Mayo Clinic experts are exploring new ways to help patients with late-stage cancers. A new approach to treating stomach cancers called hyperthermic intraperitoneal chemotherapy (HIPEC) delivers heated liquid chemotherapy directly to the abdomen where it can target the cancer. In this Mayo Clinic Minute, Dr. Travis Grotz, a Mayo Clinic surgical oncologist, discusses how HIPEC works and the potential benefits of the treatment.

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During a HIPEC treatment, the abdominal cavity is bathed with hot chemotherapy to kill any microscopic cancer cells.

"The chemo can stay locally in that region, the abdomen, and then it can continue to work even past the procedure. And then that allows us to use really high concentrations of the chemo directly where the cancer is," says Dr. Grotz.

HIPEC has been used as a treatment for other cancers for several decades, but just recently has been adapted to stomach cancer.

"We use the kind of a different combination of drugs that we've come up with based on other research and data and experience, and put them together and found that, in our experience, that they were more synergistic. They work together to kill the cancer cells very well. Our outcomes were quite a bit better than kind of traditional systemic chemotherapy," says Dr. Grotz.

The outcomes have been significantly better than those achieved with traditional chemotherapy. However, Dr. Grotz notes that more studies are ongoing.  

"We want to improve survival, help people live longer, spend more time with their family, do it in a way that's safer, and has less complications and risks to patients," says Dr. Grotz.

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Stacy Weisensel and her husband Joshua had a goal: to take their daughters to as many national parks as possible. But in the summer of 2021, while trying to enjoy the breathtaking views of Yellowstone National Park with her family, Stacy was distracted by a nagging pain in her esophagus. Over the next few months, Stacy’s symptoms grew worse and ultimately led to a frightening diagnosis — stomach cancer.

A life-changing diagnosis

In July 2021, after returning from vacation to her home in Montello, Wisconsin, Stacy decided to see her primary care physician about the pain in her esophagus. Stacy’s doctor diagnosed her with acid reflux and prescribed an anti-acid medication, which seemed to help control her symptoms, at least temporarily.

“I went back to my doctor in November for my annual physical,” Stacy says. “I told her that I wasn’t sure the antacid medication was doing anything for me because I still had that pain in my esophagus, just not all the time.”

Stacy also had begun experiencing pelvic pain and her menstrual cycles were becoming irregular. Her doctor suggested she stop taking the antacid to see what would happen. If the pain worsened, they would consider a stronger medication.

At the end of November, with the pelvic pain growing unbearable, Stacy returned to her doctor, who ordered a pelvic ultrasound to be performed in early December.

But, on Dec. 7, just before that scheduled ultrasound, Stacy woke up with intense pain.

“I could barely get out of my car when I got to work at 5:30 that morning. I made myself go in, but I could only make it until 8 a.m.,” Stacy says. “I told my colleagues while bawling that I was in so much pain I had to go to the emergency room.”

Stacy drove 45 minutes to the closest hospital in Madison, Wisconsin, where she had an emergency pelvic ultrasound. But the results showed that nothing was amiss.

Thankfully, the care team proceeded to do a CT scan, which gave insight into Stacy’s intense pain. Stacy had an ulcer, an open sore that developed on the lining of her stomach. She underwent an endoscopy the same day so the team could collect tissues to biopsy.

Two days later, Stacy received a life-changing call — the biopsy came back showing cancer.

She was immediately referred to a local oncologist who completed a full staging workup. The results showed that the cancer had metastasized to Stacy’s ovaries. At 37 years old, Stacy’s official diagnosis was stage 4 stomach cancer.

“It was a lot for me when I got that phone call,” recalls Stacy. “My husband and I were devastated. But now we have to get a game plan together.”

Stacy immediately started a chemotherapy regimen, but her medical oncologist recognized she could benefit from receiving care at a center experienced with her type and stage of cancer. He referred her to Travis Grotz, M.D., a surgical oncologist at Mayo Clinic in Rochester, Minnesota.

Treating the visible and invisible

In February 2022, Stacy and Joshua traveled to Rochester to meet Dr. Grotz. He agreed Stacy should finish her chemotherapy but suggested she consider surgery and hyperthermic intraperitoneal chemotherapy, or HIPEC, something Stacy didn’t know was an option.

“We are seeing a worrisome trend as stomach cancer is being increasingly diagnosed in younger patients,” Dr. Grotz says. “The cause of this is unknown, but unfortunately younger patients like Stacy are diagnosed with more advanced cancers. We aggressively treated her cancer with both systemic and intraperitoneal chemotherapy.”

Combining surgery with HIPEC removes what the surgeon can and cannot see.

“Imagine cleaning a countertop,” says Dr. Grotz. “The surgery cleans up the dirt I can see, while the chemotherapy cleans the microscopic dirt I can’t see.”

HIPEC is performed after all visible cancer inside the abdomen is removed. Then, the abdominal cavity, or peritoneum, is bathed with a high dose of hot chemotherapy to kill any microscopic cancer cells that remain. Heating the chemotherapy drug allows it to penetrate the tissue more deeply, increasing the number of cancer cells it can reach.

Dr. Grotz says that performing HIPEC to treat stomach cancer is important because half of stomach cancer recurrences occur in the peritoneum. Doing surgery and HIPEC together increases the success rate and the likelihood that cancer will not return.

On May 12, 2022, Stacy underwent a 12-hour surgery that included removal of 80% of her stomach, lymph nodes, and a complete hysterectomy. After all the visibly cancerous tissue was removed, Dr. Grotz administered HIPEC, heated to about 108 degrees Fahrenheit, to target any cancerous cells left behind.

Because her operation was performed using minimally invasive, robotic techniques, Stacy recalls that within six hours of being transferred to her room, she could walk down the hallway with a walker. Three days later, she was discharged from the hospital. And after a follow-up appointment on May 19, Stacy returned home to her family in Wisconsin.

“Unlike many other centers, at Mayo Clinic, we use minimally invasive techniques to perform this operation and the HIPEC procedure,” says Dr. Grotz. “By utilizing robotic surgery, we can curb the length of hospital stay and reduce the rate of complications.”

Dr. Grotz continues that, with minimally invasive techniques, he can hopefully achieve good cancer outcomes while improving quality of life after surgery.

More summer trips on the horizon

As Stacy approaches the year mark after surgery, she and her family are busy planning their next big adventure.

“We obviously want to visit more national parks,” Stacy says. “We haven’t been to the Rocky Mountains yet, so maybe we’ll visit when we go to Glacier National Park.”

And on this trip, Stacy looks forward to fully enjoying the scenery thanks to the care she received at Mayo Clinic.

“At this point, I am cancer-free,” Stacy says. “I had the best care at Mayo Clinic, and am very grateful for what everyone did for me.”

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Hyperthermic intraperitoneal chemotherapy (HIPEC) delivers chemotherapy directly into the abdominal cavity. It is used in conjunction with cancer surgery for people with advanced cancer that has spread inside the abdomen. “Hyperthermic” means warm or hot. “Intraperitoneal” means inside the abdominal cavity, which is encased in a sac called the peritoneum.

HIPEC uses high-dose chemotherapy to kill microscopic cancer cells inside the abdominal cavity. The HIPEC procedure is performed immediately after a surgeon has removed all visible cancer in the abdomen. HIPEC is well studied in several types of cancer and being explored as a potential treatment in others.

"So really any cancer that's just localized in the abdomen on the surface of the peritoneum could be a candidate," explains Dr. Travis Grotz, a Mayo Clinic surgical oncologist. "We know for sure, based on studies and data that HIPEC works well for cancers of the colon, cancers of the appendix, cancer to the ovaries, cancer of the stomach, and there's even a cancer of the lining of the peritoneum, called mesothelioma. So those would be the cancers I think that are well studied and well accepted. Then, there are more rare tumors that we have less data for, such as cancer to the pancreas or gallbladder or small intestine, that we don't know yet if that's the right treatment."

The specific type of chemotherapy used for HIPEC varies depending on the type of cancer being treated. The abdominal cavity is bathed with hot chemotherapy to kill any microscopic cancer cells that might still be present. Heating the chemotherapy enhances its effectiveness because, when it’s hot, chemotherapy penetrates the tissue more deeply, increasing the number of cancer cells it can reach.

On this Mayo Clinic Q&A podcast, Dr. Grotz explains what HIPEC is, how it is performed, and the risks and benefits of the treatment.

Related Articles:

• "New therapies bring hope for ovarian cancer."
• "Alternative chemotherapy offers hope for late-stage cancers."
• "Aggressive treatment turns tide in fighting colon cancer."

Watch: Dr. Grotz discusses HIPEC.

Read the full transcript.

For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a nonpatient care area where social distancing and other safety protocols were followed.

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The Mayo Clinic Radio program shares the latest information on the COVID-19 (coronavirus) pandemic. On the Mayo Clinic Radio podcast, Dr. Bobbi Pritt, chair of the Division of Clinical Microbiology at Mayo Clinic, explains testing options for COVID-19. Also on the program, Dr. Gregory Poland, an infectious diseases expert and head of Mayo Clinic’s Vaccine Research Group, reviews the latest literature on COVID-19, discusses vaccine trials and explains some unique symptoms of COVID-19. Then in an encore presentation of Mayo Clinic Radio, Dr. Matthew Robertson III, chair of Obstetrics and Gynecology at Mayo Clinic in Florida, explains hyperthermic intraperitoneal chemotherapy, which uses heated chemotherapy during surgery to treat ovarian cancer. And Dr. Christopher Boes, chair of Mayo Clinic's Division of Neurology Education, and Dr. Bruce Pollock, a Mayo Clinic neurologic surgeon, discuss diagnosing and treating the chronic pain condition known as trigeminal neuralgia. 

Information in this post was accurate at the time of its posting. Due to the fluid nature of the COVID-19 pandemic, scientific understanding along with guidelines and recommendations may have changed since the original publication date. 

Check the Centers for Disease Control and Prevention website for additional updates on COVID-19. For more information and all your COVID-19 coverage, go to the Mayo Clinic News Network and mayoclinic.org.

The post Mayo Clinic Radio: 5/30/20 appeared first on Mayo Clinic News Network.

Fall is here, and as the weather cools off, flu season heats up. After a particularly bad flu season in Australia, officials warn that could foretell what’s ahead for the U.S. 

Influenza is a respiratory infection that can cause serious complications, particularly in young children, older adults and people with certain medical conditions. Getting a flu shot — though not 100% effective — is the best way to prevent the misery of the flu and its complications. The Centers for Disease Control and Prevention (CDC) recommends that everyone 6 months or older be vaccinated annually against the flu.

During this Mayo Clinic Radio podcast, Dr. Gregory Poland, director of Mayo Clinic's Vaccine Research Group, will talk about the upcoming flu season, the importance of good hand-washing techniques, and the potential for a universal flu vaccine. Also on the program, Dr. Matthew Robertson III, chair of Obstetrics and Gynecology at Mayo Clinic in Florida, will explain hyperthermic intraperitoneal chemotherapy, which uses heated chemotherapy during surgery to treat ovarian cancer. And Dr. Christopher Boes, chair of Mayo Clinic's Division of Neurology Education at Mayo Clinic, and Dr. Bruce Pollock, a Mayo Clinic neurologic surgeon, will discuss diagnosing and treating the chronic pain condition known as trigeminal neuralgia. 

Here's your Mayo Clinic Radio podcast.

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LeAnn Kuper couldn't have been more surprised when she was diagnosed with advanced colon cancer and told it was incurable. Despite that shocking news, the upbeat interior designer was undeterred. LeAnn took her case to Mayo Clinic and found a determined physician who offered her a promising alternative.

All her life, LeAnn Kuper had been the epitome of good health. Fit and active, the interior designer walked and sometimes ran several times a week. The wife and mother of three adult children never needed surgery, anesthesia or any sort of hospitalization beyond birthing her babies decades ago.

So in October 2018, LeAnn was stunned when, after developing a persistent fever and fatigue, she learned that she had colon cancer. When surgery to remove the tumor revealed that the cancer had spread throughout her abdominal cavity and was deemed medically incurable, LeAnn and her husband, Jody, immediately decided to get a second opinion.

LeAnn, who lives in Milbank, South Dakota, knew she wanted to seek that opinion at Mayo Clinic, but she wasn't sure how to go about it. So she picked up the phone and called her cousin, Roger Hofer, M.D., a Mayo Clinic anesthesiologist.

"Little did we know that Roger worked with Dr. Grotz, and he was the doctor we needed to see," LeAnn says. "We are strong believers, and we believe the Lord just paved the way for us."

When Travis Grotz, M.D., a Mayo Clinic surgical oncologist, heard that that the only treatment LeAnn had been offered locally was palliative chemotherapy, he knew he could provide more than that.

A few days later, LeAnn and Jody drove to Mayo Clinic in Rochester and met with Dr. Grotz. He agreed that LeAnn needed chemotherapy, but he recommended an alternate treatment plan involving surgery and hyperthermic intraperitoneal chemotherapy, or HIPEC. The plan worked. Today, there is no evidence of cancer in LeAnn's body.

"I definitely feel that Dr. Grotz has given me a second chance at life," LeAnn says. "I know there's a chance it can come back, but it doesn't have to. I feel that prayers of many, the phenomenal support of my husband and family, along with great medical care have brought me this far."

A multiphase plan

From her first appointment with Dr. Grotz, it was clear to LeAnn that Mayo Clinic was where she was supposed to be. "My husband and I both needed to hear some hope in his voice," LeAnn says. "He had a very kind and humble confidence about him. We trusted him immediately and had confidence in his abilities and experience. It wasn't that he was painting a rose-colored picture for us, but we needed hope at that point. We all need someone who will give us a chance."

Based on LeAnn's physical evaluation, lab reports and scans, it was evident that she had cancer cells throughout her abdomen. Despite that, she was a good candidate for surgery. "Her being a really healthy person, her mindset, her grit and her strength are really what helped her get through a lot of the treatment," Dr. Grotz says.

"I'm not a worried sort of person, and I had total confidence in my medical team."

LeAnn Kuper

Although patients with colon cancer that has spread outside the colon traditionally have been told it's a terminal condition, research shows that targeted interventions can improve outcomes dramatically. "In people who got only chemotherapy, research shows they do poorly," Dr. Grotz explains. "Life expectancy is 12 months, with 24 months being the highest. Treatment with surgery and then HIPEC chemo in the most recent studies suggest that if we can remove all the cancer cells, people on average survive 41 months, which equates to a 40% five-year survival."

For LeAnn, there was no question she'd follow the path Dr. Grotz had prescribed. "There wasn't a lot of gray area. It just was what it was," she says. "I'm not a worried sort of person, and I had total confidence in my medical team."

The first phase of LeAnn's treatment took place in Milbank and Sioux Falls, South Dakota, so she could be closer to home. Every other week from November to April, LeAnn received a chemotherapy infusion. When LeAnn finished 12 rounds of infusions, she returned to Mayo Clinic for imaging.

"She had a great response to chemotherapy and all of her tumor markers came down," Dr. Grotz says. The day after scans were taken, LeAnn had a laparoscopic procedure involving video monitoring to identify where cancer cells remained in her body. Based on findings from that procedure, Dr. Grotz decided to proceed with surgery to remove the areas affected by the cancer.

A precision operation, encouraging recovery

On June 3, LeAnn underwent a 10-hour surgery, during which Dr. Grotz systematically evaluated her entire abdomen. "We looked in every nook and every cranny and at every organ to see if there was any disease," he says.

While having chemotherapy before surgery significantly reduced the amount of cancer in her body, LeAnn still had a fair amount of disease. As a result, during the surgery her abdominal lining, or peritoneum, was stripped; her uterus and ovaries were removed; her gallbladder was removed; and parts of her colon were taken out.

After all of the obvious tumors were removed, Dr. Grotz administered intraperitoneal chemotherapy, heated to approximately 108 degrees Fahrenheit, to target any microscopic cancer cells that may have been left behind.

"The heat seems to help the chemotherapy penetrate the cancer better," Dr. Grotz says. "We know cancer is more susceptible to heat, so the heat upregulates the stress in the cancer cells and makes them more susceptible to chemotherapy."

"I called her a week after she was discharged, and she was outside gardening. It was pretty amazing."

Travis Grotz, M.D.

The chemotherapy was circulated in LeAnn's abdomen for 90 minutes and then drained. After her cavity was flushed, the surgical team reconstructed her colon.

People who undergo a procedure like LeAnn's remain in the hospital an average of seven to eight days. LeAnn was discharged after four. "I called her a week after she was discharged, and she was outside gardening," Dr. Grotz says. "It was pretty amazing."

Due to the extent of the surgery, it usually takes patients between three and six months to fully recover from the procedure. "There's a lot of fatigue and gastrointestinal irritability because the bowels are bathed in chemotherapy for an hour and a half," Dr. Grotz explains.

In LeeAnn's case, recovery has gone well. Although it's only been four months since her surgery, LeAnn, who specializes in designing and installing window treatments, feels better than she has in a year. "I've gotten back to my normal walking pace, and I started installing my shades again. I came through without any of the side effects for the most part and not any complications, which is huge."

LeAnn says there was never a doubt in her mind after she met Dr. Grotz that everything would work out. "Things could not have gone better for me," she says. "Once my diagnosis was given, our path was laid out for us. We just felt like it was pretty obvious what we should do, and there weren't a lot of times we had to sit and scratch our heads and make a decision. I could just be confident that everything that could be done was being done."

HELPFUL LINKS

• Read more about colon cancer.
• Learn more about hyperthermic intraperitoneal chemotherapy.
• Visit the Division of Gastroenterologic and General Surgery.
• Connect with others talking about colon cancer on Mayo Clinic Connect.
• Explore Mayo Clinic.
• Request an appointment.

The post Second Opinion Opens the Door to Lifesaving Cancer Care appeared first on Mayo Clinic News Network.

Influenza is a respiratory infection that can cause serious complications, particularly in young children, older adults and people with certain medical conditions. Getting a flu shot — though not 100% effective — is the best way to prevent the misery of the flu and its complications. The Centers for Disease Control and Prevention (CDC) recommends that everyone 6 months or older be vaccinated annually against the flu.

On the next Mayo Clinic Radio program, Dr. Gregory Poland, director of Mayo Clinic's Vaccine Research Group, will talk about the upcoming flu season, the importance of good hand-washing techniques, and the potential for a universal flu vaccine. Also on the program, Dr. Matthew Robertson III, chair of Obstetrics and Gynecology at Mayo Clinic in Florida, will explain hyperthermic intraperitoneal chemotherapy, which uses heated chemotherapy during surgery to treat ovarian cancer. And Dr. Christopher Boes, chair of Mayo Clinic's Division of Neurology Education, and Dr. Bruce Pollock, a Mayo Clinic neurologic surgeon, will discuss diagnosing and treating the chronic pain condition known as trigeminal neuralgia.

To hear the program, find an affiliate in your area.

Miss the show? Here's your Mayo Clinic Radio podcast.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Hand-washing and flu season / hyperthermic intraperitoneal chemotherapy for ovarian cancer / trigeminal neuralgia appeared first on Mayo Clinic News Network.

ANSWER: HIPEC stands for hyperthermic intraperitoneal chemotherapy. “Hyperthermic” means warm or hot. “Intraperitoneal” means inside the abdominal cavity, which is encased in a sac called the peritoneum. And “chemotherapy” is cancer treatment that uses powerful chemicals to kill fast-growing cancer cells in the body.

HIPEC works by using high-dose chemotherapy to kill microscopic cancer cells inside the abdominal cavity. The procedure is performed in conjunction with cancer surgery. It’s used only for people who have cancer that has spread inside the abdomen, because they are the group most likely to see benefits from this treatment.

HIPEC is a unique treatment designed to combat cancer that has spread inside the abdominal cavity, such as advanced or metastatic cancer of the colon, ovary and appendix. It also may be used to treat mesothelioma, a rare type of cancer affecting the thin layer of tissue that covers many internal organs.

The HIPEC procedure is performed after a surgeon has removed all the cancer seen inside the abdomen. Then, the abdominal cavity is bathed with hot chemotherapy to kill any microscopic cancer cells that might still be present. The specific type of chemotherapy used for HIPEC varies depending on the type of cancer being treated. Heating the chemotherapy drugs enhances the procedure’s effectiveness. That’s because, when it’s hot, chemotherapy penetrates the tissue more deeply, increasing the number of cancer cells it can reach.

One of the significant benefits of HIPEC is that it allows for a high dose of chemotherapy to be given to the area that needs it with minimal chemotherapy exposure to the rest of the body. That means the typical side effects of chemotherapy, such as hair loss, diarrhea and mouth sores, often can be avoided.

There can be other side effects associated with HIPEC, however. To get the best effect with this procedure, the chemotherapy is left inside the abdominal cavity for about 90 minutes before removal. Within that time frame, some of the medication is absorbed into the body. That can have the effect of decreasing the number of white blood cells and platelets in the bloodstream, making a person more vulnerable to infections.

Given that surgery for these late-stage cancers often involves removing multiple internal organs, the risk of surgical complications, such as bleeding, infection and death, is already higher than a typical surgical procedure. When chemotherapy is added to the surgery, those risks increase. With that in mind, HIPEC usually is offered only to those individuals for whom other cancer treatment options are not available or already have proven unsuccessful. Research has shown that, in carefully selected patients, HIPEC increases the survival rate for patients whose late-stage cancers affect the abdominal cavity.

At this time, a number of select health care facilities across the world have HIPEC available. These centers provide a great deal of specialization and coordination among medical specialties, as well a significant amount of operational support and resources. In the U.S., Mayo Clinic is among the handful of medical centers that provides HIPEC as an option to its patients. — Dr. Sanjay Bagaria, surgical oncologist, Mayo Clinic, Jacksonville, Florida

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On the next Mayo Clinic Radio program, Dr. Ronald Petersen, director of Mayo Clinic's Alzheimer’s Disease Research Center, will provide an update on diagnosis and treatment options for Alzheimer’s disease. Also on the program, Dr. Landon Trost, a urologist at Mayo Clinic, shares a warning about the dangers of taking herbal Viagra. And Dr. Sanjay Bagaria, a surgeon at Mayo Clinic, will explain hyperthermic intraperitoneal chemotherapy — a cancer treatment using heated chemotherapy.

To hear the program, find an affiliate in your area.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: Alzheimer’s disease appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Ronald Petersen, director of Mayo Clinic's Alzheimer’s Disease Research Center, will provide an update on diagnosis and treatment options for Alzheimer’s disease. Also on the program, Dr. Landon Trost, a urologist at Mayo Clinic, shares a warning about the dangers of taking herbal Viagra. And Dr. Sanjay Bagaria, a surgeon at Mayo Clinic, will explain hyperthermic intraperitoneal chemotherapy — a cancer treatment using heated chemotherapy.

To hear the program, find an affiliate in your area.

Miss the show? Here's the Mayo Clinic Radio podcast.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

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