Pressurised Intraperitoneal Aerosol Chemotherapy (PIPAC)

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Pressurised Intraperitoneal Aerosol Chemotherapy (PIPAC) is a medical procedure used in the treatment of certain types of cancer, primarily abdominal cancers such as ovarian, gastric, and colorectal cancer. 

PIPAC involves the introduction of chemotherapy drugs into the abdominal cavity as an aerosol (fine mist) under increased pressure. This allows for the uniform distribution of chemotherapy drugs within the peritoneal cavity, where they can directly target cancerous cells and tumors. 

PIPAC is considered a minimally invasive approach and is often used when other forms of chemotherapy or surgery are not effective or suitable for the patient. 

How does the PIPAC system work?

The Pressurised Intraperitoneal Aerosol Chemotherapy (PIPAC) system works through a specific procedure that involves several steps:

• Laparoscopy: PIPAC begins with a laparoscopic surgery, during which a surgeon makes small incisions in the abdominal wall and inserts a laparoscope, a thin, flexible tube with a camera, and specialized instruments. This allows the surgeon to visualize the inside of the abdominal cavity.
• CO2 Insufflation: Carbon dioxide (CO2) gas is introduced into the abdominal cavity to create a controlled and stable environment.
• Drug Preparation: Chemotherapy drugs are prepared in a liquid form and placed in a nebulizer. The nebulizer turns the liquid chemotherapy into an aerosol, creating a fine mist.
• Aerosol Delivery: The nebulized chemotherapy is delivered into the abdominal cavity under increased pressure. The elevated pressure ensures that the aerosol spreads uniformly within the peritoneal cavity, reaching cancerous cells and tumors.
• Exposure Time: The aerosolized chemotherapy is allowed to remain within the peritoneal cavity for a specific period, typically around 30 minutes. This exposure time allows the drugs to interact with and potentially destroy cancer cells.
• Aerosol Removal: After the exposure time, the aerosol is removed from the abdominal cavity, and the gas used for insufflation is also released.
• Incision Closure: The small incisions made for laparoscopy are closed, typically with sutures or surgical glue.

PIPAC is a minimally invasive technique that aims to target cancerous cells within the abdominal cavity while minimizing damage to healthy tissue. It is often used when traditional chemotherapy or surgery may not be as effective or when a patient’s condition necessitates a less invasive treatment approach. 

What specific cancers are treated with PIPAC?

Pressurised Intraperitoneal Aerosol Chemotherapy (PIPAC) is primarily used to treat certain types of abdominal cancers. Some specific cancers that can be treated with PIPAC include:

• Ovarian Cancer: PIPAC is often used as a treatment option for advanced or recurrent ovarian cancer. It can target cancerous cells in the peritoneal cavity.
• Gastric Cancer: PIPAC may be considered for the treatment of advanced gastric (stomach) cancer, particularly when the disease has spread within the abdominal cavity. ( Know more about- What is Stomach Cancer Treatment? )
• Colorectal Cancer: In cases of advanced colorectal cancer, especially when metastases have occurred in the peritoneal lining, PIPAC can be a treatment option.
• Peritoneal Carcinomatosis: PIPAC can also be used to treat peritoneal carcinomatosis, a condition in which cancer has spread and formed multiple small tumors throughout the peritoneal cavity.

PIPAC is not the first-line treatment for these cancers and is typically considered when other treatment options, such as traditional chemotherapy or surgery, have limitations or when the patient’s condition necessitates a minimally invasive approach. 

Does Pressurised Intraperitoneal Aerosol Chemotherapy have an advantage over conventional chemotherapy?

Pressurised Intraperitoneal Aerosol Chemotherapy (PIPAC) offers certain advantages over conventional chemotherapy in specific situations, but it also has its limitations. Here are some of the advantages of PIPAC compared to traditional intravenous (systemic) chemotherapy:

• Targeted Delivery: PIPAC delivers chemotherapy drugs directly into the abdominal cavity, allowing for more precise targeting of cancer cells within that region. This can potentially enhance the effectiveness of treatment.
• Reduced Systemic Side Effects: Since PIPAC primarily targets the peritoneal cavity, it can lead to fewer systemic side effects compared to systemic chemotherapy, which circulates throughout the entire body.
• Minimally Invasive: PIPAC is a minimally invasive procedure, involving small incisions and laparoscopy, which typically results in shorter recovery times and less post-operative pain compared to traditional open surgeries.
• Potential for Recurrent or Advanced Cases: PIPAC may be considered when traditional chemotherapy or surgery is not as effective or suitable, particularly in cases of recurrent or advanced abdominal cancers.

PIPAC is not a replacement for systemic chemotherapy or other standard cancer treatments. It has its limitations and is typically reserved for specific situations, such as advanced or recurrent cancers with peritoneal involvement. Some important considerations and limitations include:

• Limited to Abdominal Cancers: PIPAC is primarily used for cancers that have spread within the abdominal cavity, so it may not be applicable for cancers in other parts of the body.
• Patient Selection: Not all patients are suitable candidates for PIPAC, and the decision to use it depends on individual factors, including the extent and stage of the cancer, overall health, and treatment goals.
• Limited Data: PIPAC is a relatively newer treatment approach, and long-term data on its effectiveness and outcomes are still being gathered.
• Combination with Other Therapies: PIPAC is often used in combination with other treatments, such as systemic chemotherapy or cytoreductive surgery, to optimize the chances of success.

PIPAC can offer advantages in terms of targeted delivery and reduced systemic side effects for certain abdominal cancers, but its use depends on the specific case and should be determined in consultation with a cancer specialist who can assess the individual patient’s needs and circumstances.

( Know more about- What is Chemotherapy? )

How successful is PIPAC treatment?

The success of Pressurised Intraperitoneal Aerosol Chemotherapy (PIPAC) treatment can vary depending on several factors, including the type and stage of cancer, the patient’s overall health, and individual responses to the therapy. PIPAC is a relatively newer treatment approach, and long-term data on its effectiveness are still being collected.

The effectiveness of PIPAC may be influenced by the following factors:

• Cancer Type and Stage: PIPAC is more commonly used for certain abdominal cancers, such as ovarian, gastric, and colorectal cancer, particularly when they have spread to the peritoneal cavity. The success of PIPAC can vary depending on the specific cancer type and its stage.
• Patient Selection: The suitability of PIPAC for a patient depends on their overall health, the extent of the disease, and other individual factors. The selection of appropriate candidates for PIPAC is crucial for its success.
• Combination Therapies: PIPAC is often used in combination with other treatments, such as systemic chemotherapy or cytoreductive surgery, to achieve the best possible outcomes.
• Long-Term Data: Since PIPAC is a relatively new treatment approach, there is ongoing research to gather long-term data on its efficacy and safety.

Consult with a medical oncologist or surgical oncologist who can assess your specific case and provide guidance on whether PIPAC is a suitable treatment option. They can discuss the potential benefits and risks associated with PIPAC in your particular situation and help you make informed decisions about your cancer treatment plan. Get best treatment for cancer at H N Reliance Hospital Mumbai. Early detection and better treatment for cancer can be done, by choosing full body checkups at H N Reliance Hospital Mumbai.