What Exactly Is HIPEC? A Simple and Honest Guide for Patients and Families

Medicine Made Simple Summary

HIPEC is a special cancer treatment used during surgery for cancers that spread inside the abdomen. Once the surgeon removes all visible tumors, the abdominal cavity is filled with warm chemotherapy and gently washed for about 60 to 90 minutes. This helps kill tiny cancer cells that cannot be removed by hand or seen on scans.

HIPEC is mainly used for cancers like ovarian, colorectal, appendix, stomach and pseudomyxoma peritonei. Many patients find HIPEC confusing at first. This guide explains what HIPEC is, how it works, who it helps, and what patients can expect in simple language.

Introduction

HIPEC stands for Hyperthermic Intraperitoneal Chemotherapy. Although the name sounds complicated, the idea behind it is easier to understand when broken into smaller pieces.

HIPEC is:

• A heated chemotherapy treatment
• Applied directly inside the abdomen
• Performed during surgery
• Designed to kill small cancer deposits that cannot be removed with the eyes or hands

To understand why HIPEC is useful, imagine cancer spreading like small grains of sand across the inside of the abdomen. Regular chemotherapy through the bloodstream cannot always reach these tiny grains. HIPEC brings the medicine directly to the area where the cancer is located.

Why Some Cancers Need HIPEC

Cancers treated with HIPEC usually spread across the peritoneum, the thin lining covering abdominal organs. These cancers include:

• Appendix cancer
• Colorectal cancer
• Ovarian cancer
• Stomach cancer
• Peritoneal mesothelioma
• Pseudomyxoma peritonei

These cancers do not always form one large tumor. Instead, they scatter across surfaces in many small spots. Because of this, treatment must reach many areas at once.

HIPEC offers two main advantages:

• Direct contact of chemotherapy with cancer cells
• Heated treatment that makes cancer cells more sensitive

How HIPEC Fits into Cancer Treatment

HIPEC is almost never used alone. It is part of a larger procedure called Cytoreductive Surgery (CRS).

CRS has one main goal: to remove all visible tumors.

HIPEC then follows CRS to kill the microscopic cancer cells left behind.

The treatment sequence looks like this:

• Perform major abdominal surgery
• Remove visible cancer
• Wash the abdomen with heated chemotherapy
• Drain the chemotherapy
• Close the surgical area

This combination—CRS + HIPEC—has shown benefits for many abdominal cancers.

Why Heat Is Used in HIPEC

Heat plays an important role in HIPEC. The chemotherapy is warmed to about 41–43°C because heat:

• Weakens cancer cells
• Makes the chemotherapy work better
• Helps the medicine penetrate tissues more deeply
• Improves the overall cancer-killing effect

Healthy cells tolerate this heat better than cancer cells, which makes the treatment more targeted.

How HIPEC Is Actually Performed

Here is a simple step-by-step explanation of what happens during HIPEC.

Step 1: You are placed under general anesthesia
You are asleep during the entire process and feel no pain.

Step 2: Cytoreductive Surgery begins
The surgeon removes all visible cancer deposits. This may include removing parts of organs or cleaning surfaces where cancer has spread.

Step 3: HIPEC starts
The surgeon places tubes into the abdomen to circulate chemotherapy.

Step 4: Heated chemotherapy fills the abdomen
A specially prepared solution is warmed and pumped into the abdominal cavity.

Step 5: The wash is circulated
The chemotherapy gently moves through the abdomen for 60–90 minutes.
This allows it to reach every surface.

Step 6: The chemotherapy is drained
After the circulation time, the fluid is removed.

Step 7: The abdomen is rinsed and the surgery ends
The incision is closed and you are moved to recovery.

Who Is a Good Candidate for HIPEC?

Doctors consider several factors before recommending HIPEC.

You may be a candidate if:

• Your cancer is mainly inside the abdomen
• It has not spread widely outside the abdomen
• Your overall health is strong enough for major surgery
• The cancer type is known to respond to HIPEC
• The surgeon expects to remove most or all visible tumors

You may not be a candidate if:

• The cancer has spread to the lungs, bones or liver extensively
• You have serious heart or lung conditions
• The cancer load inside the abdomen is too high
• The expected benefit is small

Doctors also measure something called the Peritoneal Cancer Index (PCI) to understand how widely cancer has spread. A lower PCI often means better outcomes with HIPEC.

Benefits of HIPEC

HIPEC offers several advantages when used in the right patients.

• Targeted delivery
  The chemotherapy touches cancer cells directly.
• Higher effectiveness
  Heat boosts the power of chemotherapy.
• Fewer whole-body side effects
  The medicine stays mainly inside the abdomen instead of spreading through the bloodstream.
• Better long-term outcomes in certain cancers
  For conditions like pseudomyxoma peritonei and some ovarian and colorectal cancers, CRS + HIPEC has become an important part of treatment.
• One-time treatment
  HIPEC is usually done once during surgery, not in repeated cycles like traditional chemotherapy.

Possible Risks and Complications

HIPEC is a major treatment and involves risks. These come from both the surgery and the chemotherapy.

Possible complications include:

• Infection
• Bleeding
• Slow return of bowel movement
• Fluid imbalances
• Kidney strain
• Low blood counts
• Fatigue
• Wound healing issues

Because this is a long and complex procedure, recovery also takes time.

What Recovery Looks Like After HIPEC

Most patients stay in the hospital for 7–14 days. Recovery varies, but many patients follow a similar journey.

Immediately after surgery

• Patients are monitored in the recovery room or ICU.

First few days

• Pain management begins
• Tubes and drains may still be in place
• Walking is encouraged early to prevent clots
• Bowel activity is slow

Days 4–7

• Bowel movements start returning
• Eating gradually resumes
• Pain reduces

After going home

• Tiredness lasts for several weeks
• Appetite improves slowly
• Most patients return to routine activities in 4–6 weeks

Full energy levels may return over two to three months.

Common Questions Patients Ask

Here are answers in simple language.

Does HIPEC replace regular chemotherapy?
Not always. Some patients need chemotherapy before or after HIPEC.

Is HIPEC painful?
You do not feel HIPEC during surgery. Recovery may involve discomfort from the operation.

How long does the effect of HIPEC last?
It depends on the cancer type, its stage and how much tumor was removed.

Can HIPEC be repeated?
Sometimes yes, depending on the cancer and patient condition.

Does everyone survive HIPEC?
HIPEC improves survival for many, but it is not a cure for all cancers.

Conclusion

If you or a loved one has been advised to consider HIPEC, understanding the procedure is the first step. Speak to a surgical oncologist at a center experienced in CRS and HIPEC. Discuss whether you are a suitable candidate, the expected benefits and the recovery process. An informed conversation can help you make the best decision for your care.