Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Care team

At Fred Hutchinson Cancer Center and University of Washington Medical Center, we surround you with experts who focus completely on cancer, day in and day out.

A handful of people are the core of your team for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). You will have a surgical oncologist who has a lot of experience with this highly specialized procedure. You will also have a surgical oncology nurse with a special focus on caring for people before, during and after CRS-HIPEC. At some visits, you might see an advanced practice provider. Before surgery, you will meet with the anesthesiology team to make sure it is safe for you to get anesthesia (drugs that keep you from feeling pain during surgery). This might mean more tests. A dietitian and physical therapist are here to help you prepare and recover.

Others may join your team based on your personal needs. If you need systemic (whole-body) chemotherapy, you will have an expert medical oncologist . If you have cancer of the ovaries or fallopian tubes, a gynecologic oncologist who is an expert in CRS will be involved. If another specialist, like a gynecologist or urologist, can help with planning or giving your treatment, we call them in. We have many specialists based at Fred Hutch and UW Medical Center who know the issues that matter for people with cancer.

Supportive care services are here to help, too. You may see Fred Hutch psychologists, a stoma nurse (in case you need a colostomy or ileostomy), social workers and others. All of us specialize in caring for people during and after cancer.

Anesthesia Drugs or other substances that cause a loss of feeling or awareness. This keeps patients from feeling pain during surgery or other procedures. A loss of feeling or awareness caused by drugs or other substances. Anesthesia keeps patients from feeling pain during surgery or other procedures. Local anesthesia is a loss of feeling in one small area of the body, such as the mouth. Regional anesthesia is a loss of feeling in a part of the body, such as an arm or leg. General anesthesia is a loss of feeling and a complete loss of awareness that feels like a very deep sleep. 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. Colostomy An opening into the colon from the outside of the body. A colostomy provides a new path for waste material, such as urine and feces, to leave the body after part of the colon has been removed. Gynecologic oncologist A physician who has special training in diagnosing and treating cancers of the female reproductive organs. Ileostomy An opening into the ileum (part of the small intestine) from the outside of the body. This provides a new path for waste materia to leave the body after part of the intestine has been removed. An opening into the ileum (part of the small intestine) from the outside of the body. This provides a new path for waste material, such as urine and feces, to leave the body after part of the intestine has been removed. 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.

“Many studies show that for people who need HIPEC, the more team-based the approach, the better the outcome for patients. That’s why we work together so closely to care for patients — from the time they first call our intake staff through their long-term follow-up.”

— Harveshp Mogal, MD, MS, surgical oncologist

Find care team profiles

Meet the caring, dedicated people who provide CRS-HIPEC care at Fred Hutch and UW Medical Center.

Dieticians

Kerry McMillen, MS, RD, CSO, CD, FAND

Kerry McMillen is a registered dietitian who has worked with cancer patients for more than 20 years. She is the manager of Fred Hutch Medical Nutrition Therapy Services, works with patients at all Fred Hutch clinic locations and has a special interest in working with hematopoietic cell transplant patients. Kerry is a fellow of the Academy of Nutrition and Dietetics and is a board-certified specialist in oncology nutrition.

Tal Ozery, MS, RD

Tal Ozery is a registered dietitian who works with patients at risk of developing a gastrointestinal cancer. She also sees patients with head and neck cancers. Tal has a special interest in counseling patients with eating disorders. She cares for patients at the South Lake Union clinic, Peninsula clinic and Issaquah clinic.

Hailey Wilson, MS, RD, CD, CNSC

Hailey Wilson is a registered dietitian who works with gastrointestinal, thoracic, head and neck cancer patients at the South Lake Union clinic and Issaquah clinic. She has eight years of experience and is a board-certified nutrition support clinician.

Physical therapists

Lexi Harlow, PT, DPT, CLT

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Lexi Harlow, PT, DPT, CLT

Jenica Holt-Melnick, PT, DPT, CLT

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Jenica Holt-Melnick, PT, DPT, CLT

What each team member does

Advanced practice provider (APP)

These health care professionals work closely with your physicians in the clinic. There are two types: physician assistants (PAs) and advanced registered nurse practitioners (ARNPs). They help provide and coordinate your treatment and can see you without your physician. They also help manage any effects of your disease and treatment.

Nurse practitioner A registered nurse who has additional education and training in how to diagnose and treat disease. In cancer care, a nurse practitioner may manage the primary care of patients and their families. A registered nurse who has additional education and training in how to diagnose and treat disease. Nurse practitioners are licensed at the state level and certified by national nursing organizations. In cancer care, a nurse practitioner may manage the primary care of patients and their families, based on a practice agreement with a physician. Physician assistant A health professional who is licensed to do certain medical procedures under the guidance of a physician. A health professional who is licensed to do certain medical procedures under the guidance of a physician. A physician assistant may take medical histories, do physical exams, take blood and urine samples, care for wounds and give injections and immunizations.

Registered dietitian

Registered dietitians are credentialed food and nutrition experts. To earn this title, they must go through a lot of training and formal education, including doing an internship and passing a national registration exam. Registered dietitians provide medical nutrition therapy, which means they use an evidence-based approach to treat and help patients manage medical conditions through diet and nutrition.

For people who are having CRS-HIPEC, dietitians focus especially on these topics:

How to get the best nutrition for strength and healing before your procedure
What to expect and how to meet your nutrition needs after your procedure

Your dietitian closely watches and treats your nutritional needs after surgery to help with healing.

Gynecologic oncologist

This type of surgeon specializes in diagnosing and treating gynecologic cancers. They do surgery to remove as much of the cancer as possible, plus a small amount of healthy tissue around the cancer, and they recommend chemotherapy-based treatments.

If you have cancer of the ovaries or fallopian tubes, a gynecologic oncologist will be involved in your care. They will examine you and talk with you about the best treatment options for your case. For example, even if CRS-HIPEC is a good option for you, you may need systemic (whole-body) chemotherapy first under their expert care.

A surgical oncologist may be involved in your cytoreductive surgery along with your gynecologic oncologist.

Medical oncologist

This physician oversees medicine-based treatments. Some people who are having CRS-HIPEC may have systemic (whole-body) chemotherapy , targeted therapy or immunotherapy as part of their overall treatment plan.

Your medical oncologist will:

Recommend medicine-based treatments to match your specific case. They select the medicines, doses, schedule and sequence. They also talk with you about the benefits and risks.
See you on a regular schedule to check how your cancer responds to treatment and how you are overall.
Offer you ways to prevent, relieve and cope with side effects of treatment, like medicine to help with nausea.
Work with the rest of your care team if you need other types of treatment.
Coordinate care with your local oncologist if you plan to get chemotherapy closer to home.

If you are from outside the Seattle area and are coming to Fred Hutch only for CRS-HIPEC, a Fred Hutch medical oncologist can coordinate with your local team about medicine-based treatments you may receive there.

If you have cancer of the ovaries or fallopian tubes, your CRS-HIPEC team will also include a gynecologic oncologist, a physician who specializes in surgery as well as chemotherapy-based treatments.

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. Gynecologic oncologist A physician who has special training in diagnosing and treating cancers of the female reproductive organs. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. 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. 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. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies. 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.

Physical therapist (PT)

People of any age who are diagnosed with cancer can improve their strength, function and independence during and after cancer treatment with the help of physical therapy. PTs can help you with issues like weakness, balance, scar tissue, lymphedema, range of motion and rehabilitation equipment. Fred Hutch PTs have advanced training in oncology care.

Before CRS-HIPEC, they offer “pre-hab” (a twist on post-surgery rehabilitation) to help you be in the best condition for surgery with good function and endurance.

After your surgery, these experts will check on your healing, treat you and provide you with tools to continue managing symptoms on your own.

Lymphedema A condition in which extra lymph fluid builds up in tissues and causes swelling. It may occur in an arm or leg if lymph vessels are blocked, damaged or removed by surgery. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.

Surgical oncologist

This type of surgeon specializes in diagnosing and treating cancer. They do surgery to remove as much of your cancer as possible, plus a small amount of healthy tissue around the cancer. They might also remove lymph nodes to see if the cancer has spread.

In CRS-HIPEC, your surgeon also gives the chemotherapy that is put into your abdomen to kill any remaining cancer cells.

Your surgeon will:

See you during your first CRS-HIPEC visit to talk about the procedure and whether it is a good option for you.
Recommend surgery to match your specific case. They explain any surgical options you have. They also talk with you about the benefits and risks.
Answer your questions about surgery, like why you need it and what to expect.
Do your surgery, along with a team that includes an anesthesiologist, a perfusionist (a health care professional who uses a machine to keep your blood moving during surgery) and nurses. Gynecologic oncologists may also be involved in your surgery, especially if you have cancer of the ovaries or fallopian tubes.
See you after surgery to check on your healing.
Offer you ways to prevent, relieve and cope with side effects of surgery.
Work with the rest of your care team if you need other types of treatment.

Surgical oncology nurse

This person may see you when you come in for surgery-related visits. They work closely with your physician to provide your care. They explain your treatment, check your health, answer your questions and help you prepare, recover and deal with side effects.

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.

Supportive care services

Many types of supportive care team members are here to help you and your family. Along with dietitians and physical therapists, they can include pain medicine specialists, psychologists, social workers, spiritual health staff, palliative care specialists, naturopaths and acupuncturists.

Learn More About Supportive Care Services

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