In the continuing advancement of technology in the medical field and in research, treatments for diseases have steadily improved, resulting in better quality of life and longer patient survival. This holds true for the “Big C”—Cancer—which continually challenges physicians to find ways to help their patients from further suffering the effects of the disease.
Dr. Cecilio “Jay” Hipolito, Surgical Oncologist and Head of the Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Service in St. Luke’s- Quezon City and Global City, seems to diverge from the gravity of how onerous his area of expertise is. Dealing with one of the most feared diseases, he discussed the nature of his oncologic expertise in the country’s leading hospital and his department’s advanced explorations in helping prolong the lives of their patients.
In 2011, St. Luke’s Medical Center introduced in the Philippines the concept of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal Carcinomatosis. This is specifically to address a life threatening condition in cancers arising from the appendix, colon, rectum, stomach and ovary that have spilled into the abdominal space and seed onto the surface lining of the intestines and abdominal organs. These “seedings” will eventually cause gastrointestinal obstruction, pain and bleeding if not treated early and ultimately cause death approximately 6-12 months from the time of diagnosis. The goal of CRS+HIPEC is to have complete eradication of gross tumor nodules in the abdominal cavity by safely removing with surgical precision and apply heated chemotherapy after surgery to expose the residual microscopic cancer cells at the time of operation.
“In our service, we have a team of surgeon oncologists, medical oncologists, gynecologic oncologists and anesthesiologists who are extremely skilled and knowledgeable in this particular disease entity and who work under a multidisciplinary approach to tailor this specific treatment for each patient with peritoneal carcinomatosis.”
HIPEC is performed to eradicate the cancer cells that are potentially left behind after CRS. “We deliver heated chemotherapy directly into the abdominal cavity and expose and kill the cancer cells that may remain on the surfaces of the intestines, liver, surface lining of the abdominal cavity and those just floating in the abdominal space. Delivering chemotherapy directly into the abdominal cavity at temperature of 41-430C exposes these cancer cells to very high concentration of chemotherapy with deeper penetration into the tumor because of the increase temperature making it more effective ” Dr. Hipolito explained.
Unlike the standard systemic chemotherapy given thru the IV, HIPEC causes minimal systemic side effects. Absorption of the drug into the blood is low thus producing minimal and limited systemic toxicity like bone marrow suppression, nausea, vomiting and hair
loss that are usually experienced in intravenous and oral chemotherapy. This frontline treatment has been proven to extend the lives and improve the quality of life of many patients suffering from Peritoneal Carcinomatosis.
“In our data of 130 patients with Peritoneal Carcinomatosis, there’s about more than 70 percent three-year survival for patients who underwent CRS + HIPEC. Appendeceal carcinoma has the highest survival approximating 80 to 90 percent at 5 years, followed by ovarian cancer. That is pretty high because particularly for ovarian cancer, where the median survival upon diagnosis of Peritoneal Carcinomatosis is only about 12 months.”
The experienced team of surgical oncologists, medical oncologists, and gyne-oncologists at St. Luke’s Cancer Institute provides the most up-to-date treatment modalities, exceptional service, and personalized care to patients with advanced malignancies. “At St. Luke’s, we have surgeons who are highly skilled in performing these kinds of procedures safely,” he said.
“Success in the management of peritoneal carcinomatosis relies heavily on the knowledge on tumor biology and its application by the medical team, surgical skill and experience of the surgeon and the capability of the hospital in providing the necessary facilities, medicines and equipment in the care of these patients during and after operation,” he explained further.
“The definition of cancer is wide. In layman’s terms, when you say cured, it will never come back. But for us oncologists or those who specialize in cancer, when you say cure, we’re looking at cancer not coming back for the next five years,” Hipolito said.
“At St. Luke’s we believe that cancer is a formidable disease to treat. We have to balance our treatment goals based on what is realistic and achievable to provide sensible hope to our cancer patients. In dealing with cancer, compassion is our edge with other medical
centers which I believe translates to comfort and better quality of life to our patients. As the saying goes “We can cure sometimes, extend life often, comfort always.”
In the attempt to combat complex diseases, there is no stopping St. Luke’s from delivering outstanding healthcare as it continues to delve in advanced applications for the well-being of the Filipino people and the international community at large.