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Peritoneal Surface Malignancy

Your abdomen houses organs from the stomach and liver down to the bladder, ureters and everything in between. The space around these organs is called the peritoneal cavity, and it’s covered by a lining called the peritoneum. Peritoneal carcinomatosis, also called peritoneal surface malignancy (PSM), affects this lining.

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Peritoneal surface malignancy (PSM) forms when existing cancer spreads to the lining of your abdominal cavity (peritoneum). We understand that this news can feel like a heavy weight to bear, but you don't have to carry it alone. We'll be there for you every step of the way, even as you undergo treatment for your pre-existing cancer.

Our commitment to your care has led us to becoming one of the few programs in the Boston area to offer a breakthrough treatment for peritoneal surface malignancy called hyperthermic intraperitoneal chemotherapy (HIPEC). This procedure is designed to improve your quality of life and care outcomes.

erry Fogarew, RN comforting Infusion Center patient at Tufts Medical Center.
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PSM forms when an existing cancer spreads to the peritoneum. The following cancers can cause this condition:

Appendix cancer
Colorectal cancer
Gastric cancer
Ovarian cancer
Peritoneal mesothelioma (cancer of the abdominal lining)
Pseudomyxoma peritonei
Sarcomatosis (a type of abdominal cancer)


One of the leading ways we can treat PSM is with cytoreductive surgery with HIPEC. It's a smart treatment option for when the cancer is only present on the surface of the abdominal walls and organs, and hasn't spread to the bloodstream.

This treatment is completed in 2 phases:

  1. First, we’ll remove all visible tumors through cytoreductive surgery, leaving only microscopic cancer cells behind. 
  2. Next, we’ll deliver a heated chemotherapy solution directly into your abdominal cavity to kill any microscopic cancer cells.

The body only absorbs a small amount of this chemotherapy, allowing doctors to use higher doses without risking side effects that can stem from traditional chemotherapy.  

About 1-2 weeks after your HIPEC treatment, we'll meet with you again to check on your progress. This is also a good time to talk with your dietitian about how nutrition can help your healing process.  

Monitoring your response to treatment

To monitor your body’s response to treatment, we recommend follow-up lab work for tumor markers CEA, CA19-9, and CA125. These should be drawn every 3 months for the first 2 years after your operation, then every 6 months for years 3–5.

We may also recommend receiving a CT scan every 6 months for the first 2 years after your operation, then annually for years 3–5. If your tumor markers are elevated at any point, your doctors will order additional CT scans.



How long is the hospital stay following HIPEC surgery?

Our patients typically remain in the hospital for 10-12 days following the HIPEC procedure. Even after you return home, our care teams will keep working with you and your loved ones to ensure that all your home care needs are met. This includes coordinating a visiting nurse, physical therapist and occupational therapist as needed.

What is the HIPEC surgery recovery process?

After cytoreductive surgery with HIPEC, some patients may feel fatigued for 2-3 months. While you should take time to rest and recover, it’s also important to move around and stay as active as possible. Activity can help you fight fatigue and prevent possible surgical complications, such as blood clots forming in your legs and pneumonia.

Recovery is a long road that's best taken day by day. Set short- and long-term goals and try your best to continue doing activities that you enjoy most.

Is nutrition important during recovery?

Nutrition plays an important role in maintaining health and wound healing. Your care team will include a dietitian. They will monitor your nutrition before and after surgery to make sure your body is getting all the calories it needs.

Sometimes, this might involve additional help with a treatment like total parenteral nutrition (TPN). If that’s the case, your dietitian will work with you to create a customized formula and post-treatment plan.

What are the possible risks of HIPEC?

After cytoreductive surgery with HIPEC, the most common complications are bleeding and infection, which can occur with any surgery.  

Other less common complications include:

  • Blood clots: They can form in the legs and travel to other parts of the body, such as the lungs. 
  • Caloric deficits: This can happen if you aren’t able to consume enough calories after surgery. If this happens, you’ll receive intravenous nutrition to help keep up your caloric needs.   
  • Openings or leaks: An enterocutaneous fistula (an opening between the intestines and the abdominal skin) or an anastomotic leak (a leak that may occur when sections of the intestines are surgically reconnected) are less common risks, but still possible.
  • Partial or complete organ removal: This might be necessary if your tumor cannot be separated from an organ’s surface. Organs that might be affected include the: 
    • Omentum (fatty layer that surrounds organs and absorbs tumor cells)
    • Gallbladder
    • Spleen
    • Part of the small or large intestine
    • Peritoneum (membrane that lines the abdominal cavity and covers the abdominal organs)
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