Colorectal cancer can spread to the abdominal cavity: prevention is better than cure

The authors discussed ways to prevent peritoneal metastasis (spreading of cancer to the lining of the abdomen) in patients with colorectal cancer.

Peritoneal metastasis is often treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC). Cytoreductive surgery involves surgical removal of all visible tumors in the lining of the abdomen. HIPEC involves bathing the abdominal cavity in heated chemotherapy to destroy any cancer cells. Even with successful treatment by these procedures, patients often have decreased survival time. Therefore, preventing peritoneal metastasis may be better than trying to cure it.

In this article the authors aimed to review options for preventing peritoneal metastases. Two approaches were discussed: up-front HIPEC and second-look HIPEC. These two approaches must be done within 9 months of the cancer being diagnosed.

Up-front HIPEC

Up-front HIPEC involves bathing the abdominal cavity in the heated chemotherapy during the first bowel surgery. Up-front HIPEC is recommended if there is a hole in the tumor or if the tumor bursts during surgery. It is also recommended if there are cancer cells in the abdominal lining or if there are cancer cells in any nearby organs or lymph nodes (tiny, bean-shaped organs that help fight infections). After treatment with HIPEC, patients continue to receive 12 cycles of standard chemotherapy.

Previous studies showed that patients who received up-front HIPEC had longer survival and lower rates of cancer returning to the peritoneum. In one study, 4% of patients who received up-front HIPEC had peritoneal relapse compared to 28% of patients who did not.

Second-look HIPEC

With second-look HIPEC,  patients undergo bowel surgery and 12 cycles of chemotherapy first. 5 to 6 weeks later, they undergo cytoreductive surgery and HIPEC. Second-look HIPEC is useful for patients with cancer anywhere in the abdominal lining or in the ovary. It is also useful for patients whose part of the cancerous intestine has been removed. This procedure can be followed even if hospitals do not have access to HIPEC during the first surgery.

Based on results from previous studies, second-look HIPEC reduced the rate of cancer return and improved survival. In one study only 8% of patients who underwent second-look HIPEC had return of cancer to the peritoneum, compared to 100% of patients who did not. After 2 years, 91% of patients who underwent second-look HIPEC were still alive compared to 38% of patients who did not.

The authors concluded that up-front HIPEC and second-look HIPEC could be effective strategies  in preventing  peritoneal metastasis in colorectal cancer patients that might otherwise develop in future. They further suggested that patients needed to be carefully considered for these procedures.