Peritoneal Cancer

Good Morning, everyone, my name is Dr Ninad Katdare I am a cancer surgeon and I specialise in gastrointestinal cancers and gynae cancer and peritoneal cancers. I practise at H.N. Reliance Hospital, Charni Road, Global Hospital, Parel, Raheja Hospital, Mahim, BSES Hospital, Andheri and HCG Cancer Centre at Borivali. Today we will be speaking about peritoneal cancer peritoneal cancers is one of the least understood cancer and as such many of these patients don't receive good form of treatment, so I will be taking you through a short presentation about what is peritoneal cancer and what are the new modalities which can be actually curative in certain cases of peritoneal cancers. So the presentation is titled peritoneal cancers which are no more a death sentence which was the situation just 5 years ago. So basically what are peritoneal cancer so those can be one, the last stage of Cancer such as colorectal cancer, stomach cancer, appendix cancer, gallbladder cancer and pancreas cancer. In all of these the fourth stage is presents with peritoneal disease and what is known as peritoneal metastasis. It can also be a third stage cancer in ovarian cancer when the disease spread out of the ovary and through the pelvis into the rest of the abdominal cavity it present with peritoneal cancer. It can also present as a primary peritoneal cancer which is called as primary peritoneal adenocarcinoma and a rare case of cancer called as mesothelioma, and there is one specific NDT called as Pseudomyxoma pertonei, all these diseases basically are club together because the routine chemotherapy which is the IV chemotherapy given through your veins is very less effective in this type of cancers. Hence newer technologies which are called as HIPEC and PIPAC which I will come to it shortly are used and this can have curative effects on this type of cancer. So why does chemotherapy fail because usually this peritoneum receive only 1% of cardiac volume that is the amount of blood which your heart pumps, that is 5 litre per minute only 1% of that is received by your peritoneum and there is something called as a peritoneum plasma barrier so whatever chemotherapy which is given through your saline, very less quantity reaches to the peritoneum and as such the routine chemotherapy does not work on this peritoneal cancers. Hence, to combat that we have interesting new technologies the first is called as Cytoreductive surgery and HIPEC so CR stands for Cytoreductive surgery and HIPEC stands for Heated Intraperitoneal Chemotherapy.

In Cytoreductive surgery what we aim is to remove all the visible disease from your abdominal cavity and once that has been clear we circulate a chemotherapy solution which is heated to around 43 degrees and is kept circulating in the abdominal cavity for 90 minutes. Using a combination of Cytoreductive surgery and HIPEC, in many of these peritoneal cancers you can have a cure, it exceeding 5 years and which is a standard patient with the standard chemotherapy with the patient would like for more than 6 months. So in such cases from 6 months, the survival goes to beyond 5 years. Certain cases which are not suitable for this CRS and HIPEC we have a revolutionary technology known as PIPAC. So what is PIPAC stand for is Pressurized Intraperitoneal Aerosol Chemotherapy, in this basically the chemotherapy which is in the liquid form is converted into a gas form and through small keyholes surgery that is called as Laparoscopy we introduce this gaseous chemotherapy into your abdominal cavity. It has been found that patients who have stopped responding to routine chemotherapy also a response to this gaseous chemotherapy. So with the help of this HIPEC and PIPEC many of the peritoneal carcinomatosis are almost 30% can be cured and another 30% can be controlled with this kind of therapy and these patients normally would have died in 6 months, some of them alive for even after 2 years and even 30% of them are alive even 5 years after the diagnosis of their disease. So these therapies can really make a difference in your treatment, thank you. For any further questions, you can contact me on lybrate.com.