New Delhi: A combination of Cytoreductive Surgery (CRS) along with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in the treatment of stage 4 ovarian cancer leads to steady post-operative progress, doctors said.
The result was reached after a 65-year-old hypertensive lady suffering from stage 4 ovarian cancer showed progress after a combination of CRS and HIPEC was performed on her.
According to doctors, Anjali (name changed) had Carcinoma – a type of cancer in the epithelial cells of the abdominal cavity – which spreads to abdominal surfaces and the peritoneum.
“This kind of spread is called peritoneal carcinomatosis and, traditionally, considered an incurable disease with a life expectancy of not more than a few months,” said the doctors.
The patient was immediately admitted at the city-based BLK hospital and a specialised oncological team led by Kapil Kumar, Director and Head of Surgical Oncology, took up the task.
“On completing detailed investigation, it was observed that the carcinoma involving the peritoneum, included metastasis (spread) of cancer of the appendix, cancer of the colon and rectum, cancer of the ovaries, and cancer of the stomach,” said Mr Kumar.
Describing the patient’s condition, Mr Kumar said despite undergoing chemotherapy, her disease was present with nearly two litres of ascites (abnormal accumulation of fluids in the abdomen) and thickened omentum and peritoneum which are the fatty lining covering stomach, large intestines and other abdominal organs containing lymph nodes.
“After going through the complete history of the patient, the team came to a conclusion of performing multiple surgeries, using the innovative technique known as CRS along with HIPEC,” said Mr Kumar.
CRS is a multiple surgical procedure in which some organs and affected tissues are resected. Because heated chemotherapy can penetrate only at a very limited distance in the tumour tissue, it is imperative to remove all visible and palpable tumour deposits before HIPEC is delivered.
“The patient was in the 4th stage of ovarian cancer and had to undergo CRS. Her uterus along with cervix, both the ovaries and fallopian tube, omentum (fatty tissues that nourishes the stomach and colon), pelvic and para-aortic lymph nodes were dissected and removed,” said Mr Kumar.
After the 11-hour-long CRS surgery, the patient was given HIPEC which was instilled through machine.
“The sterile chemotherapy solution was circulated throughout the peritoneal cavity at 42 degree C for 90 minutes to kill the remaining cancer cells. CRS and HIPEC prevent growth of microscopic cells which are left behind,” said Kumar, adding that HIPEC also improves drug absorption.
“Following the completion of the entire medical procedure, the patient made steady post-operative progress, and was discharged after two weeks. She is now undergoing her remaining chemotherapy procedure. Her quality of life has improved and chances of her survival are very much on the cards,” said Mr Kumar.