherapy (HIPEC) may be more likely to survive than others.

However, everyone responds differently to chemotherapy. People should therefore discuss with their oncologists how effective chemotherapy may be for their cancer treatment.

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