Cancers of the abdominal organs such as the large intestine, stomach, ovary and cecum are commonly caused by "abdominal metastasis", which was considered incurable in the past. The average survival time of patients is only 6 to 12 months.
However, surgeon Leung Ka-liu pointed out that with the introduction of "cytoreductive surgery" combined with "intraperitoneal hyperthermic chemotherapy" (HIPEC) in Hong Kong in recent years, it has effectively increased the chance of radical cure and brought hope to patients.
Photography: Chen Weici
Intra-abdominal metastases are common chemotherapy as traditional treatment
According to statistics, about 5,500 new cases of colorectal cancer are recorded in Hong Kong every year, of which 10% will have intraperitoneal metastasis; half of the 1,300 new cases of gastric cancer will have intraperitoneal metastasis, and 70% of ovarian cancer cases will have intraperitoneal metastasis.
Traditionally, when cancer has metastasized to the abdominal cavity, it cannot be removed surgically.
"Traditionally, even if abdominal metastases only appear in a single location, it is inferred that cancer cells exist in all locations in the entire abdominal cavity, and eventually grow into tumors that are visible to the naked eye, so they cannot be removed by surgery." Intravenous injection, which runs anticancer drugs through the bloodstream throughout the body, usually suppresses the growth of cancer cells, relieves symptoms for some patients, and prolongs life.
However, a small number of cancer cells will further mutate and become resistant to drugs, and the cancer will recur.
Compared with other distant metastases, traditional chemotherapy is also less effective for intra-abdominal metastases.
Primary peritoneal carcinomas are uncommon and more often metastasize to the abdominal cavity.
Since there are hundreds of tumors metastasized in the abdominal cavity, it is difficult to see small tumors. In the past, it was considered difficult to completely remove them by surgery, and only palliative treatment could be performed.
"Cytoreductive surgery" combined with "intraperitoneal hyperthermic chemotherapy" increases the chance of cure
In recent years, there has been a new development in the treatment of local peritoneal cancer - "cytoreductive surgery" combined with "peritoneal hyperthermic chemotherapy".
The surgeon will first remove the tumor that is visible to the naked eye as much as possible (called "cytoreductive surgery"), and then immediately perform "intraperitoneal hyperthermic chemotherapy". According to the characteristics of cancer cells, they are heated to 42 degrees Celsius. Perfusing the peritoneal cavity to eliminate cancer cells that are invisible to the naked eye.
"Compared with traditional intravenous chemotherapy, 'intraperitoneal hyperthermic chemotherapy' injects drugs directly into the abdominal cavity to increase the drug concentration received by the tumor. In addition, the scope of chemotherapy is limited to the abdominal cavity, so it has less impact on other parts of the body." This therapy was originally applied to the cecum cancer, the long-term survival rate of patients has increased from less than 10% to about 70%, and it is also used in other cancers.
Dr. Leung mentioned a case. A patient with stage 4 cecal cancer underwent "cytoreductive surgery" and "intraperitoneal hyperthermic chemotherapy". After the surgery, the cancer index returned to normal, and there was no sign of recurrence.
"Cytoreductive surgery" combined with "intraperitoneal hyperthermic chemotherapy" takes 8 to 20 hours, so make sure that the patient's physical condition allows it.
This treatment option may also be considered in patients with cancer recurrence.
In another case, a patient with stage III ovarian cancer, after conventional surgery and chemotherapy, the cancer index returned to normal.
Later, it was found that the cancer had recurred in the abdominal cavity. After using "cytoreductive surgery" combined with "intraperitoneal hyperthermic chemotherapy", the cancer index returned to normal again, and there was no sign of recurrence.
"For patients with abdominal metastases at the time of cancer diagnosis, if the situation permits, simultaneous resection of the primary tumor and intra-abdominal metastases, combined with "intraperitoneal hyperthermic chemotherapy", the operation will be relatively simple, with lower risks and higher efficacy.
"However, each patient's physical condition, tumor size, and complexity are different. Compared with ordinary surgery, this treatment method requires a longer time, and the surgical risk and the probability of complications are also higher.
Therefore, as to how to choose the best time and which treatment to perform, the doctor should analyze the patient's condition based on experience, and then make a decision after evaluating the treatment effect and risk.
*The content of this article is for reference only, if you have any questions, please consult your doctor.
For more information on colorectal cancer, gastric cancer and intra-abdominal metastases, please visit:
https://www.bestview.hk/colorectal cancer/
https://www.bestview.hk/health-information/stomach cancer/
https://www.bestview.hk/health-information/peritonealcarcinomatosis/