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PIPAC: pressurised aerosol chemotherapy, explained | CION Cancer Clinics
PIPAC is a keyhole procedure in which a small dose of chemotherapy is sprayed as a fine mist inside the abdomen, so that it coats cancer deposits on the lining of the belly. It is used when that spread cannot be removed by surgery, is repeated a few times, and is offered at only a handful of centres in India. This page explains what it does, what happens on the day, and who it does not suit. 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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The short answer
What is PIPAC treatment?
PIPAC stands for pressurised intraperitoneal aerosol chemotherapy. It is a keyhole procedure in which a small dose of chemotherapy is sprayed as a fine mist inside the abdomen, under pressure, so that it settles on cancer deposits on the lining of the belly. It is used when that spread cannot be removed by surgery.
Why a spray instead of a drip
Chemotherapy given into a vein reaches the lining of the abdomen poorly, because that lining has a thin blood supply. Spraying the drug onto it as a mist under gas pressure coats the whole surface and pushes the drug a little way into the deposits. The dose is far smaller than a drip dose, so the rest of the body sees very little of it.
What it is trying to do
PIPAC is not an operation to remove cancer. Its aim is to slow or shrink deposits on the lining, ease fluid build-up and symptoms, and in some people make a later operation possible. It is repeated several times, some weeks apart, often alongside ordinary chemotherapy into a vein.
PIPAC is still a newer treatment, and only a few centres in India offer it. Ask your centre directly whether it does.On the day
What actually happens during a PIPAC session?
General anaesthetic
You are fully asleep. The procedure is done in an operating theatre with the same checks as any keyhole surgery, and you will have been asked not to eat beforehand.
Two small cuts
The surgeon makes two small openings in the tummy wall and fills the abdomen with gas, as in any laparoscopy. A camera goes through one opening so the team can look at the lining and take small samples.
The spray
A fine nozzle goes through the other opening. The chemotherapy is pushed through it as a mist and left in the closed abdomen for a set time while everyone waits outside the theatre for safety.
Clearing and closing
The mist is drawn out through a filter system, the gas is released, and the two small cuts are closed with a stitch or glue.
Waking up and going home
Most people are up and eating the same evening and go home within a day or two. The samples taken tell the team whether the deposits are responding, which guides the next session.
Not sure whether this applies to you?
Ask an oncologistWho it is considered for
Who might be offered PIPAC, and who is not
The decision sits with your treating team. These are the situations they weigh.
Spread that cannot be removed
PIPAC is mainly considered when cancer has spread across the lining of the abdomen (peritoneal metastasis) too widely for cytoreductive surgery and HIPEC to be an option.
Most often studied in
- Stomach cancer
- Ovarian cancer
- Bowel and appendix cancers
- Peritoneal mesothelioma
Fluid and symptoms
Where fluid keeps collecting in the belly (ascites) and needs draining again and again, PIPAC is sometimes used to slow that down and ease the bloating and breathlessness it causes.
A bridge to surgery
In some people the deposits shrink enough after a few sessions that the team looks again at whether a full operation has become possible. This happens in a minority, and nobody can promise it in advance.
Who it does not suit
People with a blocked bowel, heavy scarring inside the abdomen from earlier operations, or a general condition too weak for an anaesthetic. It is also not a replacement for a full operation when that operation is possible.
If you have been told you are eligible for cytoreductive surgery, ask why PIPAC is being suggested instead.On your report
Words you will meet around PIPAC, in plain language
- Peritoneum
- The thin lining that covers the inside of the abdomen and the organs in it. Cancer that has spread onto it is called peritoneal metastasis or carcinomatosis.
- PCI
- Peritoneal cancer index. A score describing how much of the lining is affected, recorded at each keyhole look so changes can be tracked.
- Ascites
- Fluid collecting in the belly because of the cancer on the lining. It causes swelling, tightness and breathlessness.
- PRGS
- Peritoneal regression grading score. A pathologist's grade of the small samples taken at each session, showing whether deposits are responding.
- Laparoscopy
- Keyhole surgery. A camera and instruments through small cuts, rather than one long cut across the abdomen.
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Did you know
The dose of chemotherapy sprayed in a PIPAC session is a small fraction of a drip dose of the same drug. That is why most people go home the next day and why hair loss and low blood counts are uncommon after it. It is also why PIPAC cannot replace the drip chemotherapy that treats the rest of the body.
Commonly believed
What families have heard about PIPAC, and what is true
"PIPAC is a new treatment that clears the cancer."
It is not offered with that aim. PIPAC is a way of controlling cancer on the lining of the abdomen that cannot be removed: slowing it, easing symptoms and, in some people, opening the door to surgery later. Anyone promising more is going beyond the evidence.
"It is the same as HIPEC, just gentler."
They are different treatments for different situations. HIPEC is a single heated wash given at the end of a long operation that removes all visible cancer. PIPAC is a repeated keyhole spray for cancer that cannot be removed. One is not a milder version of the other.
"It is only offered when nothing else is left."
It is usually given alongside standard chemotherapy into a vein, not after it has been abandoned. Being offered PIPAC does not by itself mean the team has run out of options. Ask what the plan around it is.
"Any big hospital can do it."
It needs a special nozzle, a sealed theatre set-up, trained staff and a surgeon experienced in peritoneal disease. Few centres in India have all of that. Ask how many sessions the centre has done.
Being straight with you
What this page cannot tell you
This page cannot tell you whether PIPAC is right for you, or what it will do for your cancer. That depends on the type of cancer, how much of the lining is affected, what treatment has already been given, and how fit you are. Only your treating team can weigh that.
Where the evidence stands
Most of what is known about PIPAC comes from studies of modest size, largely from Europe, over the last decade. They show it can be given safely and repeatedly, and that deposits shrink in a share of people. Whether it helps people live longer is still being tested in trials. A careful team will say this plainly rather than oversell it.
What to ask your centre
Ask whether the centre offers PIPAC and how often it does it. Ask what the aim is in your case: symptoms, control, or a bridge to surgery. Ask how many sessions are planned and what would make the team stop. Ask what the plan is if PIPAC is not used. Bring the family member who will help you decide.
If you would like a surgical oncologist to look at your reports and say whether peritoneal treatment of any kind is worth discussing, call the helpline.Questions we are asked
Common questions about PIPAC
Is PIPAC available in India?
Yes, but at only a small number of centres, mostly large cancer hospitals in the metro cities with a peritoneal surface programme. It is not routine. If your team suggests it, ask where it would be done and how much experience that centre has. If you found it yourself, ask your oncologist whether it applies to your cancer at all.
Is it painful afterwards?
Most people describe soreness at the two small cuts and some bloating from the gas, similar to any keyhole procedure, settling within days. Ordinary pain tablets usually manage it. Severe or growing pain, fever or vomiting after you go home should be reported to the team the same day.
Will I lose my hair or feel sick like with chemotherapy?
Usually not from PIPAC itself, because the dose is small and stays mostly inside the abdomen. If you are also having chemotherapy into a vein, those side effects come from the drip, not the spray. Some people feel tired or have mild tummy upset for a few days after a session.
How many sessions will I need?
There is no fixed course. Teams commonly plan a small series, a few weeks apart, and look at the samples and scans after each one before deciding whether to continue. The number depends on how the deposits respond and how you are coping. Ask your team what they are planning and what would change it.
Can PIPAC be done instead of the big HIPEC operation?
Not as a like-for-like swap. If cytoreductive surgery with HIPEC is possible, it is usually the treatment with the stronger evidence. PIPAC is mainly for people in whom that operation is not possible. If you are eligible for surgery, ask why PIPAC is being suggested instead.
Is it safe for the family at home afterwards?
Yes. The drug is drawn out through a filter before the abdomen is opened, and what little remains in the body is handled the way any chemotherapy is. Your centre will give you instructions on toilets and body fluids for a short period, as it would after a drip. Nothing more is needed.
Is PIPAC covered by insurance or Aarogyasri?
Cover varies and is not automatic, because it is a newer procedure. Ask the centre to check with your insurer or scheme before the first session and to give you the pre-approval in writing. Aarogyasri, CGHS, ECHS and EHS each have their own package lists, and the centre can tell you where PIPAC stands.
What happens if it does not work?
The samples taken at each session show the team early whether deposits are responding. If they are not, PIPAC is stopped and the plan goes back to the other treatments for your cancer. Stopping is a normal part of how it is used and does not close off other options.
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Sources
- NICE — Cytoreduction surgery with hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis (IPG688)
- Cancer Research UK — Chemotherapy
- National Cancer Institute — Chemotherapy to treat cancer
- Macmillan Cancer Support — Treatments and drugs
- Tata Memorial Centre — Tata Memorial Centre
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
PIPAC vs HIPEC: How They DifferThe two treatments side by sideHIPEC: What Heated Chemotherapy in the Abdomen Actually IsThe operation PIPAC is most often confused withWho Should Not Have HIPECThe situations where PIPAC gets discussed insteadThe Peritoneal Cancer Index (PCI) ExplainedThe score recorded at every keyhole lookChemotherapy guideThe drip chemotherapy PIPAC is usually given alongside
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Told about PIPAC and not sure what it means?
Tell us what has been found so far. We will help you reach a surgical oncologist who can look at your reports and say whether any peritoneal treatment is worth discussing. One helpline serves every CION centre.