Before the liquid chemotherapy can circulate through the patient’s abdomen, it has to reach 105 degrees.
That temperature is about the same as a human fever, and cancer cells are more susceptible to chemotherapy when it is warm, Dr. Leopoldo Fernandez said.
Harry ‘Mac’ McCarthy monitors the temperature, before raising the bag of blue drugs in his hand.
“I’m going to add the chemo now,” he announces to the surgical team standing beside the patient — in this case, a female mannequin. Liquid chemotherapy then begins circulating through the patient’s abdomen.
Fernandez and McCarthy work for VCU Health’s Massey Cancer Center, which this year began offering HIPEC, or heated intraperitoneal chemotherapy. It is the first health system in the Richmond area to do so.
HIPEC involves circulating a heated chemotherapy solution through the patient’s abdomen following surgery. It can be used to treat a variety of advanced cancers, including stomach, ovarian and colorectal cancers.
“Traditional IV chemotherapy doesn’t really penetrate well in the abdominal cavity,” Fernandez said.
The HIPEC procedure takes place after surgical oncologists like Fernandez remove any visible tumors. That is essential before doing HIPEC because if the cancer is thicker than 2.5 millimeters, the patient will not see the same benefit as they would without it.
“Anything above that, then it gets to a thickness that the chemo cannot penetrate,” Fernandez said.
HIPEC makes a huge difference to patients who have advanced cancer in the abdomen. The 5-year survival rate — a standard measurement for cancer outcomes — for patients with colon cancer who receive the procedure is 40 percent.
According to the American Cancer Society, stage IV colorectal cancer typically has a 5-year survival rate of just 11 percent.
For patients with pseudomyxoma peritonei — a rare cancer in the appendix — the 10-year survival rate following HIPEC is 90 percent.
Elaine Zierden, specialty team manager for oncology with VCU Health, is a member of Fernandez’s team that helped bring HIPEC to the health system.
Her mother-in-law had ruptured stage III ovarian cancer 10 years ago and underwent the HIPEC procedure.
“We are 10 years out, and she’s doing great,” Zierden said.
So far Fernandez’s team has performed the procedure only once, at the beginning of this year.
Another surgery is planned for next week, but for now the team is limiting it to one procedure a month, with the goal of eventually doing two a month.
The monthly limits have largely to do with how strenuous the procedures are, lasting from eight to 10 hours and requiring a team of about six.
Once the chemotherapy has been removed from the patient’s system, a saline solution is then circulated through to clean the abdomen of any remaining chemotherapy drugs.
While cancer can frequently spread to the abdomen, few patients actually qualify for the procedure.
The cancer must be confined to the abdominal cavity and exist nowhere else in the body, and the patient must be very fit because they might not feel like themselves for another three to six months.
“It takes a big toll on the quality of life,” Fernandez said. “That’s one of the big parts of selecting patients, because if you’re not making them better you might as well not make them worse.”