Treatments

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

For people with cancer that has spread to the lining of the abdomen, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC, pronounced “high-peck”) offers hope. This treatment combines two parts in one operation: first, surgery to remove all visible signs of cancer, and second, chemotherapy that is put into the abdomen to stop any cancer cells that remain. It may be able to control advanced disease while also giving you good quality of life.

At Fred Hutchinson Cancer Center and University of Washington Medical Center, we have an experienced team that provides CRS-HIPEC. Many of our patients receive all their cancer care through Fred Hutch and UW locations. We also offer CRS-HIPEC to people from across the state, the region and beyond who are getting other parts of their care from their local clinicians. Our team gives second opinions as well.

CRS-HIPEC may be an important option even for people who were told elsewhere that there was no effective way to treat their disease.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose.

Request an Appointment

Frequently asked questions (FAQs)

What does “CRS-HIPEC” mean?

CRS stands for “cytoreductive surgery.” This is an operation to remove all the cancer that surgeons can see. “Cyto” means cell. “Reductive” has to do with reducing, or lowering, the amount. The aim of the surgery is to leave few to no cancer cells behind.

HIPEC stands for “hyperthermic intraperitoneal chemotherapy.” “Hyperthermic” means warmer than normal. Here, it means that liquid chemotherapy medicines are warmed above normal body temperature (about 106 degrees F). Then they are put inside the abdomen through a tube. The abdomen is also called the peritoneal cavity, so medicines put inside are “intraperitoneal.”

HIPEC is done right after CRS, during the same operation. The heated chemotherapy kills cancer cells that are left behind in the abdomen after surgery.

Who needs CRS-HIPEC?

This treatment is for people with peritoneal carcinomatosis, or cancer that has spread to the abdominal lining (peritoneum). This is also called peritoneal cancer. The cancer may have started in the appendix, stomach, colon, rectum, ovaries or fallopian tubes.

CRS-HIPEC is also used for mesothelioma (cancer that starts in the mesothelium, or the lining around organs) of the abdomen and some rare sarcomas that can spread to the peritoneum.

If cancer affects your peritoneum, your Fred Hutch and UW Medicine team will carefully look at your health, your disease and any treatment you have already had in order to decide whether CRS-HIPEC might be a good option for you.

First appointment

Your first CRS-HIPEC appointment is a time for you and the CRS-HIPEC team to meet. Your team includes your surgical oncologist and a medical oncologist. You may also meet the team’s surgical oncology advanced practice provider, a nurse, a dietitian, a physical therapist and a social worker. If you need CRS-HIPEC for cancer of the ovaries or fallopian tubes, you will meet with a gynecologic oncologist. Based on your needs, you might meet other team members, too. You will talk about your diagnosis and how CRS-HIPEC may fit into your treatment plan.

It is also a time for us to start getting to know you as a person. This helps us personalize our recommendations to you. Together, you and your care team will decide what needs to happen next.

We encourage everyone to bring a family member or friend to their first appointment (and any future visits).

Gynecologic oncologist A physician who has special training in diagnosing and treating cancers of the female reproductive organs. Medical oncologist A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A medical oncologist is often the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists. Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Meet Your Care Team

“Patients who come to see us about CRS-HIPEC are often still reeling from recently learning they have advanced cancer. It’s a lot to handle. We understand what you’re going through and are here to provide not only expert care but empathetic care.”

— Harveshp Mogal, MD, MS, surgical oncologist

What to expect

First appointments usually last two to four hours. Here is what you can expect to happen.

Confirming that you are a candidate

For some diseases, CRS-HIPEC works very well — clearly better than other available options — and it is the main therapy we recommend. For other diseases, CRS-HIPEC may be just one part of a larger treatment plan.

To guide your treatment, we look at your cancer type, where it is, other parts of your health and your goals. Fred Hutch and UWMC pathologists and radiologists review your tests and scans to get the most complete picture possible. They may also arrange more tests, if needed. Our specialists may discuss your case at our multidisciplinary CRS-HIPEC tumor board (a meeting between several types of Fred Hutch and UW experts) to design a complete plan for your treatment.

Looking at everything, we assess how much this procedure might help you and how long the benefits are likely to last. At your first appointment, your surgeon will explain whether we recommend CRS-HIPEC for you and why.

Discussing CRS-HIPEC

CRS-HIPEC often means a long and very difficult surgery. We will personalize your surgery, and any other care you need, to your unique situation.

During your first visit, your surgeon will talk with you about:

What your procedure will involve
How we expect it will go for you and what the results may be like
How CRS-HIPEC fits in with any other treatment options you have
What you can do to be in the best physical, mental and emotional condition before surgery to get the best outcome
How our team supports you throughout the process
Other ways we can help with your health and well-being

Getting to know you

These appointments are also a time for you to tell us about yourself. Each patient and family has their own needs, values and preferences. We want to get to know you so we understand the best way to care for you. For example, it is helpful for us to know:

How much detail you would like about your disease, the treatments and the long-term outlook
What your goals are for treatment and what matters most to you about the process of getting care
Who will support and take care of you when you need help
What concerns you have about how treatment could affect your work or home life

Answering your questions

Starting with your first appointment, we are always here to answer your questions. We want to help you understand as much as you want to know about your disease, your treatment and how care happens at Fred Hutch and UW Medical Center.

To get you started, here are some questions you might want to ask:

What are the benefits and risks of CRS-HIPEC?
How soon would I need to have this treatment?
What do you expect my recovery will be like?
What other treatments will I need before or after surgery?

We strongly encourage you to bring a friend or family member with you to help keep track of your questions and the information that your team gives you.

Deciding what is next

Before you leave, we make sure you know what is going to happen next and how you can reach us if you have questions later. We will schedule your future visits or make sure you know when and how to schedule them.

If you are from outside the Seattle area and getting other parts of your care at a center closer to home, we will communicate with your local team, too. We will make sure they understand our recommendations so we can work together to provide the care you need.

If you would like more time to think before deciding about treatment, we understand. Ask your team to explain how soon you need to decide.

Treatment process

Many people think of chemotherapy as a cancer treatment that happens before, after or instead of surgery. But CRS-HIPEC combines chemotherapy and surgery in one operation.

In this operation, one or more surgeons will remove all the cancer they can see in your abdomen. Then they put anti-cancer medicine into the abdominal cavity. These surgeons are experts who have special training in doing this surgery.

Cytoreductive surgery (CRS)

Cancer that has spread to the lining of the abdomen (peritoneum) often started in a nearby organ — the appendix, stomach, colon, rectum, ovaries or fallopian tubes. Mesothelioma and some rare sarcomas can also spread to this lining. The same lining covers the outside of many organs in the abdomen.

In CRS, the surgeon removes the parts of the lining where they can see cancer. Often, they also need to remove parts of organs that also have cancer.

Usually, this is open surgery, meaning it is done through one large incision (cut). Sometimes, we do minimally invasive laparoscopic surgery or robot-assisted surgery .

Your surgery team will talk with you about the details of your operation, including what will happen during surgery and what to expect after.

Laparoscopic surgery A surgery done with the aid of a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. Surgery done with the aid of a laparoscope. A laparoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.

Cytoreductive surgery (CRS)

Each person’s situation is different. We will personalize your surgery plan to fit you.

Hyperthermic intraperitoneal chemotherapy (HIPEC)

After taking out all the cancer they can see, your surgeon puts warm, liquid chemotherapy medicine into your abdomen. The medicine is warmed because this helps it destroy any microscopic cancer cells that were left behind because they are too small to see.

The medicine flows through a tube from a machine into your abdomen. It stays inside you for about one to two hours. This helps make sure that the medicine coats your abdomen well. Then the surgeon drains the medicine, washes out your abdomen with a sterile solution and closes the incision (cut).

Compared to standard whole-body chemotherapy, which goes into your bloodstream, HIPEC has important benefits. Because HIPEC goes only into your abdomen:

It goes directly where the cancer cells are.
Your surgeon can safely give you a higher, more effective dose.
The heat kills cancer cells directly and helps the chemotherapy kill more cancer cells.
The medicine has very little effect on other parts of your body, so there are fewer side effects.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.

Hyperthermic intraperitoneal chemotherapy (HIPEC)

HIPEC is short for “heated intraperitoneal chemotherapy.” It is sometimes called a “hot chemo bath.”

Research

At Fred Hutch and UW Medicine, our physicians and researchers are always asking how we can make treatment better and reduce side effects. This is why we do clinical trials. Through these studies, we are able to offer you therapies that are not available everywhere. This means that even if CRS-HIPEC turns out not to be the right choice for you, we may be able to provide another option.

Surgical oncologist Harveshp D. Mogal, MD, MS, has done clinical studies on outcomes for people with advanced peritoneal cancers who need CRS-HIPEC. His research has looked at topics like how we can better select candidates for this procedure, how we can reduce health concerns that might happen because of surgery and how we can improve patient well-being.

UW and Fred Hutch physicians have also done several studies for patients with advanced ovarian cancer and have ongoing studies to improve ovarian cancer outcomes.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.

Featured story

Combining surgery with heated chemo, HIPEC offers Fred Hutch patients a new way to fight cancer

It’s a fairly universal experience to feel stuffed to the brim after Thanksgiving dinner. So Angie Ballou wasn’t overly concerned when her stomach started hurting, or even when she threw up after her holiday meal in 2017. “I figured I ate too much,” says Ballou, 47, who was living in Marysville, Washington, at the time.

View Story

Combining surgery with heated chemo, HIPEC offers Fred Hutch patients a new way to fight cancer

Hyperthermic Intraperitoneal Chemotherapy Offers Important Option for Patients with Peritoneal Cancer

Hyperthermic intraperitoneal chemotherapy (HIPEC) provides an important treatment option that can improve survival for some patients with advanced peritoneal cancer. Managing this disease — and determining whether and when to use HIPEC — requires an experienced, coordinated team of specialists.

View Story

Hyperthermic Intraperitoneal Chemotherapy Offers Important Option for Patients with Peritoneal Cancer

Next Up: Care Team