Rare Cancer Treated with Surgery, Internal Chemotherapy Technique

Carla Hamilton, 56, of West Chester knew something wasn’t right in the spring of 2011. A junior high health and physical education teacher, Hamilton was busy coaching track and put off her annual gynecologic checkup for a few months. 

Her exam confirmed what Hamilton knew to be true—her ovaries were enlarged to the size of a grapefruit and orange, respectively. She was referred to a gynecologic oncologist and had surgery to remove her ovaries for suspected ovarian cancer.

"Ultimately it was discovered that I had appendiceal cancer that had metastasized to my ovaries,” says Hamilton. 

Hamilton’s tumor was deemed "low-grade” in terms of aggressiveness. Her oncologist began monitoring it through a cancer biomarker blood test (CEA) every three months. 

By October 2012, her test results were elevated to a concerning level, so she was referred to Daniel Abbott, MD, a surgical oncologist with the UC Cancer Institute Comprehensive Gastrointestinal Cancer Center. Abbott sees patients at the UC Health Barrett Center in Clifton.

Hamilton had a form of peritoneal carcinomatosis, a consequence of certain cancers spreading throughout the abdominal cavity where cancer cells can spread and cause critical organs to become blocked or have reduced function. The cancer can come from a variety of organs—including the appendix, ovary, colon and stomach—or originate from the lining of the abdominal cavity itself.  

These kinds of cancer are rare, and unfortunately detecting them is difficult: They have no obvious symptoms or known risk factors, so they are often diagnosed in more advanced stages. 

Cytoreductive Surgery and HIPEC 

Imaging tests revealed tumors throughout Hamilton’s abdominal cavity. Abbott suggested an alternative treatment approach used for abdominal cancers that combines cytoreductive surgery—removal of visible tumor—with the application of chemotherapy directly to the affected area of the body. Traditional chemotherapy medications are given as an infusion through a vein.  

"Applying the chemotherapy directly to the abdominal cavity at the time of surgery allows us to deliver a higher concentration of the drug that is better absorbed by the part of the body in need of treatment,” says Abbott, who is also an assistant professor at the UC College of Medicine. "It is also thought to reduce the negative side effects of chemotherapy treatment to other, unaffected parts of the body by delivering it directly to the targeted area.”

This intraoperative chemotherapy procedure—known as HIPEC (hyperthermic intraperitoneal chemotherapy)—is given at the end of surgery. Once the visible tumors are removed, a heated sterile chemotherapy solution is continuously circulated throughout the abdominal cavity to kill any residual cancer cells that cannot be detected by sight.

Scientific literature also suggests that adding heat to chemotherapy may improve the drug’s ability to kill cancer cells without causing additional harm to healthy cells, Abbott notes.

"For patients like Ms. Hamilton who have resectable (surgically removable) peritoneal disease, cytoreductive surgery with HIPEC can be an extremely effective  first-line treatment,” says Abbott, noting that the UC Health-based gastrointestinal cancer team offers HIPEC for appendix, colon, ovarian, peritoneal mesothelioma and certain gastric cancers.

Hamilton had her surgery and HIPEC treatment in November 2012. She spent two weeks recovering in the hospitaland then slowly transitioned back into her life. She says the recovery wasn’t easy, but: "I am doing well and am thankful for the technology and for Dr. Abbott's medical skills.”

Now she walks at least two miles every day with her dogs, has continued her work as a teacher and focuses on enjoying time with her family and friends. 

Appointments and Information

For appointments with UC Health Surgical Oncology, call 513-584-8900. To learn more about the UC Cancer Institute Comprehensive Gastrointestinal Cancer Center, visit uccancer.com/GI.