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HIPEC for pseudomyxoma peritonei: how the jelly is treated | CION Cancer Clinics
Pseudomyxoma peritonei, or PMP, is a rare, slow-growing tumour that fills the abdomen with jelly. It is treated with a long operation that strips out the jelly and the lining it clings to, followed by heated chemotherapy washed through the abdomen. That combination, cytoreductive surgery plus HIPEC, is the standard treatment at specialist centres. This page explains what is removed, who the full operation does not suit, and what to ask. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- How is pseudomyxoma peritonei treated, and why is HIPEC the main option?
- What happens from the first suspicion to the operation?
- What does the surgeon actually remove?
- Who is full surgery with HIPEC not suitable for?
- Which words on the report should you understand?
- What families often assume about PMP, and what is actually true
- Common questions about HIPEC for pseudomyxoma
The short answer
How is pseudomyxoma peritonei treated, and why is HIPEC the main option?
Pseudomyxoma peritonei, often shortened to PMP, is treated with a long operation that removes the jelly and the tissue producing it, followed by heated chemotherapy washed through the abdomen. That combination, cytoreductive surgery plus HIPEC, is the standard treatment at specialist centres worldwide. It is the condition HIPEC was largely developed for.
What PMP actually is
It is a rare, slow-growing tumour that usually starts in the appendix. Instead of forming a hard lump, it makes mucin, a thick jelly, which spills into the abdomen and slowly fills it. It rarely spreads through the blood to other organs. That is why removing it from the abdomen can make such a difference, and why chemotherapy through a vein on its own helps very little.
Why surgery and HIPEC go together
The surgeon strips out all the visible jelly and the lining it clings to. HIPEC then deals with cells too small to see, because the warmed drug soaks into a thin surface layer. One without the other leaves the job half done.
This page explains the treatment. It cannot say whether it is right for one person. That depends on the grade, the spread and fitness, and belongs to a treating team.
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One thing that cannot wait
If the abdomen has become tight and swollen and the person is now vomiting, cannot pass wind or stool, or has severe cramping pain, go to an emergency department the same day. The jelly can block the bowel. Do not wait for the specialist appointment, and do not try to manage it with laxatives at home.
Not sure whether this applies to you?
Ask an oncologistThe pathway
What happens from the first suspicion to the operation?
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It is often found by chance
Many people learn of PMP after an operation for suspected appendicitis, a hernia, or an ovarian cyst, when the surgeon finds jelly instead. Others have a CT for a swelling belly. Either way, the first surgeon is usually not the one who will treat it.
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Referral to a peritoneal surgery team
PMP is rare enough that most surgeons see a handful in a career. The pathology slides are reviewed again, and a CT of the chest, abdomen and pelvis maps where the jelly sits.
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Fitness assessment
Heart, lung, kidney and nutrition checks, because the operation is long and the recovery demanding. Some people are asked to build strength for a few weeks first.
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The operation
Cytoreduction, meaning removal of every visible deposit, then HIPEC. It commonly takes most of a day, and the exact list of what is removed is only known once the surgeon can see inside.
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Intensive care, ward, home
A period in intensive care, then the ward. Eating restarts slowly. Follow-up scans continue for years, because PMP can return quietly.
Inside the operation
What does the surgeon actually remove?
Whatever the jelly has attached itself to. That varies from person to person, so treat this as the range, not your list.
The lining of the abdomen
Stripping the peritoneum from the surfaces it coats is called peritonectomy. It is the slowest part of the operation and the part that most needs an experienced team.
The appendix and the omentum
The appendix, where the tumour started, and the omentum, the fatty apron that hangs over the bowel and collects most of the jelly. Both are removed in nearly every case.
Organs the jelly has coated
Depending on where it has settled, the surgeon may need to remove the gallbladder, the spleen, part of the large bowel, or in women the womb and ovaries. A stoma is sometimes needed, often temporary.
Ask beforehand
- Which organs might have to come out
- Whether a stoma is possible, and if so, for how long
- What changes for fertility, if that matters to you
Then the heated wash
With the abdomen cleared, warmed chemotherapy, most often mitomycin C, is circulated inside for around an hour to ninety minutes and then drained out before the wound is closed.
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Being straight with you
Who is full surgery with HIPEC not suitable for?
Not everyone with PMP is offered the full operation. These are the usual reasons.
When the small bowel is heavily coated
The lining can be stripped from most surfaces, but there is a limit to how much small bowel can be removed and still allow normal eating. If the jelly has spread widely over it, complete removal may not be possible. The team may then discuss a smaller operation to reduce the bulk and relieve pressure.
When fitness will not carry the recovery
Serious heart or lung disease, kidney trouble, or severe weight loss raise the risk of the operation more than the disease justifies. A few weeks of nutrition and exercise sometimes change the answer, which is why the fitness step comes first.
When the grade changes the plan
Most PMP is low grade and slow. A minority is high grade and behaves more like an ordinary cancer. High-grade disease is still treated with surgery and HIPEC where it can be cleared, but chemotherapy through a vein is more likely to be added, and the discussion is more cautious.
Being told the full operation is not suitable is not the same as being told nothing can be done. Ask what the alternatives are.On your report
Which words on the report should you understand?
- Mucin
- The jelly itself. A report may say "acellular mucin" when the jelly contains no tumour cells, which is a more favourable finding.
- Low-grade mucinous carcinoma peritonei
- The commonest form of PMP. Slow growing, and the form the operation is most established for. Older reports may call it DPAM.
- High-grade mucinous carcinoma peritonei
- The less common, more active form. Older reports may call it PMCA. It changes how cautious the team is, not whether surgery is considered.
- PCI
- The Peritoneal Cancer Index, a score of how widely the jelly has spread. For PMP a high score does not by itself rule surgery out.
- CC score
- Completeness of cytoreduction, scored at the end of surgery. It records how much visible disease, if any, was left behind.
- CEA, CA19-9, CA125
- Blood tumour markers used to follow PMP over time. A single value means little; the trend over several tests is what the team watches.
Commonly believed
What families often assume about PMP, and what is actually true
"It is slow growing, so we can wait a year."
Slow is not the same as harmless. The jelly keeps accumulating, and the more it coats, the harder complete removal becomes. Waiting can turn an operation that could clear everything into one that cannot. The timing should be a team decision, not a default.
"Chemotherapy drips will dissolve the jelly."
Chemotherapy through a vein reaches PMP very poorly, because the jelly has almost no blood supply. It has a role in high-grade disease and after surgery in some cases, but it does not replace the operation.
"The appendix was removed, so the problem is gone."
Removing the appendix removes the source, not the jelly already in the abdomen. If the pathology report mentions mucin outside the appendix, a specialist opinion is needed even if you feel completely well.
"Any big hospital can do this operation."
Peritonectomy is a specialised skill, and results depend heavily on the team's experience. Ask any centre how many PMP operations it does each year and what its complication figures are. A long journey to an experienced team is usually worth it.
Questions we are asked
Common questions about HIPEC for pseudomyxoma
Is pseudomyxoma a cancer?
It sits at the border. Low-grade PMP does not spread through the blood like most cancers and grows slowly, but it does spread across the abdomen and does need treatment. High-grade PMP behaves more like a cancer. Your pathology report will say which, and that word matters more than the label.
How long is the operation?
Commonly most of a working day, and sometimes longer, because stripping the lining is slow and careful work. Your family should plan for a long wait. The team will usually give you their own typical range once they have seen the scans.
Will I need a stoma?
Sometimes, if a section of bowel has to be removed and joined, the surgeon protects the join with a temporary stoma. Ask before the operation how likely it is in your case and whether it would be reversed later. Many are temporary, but not all.
Can it come back after the operation?
Yes, which is why follow-up scans and blood markers continue for years. If it returns, a second operation is sometimes possible. Ask your team what the follow-up schedule will be, and keep every scan report together so any change can be seen clearly.
Will I be able to eat normally afterwards?
Eating restarts slowly, and many people need feeding support through a tube or a drip for a while. Over months most return to a fairly normal diet, though portion size and some foods may change if bowel was removed. A dietitian should be part of your team from before the operation.
Does the heated chemotherapy cause hair loss?
Usually not. Because the drug stays mostly in the abdomen and is drained out, far less reaches the rest of the body than with chemotherapy through a vein. The main effects are on the bowel and blood counts in the weeks after surgery, and the team watches for those.
Who should I ask for an opinion?
A surgical oncologist who does peritoneal surgery regularly. Take the pathology report, the slides if you can get them, and every scan. Our helpline can help you gather the right documents and frame the questions before you go.
Is it covered by Aarogyasri or insurance?
Cover varies. Some schemes recognise the operation, others approve parts of it, and cashless insurers differ on HIPEC itself. Aarogyasri, CGHS, ECHS and EHS each have their own rules. Ask the centre's insurance desk to check your specific cover in writing before a date is fixed.
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Sources
- Cancer Research UK — Pseudomyxoma peritonei (PMP)
- Macmillan Cancer Support — Pseudomyxoma peritonei (PMP)
- NICE — Cytoreduction surgery followed by hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis (IPG331)
- National Cancer Institute — Definition of HIPEC
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
HIPEC for Appendiceal TumoursWhere most PMP starts, and how the appendix report is readPeritonectomy: Stripping the Lining of the AbdomenThe slowest and most skilled part of the operationOrgans That May Be Removed During CytoreductionThe full list, and what each removal changesRecovery After Cytoreduction and HIPECWhat the weeks after the operation look likeChoosing a Centre for HIPECThe questions that tell you whether a team is experienced
Talk to us
Been told there is jelly in the abdomen?
Send us the pathology and scan reports or call the helpline. A surgical oncologist will explain what the findings mean and which questions to take to a peritoneal surgery team. One helpline serves every CION centre.