Ovarian cancer originates from the surface lining of the ovaries and also from the peritoneum, the membrane lining the contents of the abdomen and pelvis. Ovarian cancer grows and spreads within the peritoneal cavity and does not produce symptoms till it is widespread. Peritoneal spread from ovarian cancer is Stage 3 disease.
The standard treatment for ovarian cancer is a combination of surgery and chemotherapy. Although the initial response to this treatment is good 60-70% of all patients with ovarian carcinoma will recur, and usually the disease comes back in the peritoneum . A lot of new drugs are available for ovarian cancer, but none has been able to alter the course of the disease significantly.
Intraperitoneal chemotherapy in ovarian cancer
Intraperitoneal delivery of chemotherapy (IPEC) which involves inserting the chemotherapy agents directly within the peritoneal cavity at normal temperatures has been shown to be effective in front-line treatment in ovarian cancer . This means the chemotherapy agents have the potential to directly reach all areas of the peritoneal cavity where the ovarian cancer remains ‘contained’ for long periods. Clinical trials investigating the intraperitoneal delivery of chemotherapy drugs in combination with intravenous delivery have shown a survival advantage for patients treated with intraperitoneal chemotherapy.
HIPEC for Ovarian Cancer
HIPEC (hyperthermic intraperitoneal chemotherapy) incorporates three modalities of treatment: surgery and intraperitoneal chemotherapy which have proven roles in the treatment of ovarian cancer and heat which has theoretical advantages. The surgical excision of tumors to reduce the bulk of residual disease prior to chemotherapy is the standard initial treatment for ovarian cancer and has a role in some patients with recurrent disease. Hyperthermia, on its own, is tumoricidal. In addition, it increases the ability of some chemotherapy agents to kill cancer cells and allows these agents to penetrate more deeply into tumor implants.
HIPEC can be used in the following ways in the treatment of ovarian cancer
- At the time of the first surgery (primary or interval cytoreduction)
- In certain patients with recurrent tumors when surgery is planned
- As a part of a ‘Second look’ surgery in certain patients.
At present though HIPEC is not the standard of care, its use in the treatment of ovarian cancer has been increasing worldwide.