Dr. W. Charles Conway

[MUSIC PLAYING] Hyperthermic intraperitoneal chemotherapy, or HIPEC for short, is essentially heated chemotherapy applied directly into the abdominal cavity. The mesothelioma tends to grow just within the abdominal cavity. It doesn’t tend to spread as often in the blood to distant organs or even in the lymph nodes. So it’s sort of tumor cells that are just sort of coating surfaces. And we believe that if we remove all of the disease that we can see, all the tumor tissue that we can see, that there are likely still cells left behind that we can’t see. The rationale has been put forth that perhaps we could directly treat this with chemotherapy. [MUSIC PLAYING]

[MUSIC PLAYING] Essentially, it’s where we remove the lining of the abdominal cavity. So the lining is where the mesothelial cells that have become cancerous are. And we essentially make an incision up and down on the abdomen and then remove the lining, both the side wall, up under the diaphragm, down in the pelvis, and just try to get all those surfaces where there is either obvious disease that we can see that’s grossly abnormal and we can look at it and say, yeah, that needs to come out, but also make sure we get all those surfaces where we know those mesothelial cells are. [MUSIC PLAYING]

[MUSIC PLAYING] Peritoneal mesothelioma is different than pleural mesothelioma essentially because it’s just a different site in the body. It’s a cancer that comes from the same cell of origin, the mesothelium cell. You can get cancer from really any cell in your body. You can get cancer in bone cells, fat cells, muscle cells. But in this particular case, there’s a layer of cells both in the chest as well as in the abdomen that have a lining function that regulate the passage of fluid across the membrane into the cavity or out of the cavity. And then also allow tissues to slide easily without getting stuck, which is, of course, really important when you breathe or when the bowels move around. But you have these same cells in the lining of the abdominal cavity as you do have lining the chest cavity, so you can get mesothelioma in the abdomen as well as in the chest. [MUSIC PLAYING] Mesothelioma of the peritoneal cavity only makes up about 20% to 30% of all the mesothelioma cases in the US. That comes out to an incidence of about 400 new cases per year. Likely, it’s just that the peritoneal lining is less commonly exposed to asbestos than the lining of the thoracic cavity where the fibers are easily inhaled. [MUSIC PLAYING] I try to, first, tell them that they certainly have treatment options. A lot of folks in the medical community still are fairly nihilistic about this disease. So the first thing I like to tell them is that they certainly do have options. Essentially without treatment, the median survival is a year or maybe a little bit less. With good treatment that we use now, that median survival can actually be several years. [MUSIC PLAYING] First and foremost, you need to make sure the diagnosis is correct. So you need a pathologist that’s comfortable making that kind of a diagnosis. There are some other tumor types that sometimes are mistaken for mesothelioma. So a path review I think is important. The next thing certainly is need to be in a place that has a multidisciplinary treatment team that can discuss your case, look at the imaging, and then come up with a plan that would be best on an individual basis for someone with malignant peritoneal mesothelioma, good infrastructure to be able to make that possible, surgeons that are comfortable with difficult complex cases, a place where folks aren’t terribly pessimistic or nihilistic and are willing to try treatments for this difficult to treat disease. [MUSIC PLAYING]