Intraperitoneal (IP) chemotherapy is a type of ovarian cancer treatment in which chemo drugs are directly pumped into your belly cavity (also called peritoneal cavity). When you get chemo this way, it allows a more concentrated dose of drugs to come in close contact with exposed cancer cells for a long period of time and kill them.
Unlike chemo that you get through an IV into your bloodstream, you only get IP chemo inside your abdomen. This means it lowers the odds of side effects affecting the rest of your body.
Your stomach’s lining also absorbs some of the chemo drugs into your bloodstream. This allows the drugs to reach cancer cells that may have spread to different parts of your body.
Usually, you’ll get IP chemotherapy in addition to the chemo given through IV in a vein.
Who Gets IP Chemotherapy?
If you have ovarian cancer with little to no trace of cancerous cells after surgery, your doctor may consider this therapy. IP chemotherapy is also only done if:
- Tumors are small, usually less than 1/4 inch.
- The cancer hasn’t spread to the lymph nodes.
- There are no adhesions, or bands of scar-like tissue, in your stomach cavity.
There are two types of IP chemotherapy:
- Standard IP chemotherapy
- Hyperthermic intraperitoneal chemotherapy (HIPEC)
What Is Standard IP Chemotherapy?
In standard IP chemotherapy, you’ll receive the drugs through a thin tube (catheter) that’s inserted in your upper belly. The catheter is attached to a round silicone disk called an IP port that your doctor places under the skin and surgically sutures to your rib. You’ll be able to feel it under your skin. The port has a hole on top called a reservoir.
Usually, chemo for ovarian cancer involves two different types of drugs together. It’s more effective against cancer cells, especially epithelial ovarian cancer, the most common type. Your doctor or nurse will place a needle in the reservoir and funnel two chemo drugs, such as cisplatin and paclitaxel, through this port directly into your abdominal cavity.
Once the IP port is in place, you should:
- Watch out for soreness for a few days.
- Make sure to check the area for any redness or swelling as this area is more likely to get infected.
- Don’t do any heavy exercises that may move the IP port.
- Keep the port covered and dry until it heals. Once it does, you can shower and do other normal activities.
Usually, treatment can begin 24 hours after the doctor places your port. The chemo infusion may last anywhere from 30 minutes to 3 hours. The infusion may contain chemotherapy or a mixture of chemotherapy and IV fluids. This will depend on what treatment your doctor orders.
During the therapy session, you’ll have to lie flat and stay still. That’s because the needle needs to stay in place. But they’ll ask you to switch positions every 15 minutes. This will allow the fluids to reach every part of the stomach cavity. Since your belly is being filled with chemo fluids, you may feel a slight pressure build up against your lungs. This might cause you to feel short of breath. If breathing gets too hard, let your doctor or nurse know.
Your IP port will be removed after your last treatment. If you think you might have an infection, tell your doctor or nurse as soon as possible. Your port may need to come out before your treatment is complete. For any remaining sessions, you’ll get the drugs through an IV in your vein.
How Often Is Standard IP Chemotherapy Given?
You may get IP chemotherapy for ovarian cancer at the hospital or at a doctor’s office (outpatient clinic). Usually, you’ll get chemo drugs in a specific order, called a “cycle” of treatment.
With IP, typically there are six cycles of chemotherapy. Each cycle will start with 1-2 days of therapy. This is then followed by five days of rest at home. One week after the first treatment, you’ll get one IP treatment in your doctor’s office. The next cycle will begin in 2 weeks.
What Is Hyperthermic Intraperitoneal Chemotherapy (HIPEC)?
Also known as “hot chemotherapy,” HIPEC is a procedure in which your doctor will fill your abdominal cavity with a strong dose of warm chemo fluids. This is usually done after a surgery to remove (or "debulk") all visible tumors or lesions around your ovaries. The goal is to kill any remaining cancer cells that your doctor wasn't able to get during surgery.
The chemo drug cisplatin is heated to 103 F before it’s pumped into your belly. Doctors think that the heat will help to destroy the cancer cells more effectively. To keep your body temperature regulated, you’ll lie on a cooling blanket.
Your surgery team will physically rock you back and forth for up to 2 hours. They do this to make sure the chemo reaches every part of your abdomen. This will lower the odds of your cancer coming back.
You’ll only need HIPEC once, and your doctor will do it in an operating room. You don’t need multiple sessions.
After you get HIPEC, you’ll get your nutrition through a feeding tube or IV for about 2 weeks. This will give your gut a much-needed break to heal from the high dose of chemo.
What Are the Benefits of IP Chemotherapy for Ovarian Cancer?
- IP chemotherapy directly affects ovarian cancer cells. Studies show that this can improve your odds for survival in certain types and stages of ovarian cancer.
- There are fewer side effects in other areas of the body.
- Because it's a concentrated high dose of chemo, it’s more effective at killing cancer cells.
If your doctor suggests HIPEC, you’ll only need one session of chemotherapy.
Side Effects of IP Chemotherapy
Research shows IP chemotherapy may help you live longer than with IV chemo alone, but the side effects can be very serious.
Side effects can include:
- Electrolyte imbalance
- Stomach pain
- Kidney injury
- Frequent peeing and full bladder during treatment
- Lack of appetite
- Shortness of breath
- Belly pressure or cramps
Some people may also have low blood count, or myelosuppression. This means you have fewer red and white blood cells and platelets. It may be caused by the IP chemotherapy, or it may happen when it’s given along with IV chemotherapy.
Other side effects might depend on the type of chemo you get. Your doctor or nurse will discuss the risks and benefits related to the medications you will get. But if you notice side effects, let your cancer care team know.
Things You Need to Know
It’s important to note that stomach tissue can only absorb a small amount of the chemo drugs into your bloodstream. This therapy might not be as effective at reaching cancer cells that have spread elsewhere in your body.
IP chemo can only work for tumors less than 1 centimeter across. If your doctor is unable to remove as much of the tumor as possible during surgery, this therapy might not work well for you.