Hyperthermic intraperitoneal chemotherapy (HIPEC) in gynaecological oncology: what patients need to know

Advances in cancer treatment continue to improve outcomes for women with gynaecological cancers. One such development is hyperthermic intraperitoneal chemotherapy (HIPEC). You may hear this treatment mentioned in relation to advanced ovarian cancer or other cancers affecting the abdomen. 

In this article, a consultant gynaecological oncologist explains what HIPEC is, when it may be used within gynaecological oncology, and what it could mean for patients.

What is hyperthermic intraperitoneal chemotherapy (HIPEC)?

HIPEC is a specialised cancer treatment delivered during surgery, rather than before or after an operation. Once the surgeon has removed all visible disease from the abdomen, warmed chemotherapy is circulated throughout the abdominal cavity for a fixed period, typically between 60 and 90 minutes.

Heating the chemotherapy improves its ability to penetrate tissues and destroy cancer cells. This approach allows treatment to be delivered directly to areas most at risk of microscopic disease.

Why is HIPEC used in gynaecological cancers?

HIPEC is most commonly used in ovarian cancer, particularly when the disease has spread within the lining of the abdomen, known as the peritoneum. Ovarian cancer frequently spreads in this pattern, making it suitable for this targeted treatment.

The aim of HIPEC in gynaecological oncology is to treat cancer cells that are too small to see or remove surgically, potentially reducing the risk of recurrence.

When might HIPEC be recommended?

HIPEC is not appropriate for all patients. It may be considered for women who:

• Have advanced ovarian cancer confined to the abdomen.
• Are undergoing extensive cytoreductive (debulking) surgery.
• Are medically fit enough to tolerate a longer and more complex procedure.

Evidence supports the use of HIPEC particularly during interval debulking surgery, following initial chemotherapy. Decisions are made on an individual basis by a specialist multidisciplinary team.

What are the potential benefits of HIPEC?

In carefully selected patients, HIPEC treatment may:

• Improve survival outcomes in advanced ovarian cancer.
• Deliver high concentrations of chemotherapy directly to affected tissues.
• Limit systemic chemotherapy exposure, potentially reducing some side effects.

HIPEC is used alongside standard treatments and is not a standalone cure.

What are the risks and side effects?

As HIPEC is combined with major abdominal surgery, recovery may be longer. Possible risks include:

• Infection or bleeding.
• Temporary bowel dysfunction.
• Fatigue and delayed recovery.
• Side effects related to chemotherapy.

Patients are closely monitored by experienced specialist teams before, during, and after treatment.

Is HIPEC available in the UK?

HIPEC in the UK is available in selected specialist cancer centres with expertise in advanced gynaecological oncology surgery. Availability depends on individual clinical factors and regional services.

While HIPEC is not suitable for everyone, it offers an additional approach that may improve outcomes for carefully chosen patients. Women who have been advised about HIPEC, or who wish to understand whether it may be appropriate for them, should seek guidance from a consultant gynaecological oncologist with expertise in this area.