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How chemotherapy is given

Intraperitoneal Chemotherapy: — Treatment Inside the Abdomen

Intraperitoneal chemotherapy puts drugs directly into the space inside your abdomen rather than into a vein. It is used when cancer has spread to the peritoneal lining, and it is given either through a port in clinic or as HIPEC — heated chemotherapy delivered during surgery.

Medically reviewed by Dr. T. Raghavender Reddy, Medical Oncologist, MBBS · DM (Medical Oncology) · MD (Radiation Oncology) · Last reviewed September 2026

  • Not a vein infusion — The drug goes directly into the abdominal cavity, reaching the peritoneal lining at higher concentrations than an IV drip can achieve.
  • Two different forms — Standard intraperitoneal chemotherapy uses a port or catheter in clinic. HIPEC is a single heated treatment given during surgery.
  • Specific to peritoneal disease — Used when cancer has spread to the lining of the abdomen, most commonly in ovarian, fallopian tube and peritoneal cancers.
  • A specialist procedure — Both approaches require an experienced oncology team and are not available at every centre.
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Intraperitoneal chemotherapy delivers drugs directly into your abdominal cavity rather than through a vein. It reaches the peritoneal lining at higher concentrations than IV chemotherapy can. It is given through a catheter or port as a day-care or clinic procedure, or as HIPEC — heated chemotherapy circulated inside the abdomen during surgery.

Why is chemotherapy delivered inside the abdomen?

When cancer spreads to the peritoneum — the thin lining that covers the inside of your abdomen and the surface of organs within it — chemotherapy given through a vein has to travel through the bloodstream to reach it. Concentrations at the disease site are often lower than those needed.

Intraperitoneal chemotherapy places the drug where the disease is. Delivered directly into the peritoneal cavity, it contacts the lining at much higher local concentrations and stays in contact for longer.

In many treatment plans, intraperitoneal and intravenous chemotherapy are used together. Your oncologist decides the combination based on your cancer type and how far it has spread.

Which cancers is intraperitoneal chemotherapy used for?

  • Ovarian cancer — the most common indication in India
  • Primary peritoneal cancer and fallopian tube cancer
  • Colorectal cancer that has spread to the peritoneum
  • Appendiceal cancer and pseudomyxoma peritonei
  • Peritoneal mesothelioma
  • Gastric cancer with peritoneal spread, in selected cases

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What is HIPEC, and how is it different?

HIPEC stands for hyperthermic intraperitoneal chemotherapy. It is given during surgery, not as a separate clinic visit.

After the surgeon removes as much visible tumour as possible — a step called cytoreductive surgery — the abdominal cavity is filled with a heated chemotherapy solution. The solution is circulated through the abdomen for a set time, then drained before the wound is closed.

Heating the drug is intended to help it penetrate tumour tissue more deeply. The operation is long, and the hospital stay for recovery typically runs from several days to a few weeks.

Standard intraperitoneal chemotherapy is different: given through a port or catheter on a repeating schedule, usually between IV chemotherapy cycles, as a day-care or short inpatient visit — not as part of surgery.

How is a HIPEC procedure done?

  1. Assessment

    Your oncologist and surgeon review scans and assess your fitness for a major operation. Not everyone with peritoneal disease is suitable for HIPEC.

  2. Cytoreductive surgery

    The surgeon removes visible tumour deposits from peritoneal surfaces and affected organs. The aim is to leave no tumour visible to the naked eye.

  3. Preparing the solution

    The perfusion team heats the chemotherapy solution using a specialised circuit while surgery continues. Temperature is monitored throughout.

  4. Circulating the chemotherapy

    The heated solution is delivered into the closed abdomen and circulated for a set period. The team gently moves the abdomen to distribute it evenly.

  5. Draining and closing

    The solution is drained, the abdomen is washed, and the wound is closed. The total procedure takes several hours.

  6. Recovery

    The first day or two are in intensive care or a high-dependency unit. Ward recovery follows, with the total hospital stay depending on how the operation went.

Questions people ask before agreeing to this treatment

What makes someone not suitable for HIPEC?

The two main factors are the extent of peritoneal disease and general fitness. If cancer has spread so widely that complete surgical removal is not achievable, the potential benefit of HIPEC is much reduced. Your heart, lung and kidney function will also be assessed because the operation is long. Your surgeon will explain their specific assessment of your case and what the scans show.

What side effects should I expect after HIPEC?

HIPEC combines a major abdominal operation with chemotherapy, so side effects reflect both. Pain, fatigue, nausea and slow return of appetite are common in the weeks after surgery. There is also a risk of complications specific to abdominal operations, including infection and slow return of gut function. Your team will go through the risks specific to your drugs and your operation before you agree.

How is the port-based intraperitoneal approach given?

A small port is placed under the skin of your abdomen in a minor procedure, usually under local or general anaesthesia. At each treatment visit, the chemotherapy solution is connected to the port and infused over a set period. You may be asked to change position during the infusion to help the drug distribute evenly. The port stays in place between cycles and is removed after treatment is complete.

How long will I be in hospital for HIPEC?

Most people stay for one to three weeks, depending on how surgery went and how quickly gut function returns. Intensive care is usually for the first one to two days, followed by ward recovery. If there are complications, the stay will be longer. Your team will give you an estimate before the operation, with the caveat that what they find inside the abdomen sometimes changes the picture.

Can I get a second opinion before agreeing?

Yes — for a procedure of this scale, a second opinion is a reasonable and expected request. HIPEC with cytoreductive surgery is a major undertaking, and outcomes depend significantly on the experience of the team performing it. Asking another specialist to review your scans and confirm the plan is not unusual. Your oncologist can advise on what records need to be shared.

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Common questions

Frequently asked questions

Is intraperitoneal chemotherapy the same as HIPEC?

No. HIPEC is one form of intraperitoneal chemotherapy, given as a single heated treatment during surgery. Standard intraperitoneal chemotherapy is given through a port or catheter in clinic on a repeating schedule, without surgery at each visit and without heating the drug. Your oncologist will explain which approach is being considered for you and why.

Will I need to stay in hospital for every treatment?

For the port-based approach, each dose is usually given as a day-care or short inpatient visit, not a long admission. HIPEC is different — it is part of major surgery and requires a hospital stay of one to three weeks. Your team will tell you what to expect for the specific approach planned for you before treatment begins.

Which drugs are used for intraperitoneal chemotherapy?

The drugs depend on your cancer type. For ovarian cancer, cisplatin and paclitaxel — both available under Indian generic and brand names — are among those commonly used. Your oncologist will explain the specific drugs in your plan. Dose and schedule are a clinical decision made for your individual case and should not be compared between patients, as the same drugs can be used in very different ways.

How will I know if the treatment has worked?

Response is assessed through symptoms, blood markers such as CA-125 in ovarian cancer, and imaging — usually CT or PET-CT — at intervals your team will set. For HIPEC, response is typically assessed at follow-up appointments after you have recovered from surgery. Your oncologist will explain what they are watching and when the first assessment is expected.

Is intraperitoneal chemotherapy available at CION?

CION centres treat ovarian, peritoneal and related cancers, and your oncologist can advise on whether intraperitoneal chemotherapy is appropriate for your case and which centre in the network has the facilities for it. Standard intraperitoneal chemotherapy is administered as day care. PET-CT for response assessment is coordinated with partner imaging centres.

What should I ask at my next appointment?

Ask whether intraperitoneal chemotherapy is being considered for your case and why — or why not if it has been ruled out. If HIPEC is being discussed, ask what the surgeon expects to find and what recovery realistically looks like. Ask what the assessment plan is after treatment so you know what you are working toward. Writing the answers down helps — these conversations are hard to recall clearly when you are worried.

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