Peritonectomy and HIPEC
Peritoneum cancer is cancer that affects the peritoneum, the ‘outer skin’ lining of the organs within the abdominal cavity, such as the stomach, colon and rectum, small intestines, liver, spleen and pancreas. Peritoneum cancer can either arise from itself, or when it spreads from the primary cancerous organ. This spread, known as metastasis, occurs commonly in cancers of the colorectal, gastric, ovarian or appendix area. Peritoneum cancer affects up to 25% of people with advanced gastrointestinal and gynaecological cancer, and it is a common terminal end point for people with advanced Stage 4 cancer.
Peritonectomy (also known as cytoreductive surgery) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a new combined procedure proven to increase the effectiveness in fighting peritoneal cancer. Following peritonectomy surgery to remove the intra-abdominal tumour along with the affected peritoneal lining, a special HIPEC solution is perfused into the abdominal cavity at 42 degrees Celsius for up to 90 minutes (Sugarbaker protocol). This direct delivery of chemotherapy has a higher chance of completely killing all remaining cancer cells on the peritoneal surface.
Peritonectomy and HIPEC can double the average survival rate of suitable patients who have abdominal cancers with peritoneal metastases. For patients with colorectal cancer that has spread to their peritoneum, up to 30% of patients suitable for HIPEC are able to survive for 5 years or even cured, something that was previously almost impossible. With complication rates of less than 10%, it is a procedure accepted worldwide and have shown to improve the survival and recovery rates of cancer patients who are able to undergo this procedure.
A thyroidectomy is the surgical removal of part or all of the thyroid gland. The thyroid gland is a butterfly-shaped gland at the base of the neck, and it is responsible for the production of hormones that regulate the metabolism. A thyroidectomy is a procedure that treats thyroid cancer and other major thyroid disorders such as hyperthyroidism, which is an overactive thyroid gland.
Whether the thyroid gland is removed in whole or partially depends on the particular condition. For example, if cancer only affects a specific portion of the gland, it may be feasible for the surgeon to only remove that portion. In these cases, there is a chance that the thyroid can continue to function normally. If the thyroid gland is removed in whole, hormone replacement therapy will be required to replace regular thyroid function.
Orthopaedic Cancer Management
Cancer of the bones and soft tissue are relatively rare compared to the most common cancers, but this can also mean that expertise in its management may be less commonly found. In many cases of bone cancer, a common treatment approach is amputation of the entire affected limb. At Mount Elizabeth Hospitals, we have orthopaedic surgeons that are experienced in limb salvaging therapy, where it may be possible to treat the bone cancer without the need for entire limb amputation.
Limb salvaging treatment involves the removal of the part of bone affected by cancer. Bone grafts may be required to replace the removed bone, or in some cases a prosthesis or implant may be used. The feasibility of limb salvaging treatment requires the effective use of chemotherapy and radiation therapy to control and eradicate cancer cells either prior or post-surgery. Successful management of bone cancer requires the cooperation and contribution of surgeons and specialists from multiple specialties such as medical oncology, radiation oncology, orthopaedic oncology etc.
Ovarian Tissue Freezing
While ovarian tissue freezing, also known as cryopreservation, is not an actual cancer treatment, it is an option made available to female cancer patients who are about to undergo treatment. Certain cancer treatments, such as chemotherapy and radiation therapy, may affect the ovaries of a patient, especially in the case of breast cancer, ovarian cancer or cervical cancer. A female cancer patient who has gone through these treatments may find that they are unable to conceive after the treatment is complete.
Ovarian tissue freezing is the removal of ovarian tissue and eggs and freezing them in order to preserve their functionality. After cancer treatment is completed, the preserved tissue may be implanted back into the patient’s body, or it may be used as part of in-vitro fertilisation (IVF). It is a method for female cancer patients to preserve their fertility so that they can continue to conceive after their cancer is cured, and can be especially useful for young women who have cancer.