HIPEC with only lymph node mets

[rnorris]

I am very interested in the HIPEC treatment for my third round with colon cancer. I have 3 detectible mets, all appear to be in lymph nodes in the lower abdomen. I contacted Dr. Barlett at U Pittsburg and they are saying they'd be glad to do the surgery, but if they do not find other "flat" tumors during surgery they would not do the HIPEC. They say they don't do it for lymph nodes only. I am wondering if this is standard or just this hospital? I'm hesitant to go all the way for Seattle for the surgery if it is just a surgery as we have good doctors here, just no one doing HIPEC.

[jenhopesprays]

RNorris,

Have you considered a call to Dr. Labow at Mt Sinai in New York?

http://www.mountsinai.org/Find%20A%20Fa ... 1497199732

I think it might be worth a call.

Jennifer

[justsing]

I think you're missing one of the crucial aspects of HIPEC, or at least as it's been explained to me. (Full disclosure - it was explained to me by Bartlett and Co)

HIPEC depends upon the barrier that exists between the interior systems in our body: vascular, lymphatic, etc -- being CLOSED. That means that the massively high concentrations of the chemo drugs do not get into our bodily systems and can go to work on the tumors that are in the open peritoneal cavity.

That barrier also prevents, or at least drastically impedes, systemic chemo given through the vascular system from treating those tumors in the open peritoneal cavity.

Lymph nodes are not considered to be part of the "open" zone. They are part of the interior system. So they will respond to systemic chemo, but probably would not respond to the HIPEC wash chemo. The wash would not cross the barrier.

And the process of washing your abdominal cavity with super hot anything is not a benign procedure. It was described to me as "COOKING" your abdominal organ. As you do a cost benefit analysis, killing off surface tumors is worth a little poaching of your organs. But it's a different calculation if the prospective efficacy is limited.

By all means shop around, but ask lots and lots of questions. "Fools rush in . . ."

[jenhopesprays]

I recommend Dr Labow because in speaking to him, he told me directly that having a node that they could access and remove in the abdomen was not a deal breaker for the treatment and good outcomes.

I am assuming that there are other mets in the abdominal area to remove and the addition of the HIPEC could be of benefit to rnorris.

We call it stage III when it is is just in the nodes that are removed and not found in other organs, so apparently removing nodes that are cancerous is done on a regular basis with good results. It is also my understanding that the one of reasons we find cancer in the abdominal nodes is it was floating around the abdominal cavity and picked up by abdominal nodes.

[JillCurtis]

I think you're missing one of the crucial aspects of HIPEC, or at least as it's been explained to me. (Full disclosure - it was explained to me by Bartlett and Co)

HIPEC depends upon the barrier that exists between the interior systems in our body: vascular, lymphatic, etc -- being CLOSED. That means that the massively high concentrations of the chemo drugs do not get into our bodily systems and can go to work on the tumors that are in the open peritoneal cavity.

That barrier also prevents, or at least drastically impedes, systemic chemo given through the vascular system from treating those tumors in the open peritoneal cavity.

Lymph nodes are not considered to be part of the "open" zone. They are part of the interior system. So they will respond to systemic chemo, but probably would not respond to the HIPEC wash chemo. The wash would not cross the barrier.

And the process of washing your abdominal cavity with super hot anything is not a benign procedure. It was described to me as "COOKING" your abdominal organ. As you do a cost benefit analysis, killing off surface tumors is worth a little poaching of your organs. But it's a different calculation if the prospective efficacy is limited.

By all means shop around, but ask lots and lots of questions. "Fools rush in . . ."

THANK YOU so much for posting this. I have been wondering about this procedure, but as I have only chemo in my lymph nodes this makes sense that it wouldnt work for me.

[Gaelen]

It is also my understanding that the one of reasons we find cancer in the abdominal nodes is it was floating around the abdominal cavity and picked up by abdominal nodes.

Jen, justsing's description of the open/closed systems is on point. And the lymphatic system is a closed system. If cancer cells are floating in th abdominal cavity, they might attach to (the exterior of) lymph nodes. But in order for the cancerous cells to be inside a LN (if I'm remembering anatomy and physiology right), cancer would have had to infiltrate the lymphatic system and be IN the closed system, not just in the ab cavity attached to the exterior of a LN.

[jenhopesprays]

Mr. Norris was encouraged to come to this site by me personally. I also happen to be the one who recommended him to Bartlett based on the knowledge and experiences shared with me. I am SURE that whatever Dr Bartlett would do would be the right thing to do in his case.

I also believe that second opinions are a wonderful thing for many reasons. Even in my crisis mode and acute situation, I managed to squeeze in a second opinion in another state one day before my surgery. That would be the reason for recommending Labow. Mr. Norris came to this site looking for more knowledge because he is most definitely not going to be a "Fool rushing in" (cue music).

Gaelen - I have taken anatomy and phys in the last 5 years but that in no way makes me an expert nor do I play one on internet boards. I will tell you that after HIPEC in my situation my body absorbed the chemo that was placed in my abdomen and caused me to puff up like the Michelin man for a few days. My surgical onc leaves the stitches in place for twice as long as a regular abdominal surgery because of the uptake of chemo by the body greatly reduces the natural healing at the incision site.

Does that make a case for using HIPEC if it is just three regular nodes? I don't know the answer. I am ever so glad that there are greater minds up to that task of answering it. If I was on the table and they opened me up and found more than the scans showed, as is often the case, I would be glad to have gone the extra mile or 2500 to avail myself to the HIPEC.

I am sure that the surgical oncologists involved will fill Mr Norris in and give him more knowledge on his specific situation.

I believe patient to patient sharing is very important. It has literally changed and quite possibly saved my life. I am so grateful for it. I in no way am saying that CRS with HIPEC is the right or wrong thing for Mr Norris.

I in NO WAY GAIN from it one way or the other. Do I think that there are lots and LOTS of people who are not getting this procedure who could really greatly benefit from it? An emphatic YES to that. That is why I speak of it and encourage others to seek out more information, second opinions and patient experiences on the topic. I do ultimately believe that patient KNOWLEDGE is power.

[frickletsx3]

Wow, all of you seem so knowledgeable about this topic. I would just like to step back a moment and share my views. It seems that most people, me included, come to this site for support, information and hope.

I posted a question concerning HIPEC while NED awhile back and had quite a bit of feedback. Some positive and some negative. Several people discouraged me from seeking more information about the procedure based on their knowledge of the procedure and their perception of the efficacy in my situation. It did and still does sadden me when I think about it, because it made me lose some hope.

I would say that I am quite knowledgeable about the procedure in that I have read hundred's of articles, studies and patient accounts but am in no way an expert, I wasn't seeking technical advice. I have consulted no less than 6 HIPEC providers and found that they have vastly differing opinions and offered different options.

I guess what I am trying to convey is that people often visit this site and ask questions not looking for expert medical advice but more for the encouragement, hope and other possible options that those who have traveled these roads before can offer. Expert medical opinions 2nd, 3rd...6th need to be left to the experts and we should all encourage each other to seek them. Please don't discourage others from seeking more knowledge. Knowledge is power and power is hope.

I often visit this site yet infrequently post because more than once I felt as though I had been "slammed" for offering my opinion on the topic. I hope that had not been the intention of those posting but that is certainly the way it comes across sometimes. We need to remember that we are ALL frightened people seeking hope.