Cancer Care Managing Aggressive Metastatic Abdominal Cancer By UPMC Hillman Cancer Center, March 5, 2018 Most people understand what primary cancer is; it is cancer that occurs in one part of the body, such as the breast or colon. What is less understood is secondary cancer, called metastatic cancer, which is cancer that has spread to a different part of the body than where it started. Learn more about HIPEC treatment on the UPMC Hillman Cancer Center website. One of the trickiest metastatic cancers to treat is peritoneal metastasis. The peritoneum is the layer of tissue surrounding the organs in the abdomen. Cancer that spreads to the peritoneum usually starts in the appendix, colon, or ovaries. For this reason, 150 to 200 people — more than two-thirds of them from out of state — come to UPMC Hillman Cancer Center for treatment each year. In some cases, they come for re-operations after having failed surgeries in the past. Treating Abdominal Cancer “Patients whose cancers have spread to the peritoneum are challenging,” says David L. Bartlett, MD, a surgical oncologist at UPMC Hillman Cancer Center and an expert in treating advanced, complex abdominal cancers. “These patients often need a complete program of services to manage their cancers.” The services you may need include: Chemotherapy: drugs that help reduce the size of the tumors or stop cancer from growing Perfusion therapy: a way of delivering anticancer drugs directly into an organ or body area Palliative surgery: an operation to remove a blockage or mass to relieve pain Nutrition support: the delivery of nutrients for those who are unable to eat Clinical trials: advanced experimental treatments and techniques People with peritoneal metastases benefit from these services through a multidisciplinary approach, such as the ones used at UPMC Hillman Cancer Center. “This means that doctors from different specialties examine the patient and work together to plan the right combination and timing of treatments for their individual cancer,” says Dr. Bartlett. “The disease can be very aggressive, so it must be managed aggressively right from the start.” Hyperthermic Intraperitoneal Chemotherapy One aggressive treatment that Dr. Bartlett helped to develop and continues to perform is hyperthermic intraperitoneal chemoperfusion (HIPEC), a procedure sometimes described as a hot chemo bath over the cancer site. HIPEC can be used for people whose cancer hasn’t spread outside the peritoneal cavity. The technique begins in the operating room with the surgical removal of as much of the tumor as possible, known as debulking. Then, the surgeon inserts tubes into the abdomen to deliver the heated chemotherapy liquid and return fluid to the heating equipment. The hot chemo liquid circulates for nearly two hours to kill cancer cells. New techniques are being developed to treat these cancers, as well. “Researchers are working on ways to use immune therapies in the peritoneal cavity,” says Dr. Bartlett. “T cells or viruses can be introduced to the peritoneal cavity to help the patient’s own immune system fight cancer cells. Immune therapy is going to be important to future advances in treating this type of cancer.” For more information about surgery for and management of advanced abdominal cancers, contact UPMC Hillman Cancer Center.