They Nip the Cancer in the Gut

They Nip the Cancer in the Gut

When Soma Devi was admitted to Madras Institute of Orthopaedics and Traumatology (MIOT) Hospitals to treat her abdominal cancer, she was not very confident if she would walk out of the ward after her treatment. However, the 52-year-old from Uttar Pradesh got a new lease of life after she underwent HIPEC (Hyperthermic Intraoperative Peritoneal Chemotherapy) surgery. HIPEC is a novel and revolutionary process of administering heated chemotherapy to treat abdominal cancer. Today, she has overcome the deadly disease and is leading a stable life.

Dr Sreekumar Pillai, director, oncology and chief surgical oncologist of MIOT International Centre, says: “Soma Devi is doing well after surgery. Though it was an extensive surgery that required cytoreduction (removal of tumour) and HIPEC, the patient withstood all the procedures well. No significant complications were observed and she was discharged in time as per schedule on 12th day following the surgery.”

Abdominal cancer is quite rare in India (about 1,000 or more cases per year) when compared to the other types, yet diagnosis is very poor and expertise not widely available. Usually, the survival rate is very low (less than 5 per cent) even after adequate chemotherapy, ranging from weeks to few months owing to late diagnosis. There are a few niche centres for treatment and MIOT Hospitals is one among these which has effectively demonstrated this procedure. “Since the overall survival rate has increased from 5 per cent to 25 per cent, this procedure offers more hope for the patients, and can be done safely on well-selected patients,” says Dr Pillai.

This treatment increases the average life expectancy by up to 25 to 30 per cent. To understand how this surgery works, one needs to focus on the buildup of the stomach. Peritoneum is a two-layered membrane that lines the inner surface of the abdomen that allows different organs to glide smoothly over another. Between the two layers is a fluid-filled space that is called peritoneal cavity. The cancers that occur in this layer are rare, yet very poorly diagnosed. “The types of cancers are called primary peritoneal cancer, peritoneal mesothelioma, pseudomyxoma peritonei, and colorectal cancer (also called colon cancer). They are often lately diagnosed and hence, the chances of survival are low,” says Dr Ram Prabhu, medical oncologist of MIOT International Centre.

Since this process has been in practice in the US and UK for more than a decade, the data about efficacy there is much clearer than in India. Though we have a huge population, our incidences are still low; timely diagnosis is inadequate and the data is still considered insufficient, opines Dr Prabhu. Christie Cancer Clinic, Manchester, UK, that has a proven track record of several successful HIPEC procedures has extended support to MIOT Hospitals through a tie-up of knowledge and expertise-sharing. Dr Prabhu is one among the oncology specialists who have travelled to Christie for learning the procedure.

After diagnosis, a cytoreductive surgery (removal of tumour) is done to remove almost all of the malignant growth, and the HIPEC chemotherapy is administered. The machine for this costs about `1 crore and is like a dialysis machine that pumps heated chemotherapy liquid into the peritoneal cavity for about 30 to 90 minutes. The chemotherapy agent is mixed in an aqueous medium (water-base) and heated to 42 to 43 degree celsius and is infused into the peritoneal cavity through a tube, to circulate into the cavity. “The chemotherapy, directly exposed to the remnant tumour cells at the elevated temperature, increases the chances of killing the malignant cells by a scale of 10 to 1,000 times when compared to the normal chemotherapy process that is administered intravenously. Years of study have shown that the temperature of 42-43 degree celsius does the trick effectively. The fact that it is direct, and also is quicker as it is done intra-operatively (done during the tumour removal surgery) makes it a success,” explains Dr Prabhu.

The cost of HIPEC procedure on a patient would typically be about `1-4 lakh when compared to `15 lakh with conventional chemotherapy. “All patients are not suited for this treatment,” explains Dr Prabhu, saying patients with major organ dysfunction, especially heart, liver and kidney, and elder patients above 65 years of age usually do not respond well to the procedure that uses a special type of monoclonal antibodies in the chemotherapy to kill cancer cells.