If bowel cancer has spread to the peritoneum
All the organs in your abdomen are covered with a membrane called the peritoneum, which coats the organs like cling film. When bowel cancer grows through the bowel wall it can spread through the lymph glands and on to other organs such as the liver or it can spread in the peritoneum. Treatment options can include:
If bowel cancer spreads to the peritoneum cytoreductive surgery may be a treatment option. Cytoreductive surgery is a procedure which aims to remove or ‘debulk’ as much visible tumour as possible.
Cytoreductive surgery is usually carried out in combination with HIPEC (see below) and is performed in specialist centres only. If you are not in a specialist centre your oncology team will refer you to one for their opinion as to whether this treatment is suitable for you.
The specialist team will evaluate your case as part of a multidisciplinary team (MDT) and identify the extent of the disease. In some cases the disease may involve other organs such as the bladder, kidneys (or ovaries and uterus in women). The team will decide whether all the tumours can be removed or not. Involvement of the small bowel is particularly difficult to treat.
Sometimes the MDT will be unable to decide whether major surgery is possible or sensible and will undertake a keyhole inspection of the abdomen (laparoscopy) as this can sometimes identify disease that has not been picked up on the scans.
If surgery is to go ahead the lead surgeon and clinical nurse specialist will discuss the surgery with you and explain that the procedure might require the involvement of other specialist surgeons such as urology or gynaecology specialists.
Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
When you have cytoreductive surgery, if the surgeons were able to remove all the disease they will introduce heated chemotherapy fluid (HIPEC) into the abdomen while you are still under the anaesthetic. Different drugs are used depending on whether you had chemotherapy before the surgery. The fluid bathes the affected organs for up to two hours and is then drained out.
The average length of the treatment is 10 to 12 hours. The majority of patients recover quickly and are out of hospital within two to three weeks. There are very few side effects from this chemotherapy as it works on local tissues and not via the blood stream.
This procedure is currently only available at The Christie Hospital, Manchester; North Hampshire Hospital, Basingstoke, Hants; St Mark’s Hospital, Harrow, NW London; and Good Hope Hospital, Sutton Coldfield, West Midlands. There may be further centres in the future, please speak to your healthcare team for more information.
Updated November 2017. Due for review March 2019.