Intraperitoneal Chemotherapy (IP Chemo)
What is intraperitoneal (IP) chemotherapy?
Intraperitoneal is the space within the peritoneum. The peritoneum is the membrane (thin tissue) that lines the abdominal (belly) cavity and surrounds your abdominal organs. Intraperitoneal chemotherapy can be given directly into this space to treat cancers of the stomach (gastric), appendix (appendiceal), and ovaries.
There are two types of IP chemotherapy. The first type is given through a port in the abdomen and is done in the hospital or an outpatient (clinic) setting. The second type, called Hyperthermic Intraperitoneal Chemotherapy (HIPEC), is given in the operating room after surgery to remove part or all of the tumor, also called debulking. The chemotherapy is warmed and put directly into the intraperitoneal cavity.
For IP chemotherapy to work, your tumor must be less than 1cm in size. IP chemotherapy is unable to penetrate (get into) a tumor larger than 1 cm. Also, metastases in other parts of the body will not be affected by IP chemotherapy.
Why is intraperitoneal chemotherapy prescribed?
- IP chemotherapy directly affects cancer cells when it comes in contact with them.
- Higher doses of chemotherapy can be given intraperitoneally as compared to through an IV (intravenously).
- IP chemotherapy lessens the systemic (entire body) effects that can be caused by IV chemotherapy since the chemo stays in the peritoneal cavity.
Standard Intraperitoneal Chemotherapy
Before IP chemotherapy is given, a port must be placed to give the medicine. The port is placed in the abdomen during a surgical procedure, either in the operating room during surgery to debulk a tumor, or by an interventional radiology team if no surgery is being done. The port is placed underneath the skin and then sutured to the ribs. You can feel the port under the skin. There is a tube that goes from the port into the peritoneal cavity. Often, a port can be used just 24 hours after it is placed.
You may need an intravenous (IV) line if you don’t have a central line. You may get IV fluids and pre-medications, including anti-nausea medications and steroids. You should use the bathroom if you don’t have a foley catheter (tube placed into the bladder through the urethra to collect urine) placed. You will not be able to get up during the infusion. A needle will be placed into your port and secured (taped down).
Your infusion will be started. Infusions can last anywhere from 30 minutes to 3 hours. You may have only chemotherapy or a combination of chemotherapy and an IV fluid put through your port. You need to stay still during the infusion to keep the needle from moving. If you need to lay on your back during the infusion, the pressure of the fluid may press against your diaphragm and lungs and cause you to feel short of breath. You may also feel some discomfort, like fullness after eating a large meal. It is important to tell your nurse if you become short of breath or if you are very uncomfortable.
After your infusion is done, the needle will be removed from your port. You will likely be told to change your position every 15 minutes for 1-2 hours. This is important so that the chemotherapy comes in contact with any cancer cells. The chemotherapy is not removed and will be absorbed into your peritoneal cavity.
Hyperthermic Intraperitoneal Chemotherapy
During surgery to debulk a tumor, cancer cells may be left behind and HIPEC is used to kill these cells. The chemotherapy is warmed because it is thought that heat helps break down and eliminate cancer cells better.
After the tumor has been removed or is less than 1cm in size, the chemotherapy is run through a machine to warm it and it then fills the peritoneal cavity. The chemotherapy is moved around by a provider using their hands, or by moving your body around for about 90 minutes. The goal is for the whole abdominal cavity to be evenly exposed to the heated chemotherapy. The chemotherapy stays in the peritoneal cavity and the surgical wound is fully closed. The chemotherapy is slowly absorbed into the peritoneal cavity. If for some reason the treatment needs to be stopped, the chemotherapy is suctioned out of the peritoneal cavity.
What are the side effects of IP chemotherapy?
Side effects can include nausea, vomiting, electrolyte imbalance, abdominal pain, and kidney injury. Some patients will have low blood counts (called myelosuppression), which may be caused by IP chemotherapy. It is also possible to have issues with your port, like infection, pain, and trouble infusing the chemotherapy because the catheter is bent.
Your provider will be able to answer your questions about treatment with IP chemotherapy. Always report any side effects during and after your treatment to your provider or nurse.
Ben Aziz, M. and Di Napoli R. Hyperthermic Intraperitoneal Chemotherapy. 2023. National Library of Medicine.
Goodman M.D. et al. Chemotherapy for intraperitoneal use: a review of hyperthermic intraperitoneal chemotherapy and early post-operative intraperitoneal chemotherapy. Journal of Gastrointestinal Oncology. 2016. Feb; 7(1): 45-47.
Markman, Maurie MD and Olawaiye, Alexander B MD. Intraperitoneal chemotherapy for treatment of ovarian cancer. 2021. Found at: https://www.uptodate.com/contents/intraperitoneal-chemotherapy-for-treatment-of-ovarian-cancer