A Combination Treatment Option for People With Advanced Disease
Experienced Team
At Fred Hutchinson Cancer Center and University of Washington Medical Center, we have an experienced team that provides CRS-HIPEC. Many of our patients receive all their cancer care through Fred Hutch and UW locations. We also offer CRS-HIPEC to people from across the state, the region and beyond who are getting other parts of their care from their local clinicians. Our team gives second opinions as well.
Meet the CRS-HIPEC Care Team
For people with cancer that has spread to the lining of the abdomen, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC, pronounced “high-peck”) offers hope. This treatment combines two parts in one operation: first, surgery to remove all visible signs of cancer, and second, chemotherapy that is put into the abdomen to stop any cancer cells that remain. It may be able to control advanced disease while also giving you good quality of life.
CRS-HIPEC may be an important option even for people who were told elsewhere that there was no effective way to treat their disease.
What Does “CRS-HIPEC” Mean?
CRS stands for “cytoreductive surgery.” This is an operation to remove all the cancer that surgeons can see. “Cyto” means cell. “Reductive” has to do with reducing, or lowering, the amount. The aim of the surgery is to leave few to no cancer cells behind.
HIPEC stands for “hyperthermic intraperitoneal chemotherapy.” “Hyperthermic” means warmer than normal. Here, it means that liquid chemotherapy medicines are warmed above normal body temperature (about 106 degrees F). Then they are put inside the abdomen through a tube. The abdomen is also called the peritoneal cavity, so medicines put inside are “intraperitoneal.”
HIPEC is done right after CRS, during the same operation. The heated chemotherapy kills cancer cells that are left behind in the abdomen after surgery.
Who Needs CRS-HIPEC?
This treatment is for people with peritoneal carcinomatosis, or cancer that has spread to the abdominal lining (peritoneum). This is also called peritoneal cancer. The cancer may have started in the appendix, stomach, colon, rectum, ovaries or fallopian tubes.
CRS-HIPEC is also used for mesothelioma (cancer that starts in the mesothelium, or the lining around organs) of the abdomen and some rare sarcomas that can spread to the peritoneum.
If cancer affects your peritoneum, your Fred Hutch and UW Medicine team will carefully look at your health, your disease and any treatment you have already had in order to decide whether CRS-HIPEC might be a good option for you.
“Patients who come to see us about CRS-HIPEC are often still reeling from recently learning they have advanced cancer. It’s a lot to handle. We understand what you’re going through and are here to provide not only expert care but empathetic care.”
— Harveshp Mogal, MD, MS, surgical oncologist
First Appointment
Your first CRS-HIPEC appointment is a time for you and the CRS-HIPEC team to meet. Your team includes your surgical oncologist and a medical oncologist. You may also meet the team’s surgical oncology advanced practice provider, a nurse, a dietitian, a physical therapist and a social worker. If you need CRS-HIPEC for cancer of the ovaries or fallopian tubes, you will meet with a gynecologic oncologist. Based on your needs, you might meet other team members, too. You will talk about your diagnosis and how CRS-HIPEC may fit into your treatment plan.
It is also a time for us to start getting to know you as a person. This helps us personalize our recommendations to you. Together, you and your care team will decide what needs to happen next.
We encourage everyone to bring a family member or friend to their first appointment (and any future visits).
What to Expect
First appointments usually last up to one hour. Here is what you can expect to happen.
Discussing CRS-HIPEC
CRS-HIPEC often means a long and very difficult surgery. We will personalize your surgery, and any other care you need, to your unique situation.
During your first visit, your surgeon will talk with you about:
- What your procedure will involve
- How we expect it will go for you and what the results may be like
- How CRS-HIPEC fits in with any other treatment options you have
- What you can do to be in the best physical, mental and emotional condition before surgery to get the best outcome
- How our team supports you throughout the process
- Other ways we can help with your health and well-being
Getting to Know You
These appointments are also a time for you to tell us about yourself. Each patient and family has their own needs, values and preferences. We want to get to know you so we understand the best way to care for you. For example, it is helpful for us to know:
- How much detail you would like about your disease, the treatments and the long-term outlook
- What your goals are for treatment and what matters most to you about the process of getting care
- Who will support and take care of you when you need help
- What concerns you have about how treatment could affect your work or home life
Answering Your Questions
Starting with your first appointment, we are always here to answer your questions. We want to help you understand as much as you want to know about your disease, your treatment and how care happens at Fred Hutch and UW Medical Center.
To get you started, here are some questions you might want to ask:
- What are the benefits and risks of CRS-HIPEC?
- How soon would I need to have this treatment?
- What do you expect my recovery will be like?
- What other treatments will I need before or after surgery?
We strongly encourage you to bring a friend or family member with you to help keep track of your questions and the information that your team gives you.
Deciding What is Next
Before you leave, we make sure you know what is going to happen next and how you can reach us if you have questions later. We will schedule your future visits or make sure you know when and how to schedule them.
If you are from outside the Seattle area and getting other parts of your care at a center closer to home, we will communicate with your local team, too. We will make sure they understand our recommendations so we can work together to provide the care you need.
If you would like more time to think before deciding about treatment, we understand. Ask your team to explain how soon you need to decide.
Treatment Process
Many people think of chemotherapy as a cancer treatment that happens before, after or instead of surgery. But CRS-HIPEC combines chemotherapy and surgery in one operation.
In this operation, one or more surgeons will remove all the cancer they can see in your abdomen. Then they put anti-cancer medicine into the abdominal cavity. These surgeons are experts who have special training in doing this surgery.
Cytoreductive Surgery (CRS)
Cancer that has spread to the lining of the abdomen (peritoneum) often started in a nearby organ — the appendix, stomach, colon, rectum, ovaries or fallopian tubes. Mesothelioma and some rare sarcomas can also spread to this lining. The same lining covers the outside of many organs in the abdomen.
In CRS, the surgeon removes the parts of the lining where they can see cancer. Often, they also need to remove parts of organs that also have cancer.
Usually, this is open surgery, meaning it is done through one large incision (cut). Sometimes, we do minimally invasive laparoscopic surgery or robot-assisted surgery .
Your surgery team will talk with you about the details of your operation, including what will happen during surgery and what to expect after.
Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
After taking out all the cancer they can see, your surgeon puts warm, liquid chemotherapy medicine into your abdomen. The medicine is warmed because this helps it destroy any microscopic cancer cells that were left behind because they are too small to see.
The medicine flows through a tube from a machine into your abdomen. It stays inside you for about one to two hours. This helps make sure that the medicine coats your abdomen well. Then the surgeon drains the medicine, washes out your abdomen with a sterile solution and closes the incision (cut).
Compared to standard whole-body chemotherapy, which goes into your bloodstream, HIPEC has important benefits. Because HIPEC goes only into your abdomen:
- It goes directly where the cancer cells are.
- Your surgeon can safely give you a higher, more effective dose.
- The heat kills cancer cells directly and helps the chemotherapy kill more cancer cells.
- The medicine has very little effect on other parts of your body, so there are fewer side effects.
Research
At Fred Hutch and UW Medicine, our physicians and researchers are always asking how we can make treatment better and reduce side effects. This is why we do clinical trials. Through these studies, we are able to offer you therapies that are not available everywhere. This means that even if CRS-HIPEC turns out not to be the right choice for you, we may be able to provide another option.
Surgical oncologist Harveshp D. Mogal, MD, MS, has done clinical studies on outcomes for people with advanced peritoneal cancers who need CRS-HIPEC. His research has looked at topics like how we can better select candidates for this procedure, how we can reduce health concerns that might happen because of surgery and how we can improve patient well-being.
UW and Fred Hutch physicians have also done several studies for patients with advanced ovarian cancer and have ongoing studies to improve ovarian cancer outcomes.