HIPEC: An additional treatment option for GI cancer
Signet ring cell carcinomas develop in the organs of the gastrointestinal tract: the stomach, appendix, colon, bladder and pancreas. The cancer gets its name from the ring appearance the cells take on under the microscope.
It's been historically tough to treat, but in select patients, surgery and a new method of delivering chemotherapy have been making a difference.
Sixty-seven-year-old Jim Gibbs was working full-time and feeling healthy until Super Bowl Sunday 2016 when he had a sudden pain in his left side.
"The next day, I was attending some meetings and it was there, nagging," Gibbs said.
"There were no signs, no other signs," said Carol Gibbs, Jim's wife.
A CT scan showed something unusual on his appendix. His doctor ordered more tests.
"He called me a week later and said, well, it's cancerous, and it's signet ring cell cancer," Jim said.
Surgical oncologist Dr. Vadim Gushchin says signet ring cell carcinomas are aggressive. Patients have very few symptoms, so the cells often spread before they're caught.
"By the time a typical diagnosis of a signet ring cell carcinoma of the stomach is made, the entire stomach is engulfed in tumor," Gushchin said.
Surgery may be a treatment option, but doctors can't always remove all the cancer. For Jim, Gushchin added HIPEC, heated intraoperative peritoneal chemotherapy.
"They hook you up to a pumping system that pumps in heated chemotherapy, and it bathes the entire abdominal cavity, and then they pump it out," Jim said.
Most cancers recur within two years after surgery, so Jim spent that time volunteering, doing cancer charity walks.
"I can look back and say, 'You know, I spent that time in the most life-giving way I could,'" he said.
Jim finished his treatment more than two years ago and remains disease-free.
Gushchin cautions that, even with the addition of HIPEC, the cancer is still tough to wipe out. Gushchin says patients who do best with this treatment have no lymph nodes involved and have the tumor contained within one of the organs.
TOPIC: HIPEC FOR SIGNET RING CELL CARCINOMA
REPORT: MB #4581
BACKGROUND: Our body is made up of billions of different types of cells that can only be seen under a microscope. These cells are grouped according to the job they do or the type of body tissue they make up. Signet cells are a type of epithelial cell called glandular cells. Epithelial tissue is skin tissue, covering and lining the body both inside and out. Signet cell cancer is also called signet ring cell cancer. This is because under a microscope the cells look like signet rings. Signet cell cancer is a rare type of cancer that starts in glandular cells. It is most often found in the stomach but can develop in other parts of the body. This includes the breast, bowel, pancreas, bladder, and lung. (Source: https://www.cancerresearchuk.org/about-cancer/signet-cell-cancer)
TREATMENT: Signet ring cell cancer is a subtype of adenocarcinoma, which is the most common type of cancer arising from the stomach. Surgical removal of stomach cancer is the treatment of choice, although an operation to remove the cancer is unlikely to be of benefit. Several clinical studies have reported results that indicate a moderate survival or palliative benefit for patients with advanced stomach cancer. There is no combination of chemotherapy which is clearly superior to others, but most active regimens include 5-Fluorouracil (5-FU), Cisplatin, and/or Etoposide. Vadim Gushchin, MD, Director of Surgical Oncology at Mercy Medical Center said, "Surgeons typically have very bad luck with signet ring cell carcinomas. If you look for articles on surgical treatment of signet cell carcinoma of the appendix, there are very few publications you come across. Our center is known for a more aggressive approach. We are very careful in selecting patients and reasonable in our surgical approach we personally achieved. Thirty to 40 percent five-year survival so meaning that three out of ten patients will survive for four or five years." (Source: https://www.oncolink.org/frequently-asked-questions/cancers/gastrointestinal/general-concerns/signet-ring-cell-cancer & Vadim Gushchin, MD)
HIPEC: Hyperthermic intraperitoneal chemotherapy (HIPEC) is being used to treat signet ring cell carcinomas. Dr. Gushchin explained, "these tumors typically spread early on and they typically present with advanced disease. For example, signet ring cell. Tumors of the appendix spread on the surfaces of the bowel pretty commonly and that's where the technique of site reduction surgery with HIPEC becomes very handy. And again this is a very aggressive treatment. The tumor is very difficult to treat and we think that the treatment matches the enemy." (Source: Vadim Gushchin, MD)