When Do Doctors Recommend HIPEC? Understanding the Criteria and Cancers Treated
Medicine Made Simple Summary
HIPEC is a specialised cancer treatment used only in selected patients, but many families do not know when or why doctors recommend it. It is not used for all cancers, and not every patient with abdominal tumours qualifies. This article explains, in simple language, the exact criteria doctors use, which cancers respond best, how the decision is made and why timing matters. By the end, you will clearly understand when HIPEC becomes an option, why it is offered, and whether it may be suitable for you or your loved one.
Understanding Why HIPEC Is Not for Everyone
HIPEC, or Hyperthermic Intraperitoneal Chemotherapy, is a highly specialised treatment that combines major cancer surgery with heated chemotherapy inside the abdomen. Because it is a complex procedure, doctors must carefully evaluate who will benefit. HIPEC is most effective when cancer is limited to the abdominal cavity and can be removed surgically. It is not helpful when cancer has spread to distant organs like the lungs, bones or brain. This is why doctors study the cancer pattern before offering HIPEC. Suggested image: Diagram showing difference between abdominal spread vs distant metastasis.
How Cancer Spreads Inside the Abdomen
Some cancers shed tiny cells into the space around the abdominal organs. These cells settle on the lining called the peritoneum. They may form seeds or patches that grow over time. These cancers often do not respond well to regular chemotherapy because blood supply to these areas is limited. HIPEC delivers heated chemotherapy directly inside the abdomen where these cancer cells hide. This makes the treatment highly targeted.
The Two Conditions Required Before HIPEC Is Offered
Doctors must be confident about two conditions. First, the cancer must be mostly or completely removable through surgery. Second, after removing the visible cancer, HIPEC must reach the remaining microscopic cells. If both conditions are met, HIPEC becomes a strong option.
Cancer Types Where HIPEC Is Most Commonly Recommended
HIPEC is used for specific cancers. These include appendix cancer, colorectal cancer that has spread to the peritoneum, stomach cancer with limited peritoneal spread, ovarian cancer with peritoneal deposits and peritoneal mesothelioma. These cancers often behave in a way that makes HIPEC suitable. They remain inside the abdominal cavity for a long time before spreading elsewhere. This allows doctors to treat them directly through surgery plus HIPEC. Suggested image: Chart listing cancers responsive to HIPEC.
HIPEC for Appendix Cancer
Appendix cancer often spreads widely inside the abdomen but responds well to complete tumour removal and HIPEC. Patients with pseudomyxoma peritonei, a jelly-like tumour from the appendix, may benefit greatly. Doctors recommend HIPEC in early and moderate disease when complete removal is possible.
HIPEC for Colorectal Cancer
Colorectal cancer may spread to the peritoneum in some patients. HIPEC is recommended when the disease is limited to the abdomen and there is no spread to the liver or lungs. Success depends on how much cancer is present and whether the surgeon can remove it. Selected patients may achieve long survival with HIPEC.
HIPEC for Ovarian Cancer
In ovarian cancer, HIPEC is sometimes used during interval cytoreductive surgery after chemotherapy. It helps target cancer cells on the peritoneal surfaces. It is recommended mainly for advanced cases where spread is inside the abdomen and responsive to treatment.
HIPEC for Gastric (Stomach) Cancer
Stomach cancer spreads to the peritoneum in some patients. HIPEC is offered only in early or minimal peritoneal disease. It is not useful for widespread deposits. Doctors choose carefully because gastric cancer can behave aggressively.
HIPEC for Peritoneal Mesothelioma
This rare cancer arises from the lining of the abdomen. HIPEC is one of the main treatments for it. Since it remains inside the peritoneum for a long time, HIPEC offers strong benefit when combined with complete tumour removal.
Why Complete Tumour Removal Matters for HIPEC
HIPEC works best when the surgeon removes all or most visible cancer during cytoreductive surgery. This is because HIPEC targets microscopic disease that remains behind. Large tumour deposits do not respond as well to heated chemotherapy alone. The more complete the surgical removal, the better the outcomes. Surgeons use a scoring system called the Peritoneal Cancer Index (PCI) to measure the extent of disease. Lower PCI scores usually mean better chances for HIPEC to work. Suggested image: PCI scoring diagram for educational understanding.
When Doctors Do Not Recommend HIPEC
HIPEC is not suitable in certain situations. If cancer has spread outside the abdomen, HIPEC will not help. If the PCI score is too high and the cancer cannot be removed, surgery may not be safe or effective. HIPEC is avoided when the patient’s health is too weak to handle major surgery. It is also not recommended if the cancer type does not respond to heated chemotherapy.
When Timing Matters: Early vs Late Disease
Doctors prefer to offer HIPEC when the disease is still manageable in the abdomen. If cancer is caught early during peritoneal spread, HIPEC has a strong chance of helping. When the disease becomes bulky or widespread, surgery becomes risky and HIPEC becomes less effective. This is why timely referral to a specialist is important.
HIPEC After Chemotherapy
In some cancers, regular chemotherapy is given first. If the tumour shrinks or becomes stable, HIPEC may be offered. For example, in ovarian cancer, interval surgery plus HIPEC is common. In colorectal cancer, chemotherapy response helps doctors decide whether HIPEC is beneficial.
HIPEC for Recurrent Cancer
Some patients may be offered HIPEC when the cancer returns inside the abdomen. If the recurrence is limited and safely removable, HIPEC can be repeated in selected cases. However, this is uncommon and not appropriate for everyone.
What Doctors Check Before Approving HIPEC
Before recommending HIPEC, doctors thoroughly evaluate the patient. They check overall health, kidney function, heart function and nutritional status. They review scans to measure PCI and identify whether the disease is removable. They discuss expectations, recovery time and possible risks. A multi-disciplinary team, including surgeons, medical oncologists and radiologists, usually decides together. Suggested image: Flowchart showing the decision-making process for HIPEC eligibility.
Benefits of HIPEC When Used Correctly
When HIPEC is recommended for the right patient at the right time, it can improve survival, reduce recurrence and provide long-term control. It allows doctors to attack cancer where it is most concentrated. Because the chemotherapy stays inside the abdomen, side effects are fewer compared to traditional chemotherapy.
Limitations of HIPEC You Should Know
HIPEC is not a miracle cure. It cannot treat cancers outside the abdomen. It requires major surgery and recovery. Not all patients qualify. It should only be performed in centres with experience and specialised equipment. Being aware of limitations helps set realistic expectations.
Why Choosing the Right Specialist Matters
HIPEC requires skilled surgeons who specialise in cytoreductive surgery and peritoneal surface malignancies. The surgeon’s expertise directly impacts the completeness of tumour removal, which affects success rates. Hospitals with dedicated HIPEC teams and advanced infrastructure provide safer outcomes.
Conclusion
If you or a loved one has been diagnosed with cancer that has spread inside the abdomen, consult a specialist who performs cytoreductive surgery and HIPEC. Early evaluation improves the chances of receiving this treatment safely and effectively. Speak to your oncologist about your eligibility, ask about PCI scoring and request referral to a HIPEC centre if appropriate. Understanding the criteria helps you make informed and confident decisions about your care.
