Turning Up the Heat on Cancer
Innovative “regional therapies” offer new hope for patients with advanced disease.
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Last April, Liz Herzog of Sheboygan began waking up in the middle of the night with abdominal pain. “Each time it would keep me up for about an hour,” she said. Liz saw her doctor and underwent several tests. The diagnosis came back within days: cervical cancer.
Seeking clarification on her treatment plan, Liz sought a second opinion at Froedtert & The Medical College of Wisconsin. There, physicians discovered something even more troubling — Liz’s cancer had spread throughout her abdomen.
In the past, very little could have been done for a patient with such extensive disease. But at the Froedtert & The Medical College of Wisconsin Clinical Cancer Center, Liz learned about an advanced procedure called HIPEC that combines surgery and chemotherapy to treat difficult cancers. It is one of several novel techniques known as “regional cancer therapies” that concentrate treatment where it’s needed most.
Chemo Bath
According to Kiran Turaga, MD, MPH, Medical College of Wisconsin surgical oncologist, the idea of regional therapy is to isolate the part of the body affected by cancer and deliver a high dose of chemotherapy to that region alone. HIPEC, which stands for hyperthermic intraperitoneal chemotherapy, is an advanced regional therapy for cancers that have spread to the abdominal cavity.
“During a HIPEC surgery, we first remove as much tumor tissue as we can,” Dr. Turaga said. “Then, we circulate a chemotherapy solution inside the patient’s belly cavity. The dose is almost 10 times as high as what can be given through an IV.”
Bathing the abdominal organs in chemotherapy puts the agent in direct contact with microscopic cancer cells. In addition, the solution is heated to approximately 108 degrees.
Hyperthermic intraperitoneal chemotherapy (HIPEC), delivers heated chemotherapy to treat advanced abdominal cancers
“Heat has a cancer-killing effect. It also increases the potency of the drug and helps it penetrate tissues better,” said Sam Pappas, MD, Medical College of Wisconsin surgical oncologist.
Dr. Turaga said HIPEC is performed at a limited number of medical centers nationwide: “It is usually available only at academic medical centers, because it requires coordination of care among different specialists.” At Froedtert & The Medical College, the team includes surgical oncologists, medical and radiation oncologists, interventional radiologists, pathologists and specialized surgical nurses.
“That Gave Us Pause”
Liz Herzog came to Froedtert & The Medical College at the suggestion of a friend, an oncologist at a prestigious national cancer center. She met with Beth Erickson, MD, Medical College of Wisconsin radiation oncologist.
“I called on a Wednesday, and I got in on Friday,” Liz said. “Dr. Erickson looked at all my scans and said, “Yes, you have cancer in your cervix, but we really think there’s a lot more going on than that.”
“Liz had signet ring cell carcinoma, and that gave us pause,” Dr. Erickson said. This cell type rarely originates in the female organs and usually starts in another part of the body.
Additional scans revealed metastases in Liz’s abdominal cavity, including her ovary. Pathology studies suggested the cancer was gastrointestinal in origin, but a colon stricture prevented physicians from pursuing that lead with a diagnostic colonoscopy.
Finally, with Liz’s consent, William Bradley, MD, Medical College of Wisconsin gynecologic oncologist, performed surgery to remove her gynecologic tumors and make a definitive diagnosis. What he found changed the picture dramatically: Liz had stage 4 cancer of the appendix.
Special Report 2011 866-680-0505 9
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