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HIPEC: what heated chemotherapy in the abdomen actually is | CION Cancer Clinics
HIPEC stands for hyperthermic intraperitoneal chemotherapy. In plain words, it is a warmed chemotherapy solution washed around the inside of the abdomen during an operation, after the surgeon has removed every visible tumour deposit. It is used for cancers that have spread across the lining of the abdomen. This page explains what happens, who it is considered for, and what it cannot promise. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is HIPEC surgery, in plain words?
- What are the parts of a HIPEC operation?
- What actually happens while you are asleep?
- How is HIPEC different from ordinary chemotherapy?
- Four things families ask about HIPEC, and what is actually true
- Words you will meet, in plain language
- Who is HIPEC not for, and what this page cannot tell you?
- Common questions about HIPEC
The short answer
What is HIPEC surgery, in plain words?
HIPEC is chemotherapy given as a warm liquid inside the abdomen during an operation. The letters stand for hyperthermic (heated) intraperitoneal (inside the lining of the abdomen) chemotherapy. It is always the second half of a bigger operation, in which the surgeon first removes every tumour deposit that can be seen.
Why it is given inside the abdomen rather than through a vein
Some cancers spread as small seeds across the peritoneum, the thin lining that covers the organs and the inside wall of the abdomen. Drip chemotherapy reaches this lining poorly, because it has a thin blood supply. Washing the drug over the surface puts a far higher concentration where the cancer is.
Why the surgery has to come first
Heated chemotherapy only soaks into a very shallow depth of tissue. It cannot shrink a lump you can see on a scan. Its job is to deal with cells too small for the surgeon to find, after the visible disease has been removed. That is why a heated wash without a complete surgical clearance is rarely offered.
Whether HIPEC is an option depends on your cancer type, how widely it has spread and how fit you are. Your treating team weighs all three together. This page cannot do that for you.Four parts, one operation
What are the parts of a HIPEC operation?
The name describes only the chemotherapy. The operation itself has four parts, and each one shapes how you recover.
The surgical clearance
Called cytoreductive surgery, or CRS. The surgeon removes every deposit that can be seen or felt, and strips or removes the parts of the lining and any organs the cancer has grown into. This is the longest part, and the part that decides whether the wash is worth giving.
The heated wash
Warm chemotherapy fluid is pumped into the abdomen and circulated through a machine that keeps it at a set temperature, usually for sixty to ninety minutes. You are asleep throughout. Nothing about it is felt.
The drug and the dose
The drug is chosen for your cancer type, and the dose is worked out for your body size. Your surgeon will tell you which one is planned.
Chosen by
- The cancer being treated
- Your kidney function
- Any chemotherapy you have already had
The recovery
Because the surgery is large, recovery is measured in weeks, not days. Most people spend the first night or two in intensive care and then a longer stay on the ward. Eating restarts slowly.
Not sure whether this applies to you?
Ask an oncologistIn the theatre
What actually happens while you are asleep?
Opening and looking
The surgeon opens the abdomen through a long cut down the middle and looks at every region in turn, scoring how much cancer is present. If there is far more disease than the scans suggested, the operation may be stopped here rather than continued.
Removing the deposits
Every visible deposit is removed. This can mean peeling the lining off the wall of the abdomen, and removing the omentum (a fatty apron over the bowel), the spleen, part of the bowel or, in women, the womb and ovaries. Several hours can pass here.
Setting up the circuit
Tubes are placed into the abdomen and connected to a pump with a heater. Temperature probes let the team watch the fluid temperature and your own body temperature at all times.
The wash
The warm chemotherapy fluid circulates while the abdomen is gently moved so it reaches every corner. The anaesthetist cools you from the outside so your core temperature does not climb.
Draining and closing
The fluid is drained out and the abdomen rinsed. Any bowel joins are completed, drains are placed and the wound is closed. You wake up in intensive care.
Side by side
How is HIPEC different from ordinary chemotherapy?
Chemotherapy through a drip
HIPEC
Travels through the blood to the whole body
Washed over the inside of the abdomen only
Given in cycles over months, as a day patient
Given once, during a single operation
Can reach spread in the liver, lungs or bones
Reaches only the surface it touches
Side effects come from the drug in the bloodstream
Side effects come mostly from the surgery itself
Often used before or after the operation as well
Does not replace drip chemotherapy in most plans
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Commonly believed
Four things families ask about HIPEC, and what is actually true
"HIPEC is a last resort, for when nothing else has worked."
It is the opposite. HIPEC is considered when the spread is still limited enough to be removed completely and the person is fit enough for a long operation. Once the disease is widespread or the person is weak, it is usually no longer an option.
"The heat burns the cancer away, so the surgery matters less."
The wash reaches only a paper-thin layer of tissue. If the surgeon cannot remove all the visible disease, the wash adds little. Centres judge their results by how complete the surgical clearance was, not by the chemotherapy.
"One wash and the cancer is gone for good."
HIPEC lowers the chance of the cancer growing back on the lining. It does not remove that chance, and it does nothing for cancer elsewhere in the body.
"It is too big an operation for anyone over sixty."
Age on its own is not the test. Heart, lung and kidney function, weight, nutrition and how active the person is matter far more. A fit seventy-year-old may be offered it; a frail fifty-year-old may not.
On your report
Words you will meet, in plain language
- Peritoneum
- The thin, smooth lining that covers the organs and the inside wall of the abdomen. Cancer that has settled on it is called peritoneal spread, or peritoneal metastases.
- Cytoreductive surgery (CRS)
- The surgical half of the operation. In practice it means removing every deposit that can be seen.
- Peritoneal Cancer Index (PCI)
- A score the surgeon gives after looking inside, adding up how much cancer sits in each region of the abdomen. Lower means less disease.
- CC score
- Completeness of cytoreduction. It records how much disease, if any, was left behind. CC-0 means nothing visible was left.
- Carcinomatosis
- An older word for cancer scattered across the lining of the abdomen. It means the same as peritoneal spread.
- Perfusion
- The circulating of the warm chemotherapy fluid through the abdomen. "Perfusion time" is how long the wash ran.
Being straight with you
Who is HIPEC not for, and what this page cannot tell you?
HIPEC does not suit everyone with cancer in the abdomen. It is usually not offered when the cancer has also spread to the liver, lungs or bones, when the deposits are too widespread to remove, or when the person is not fit enough to come through a long operation and a slow recovery.
It is not offered for every cancer type
The evidence is strongest for a rare tumour of the appendix called pseudomyxoma peritonei, for peritoneal mesothelioma, and for selected bowel and ovarian cancers. For stomach cancer and several others, the studies are smaller and the operation is offered more cautiously, often only inside a trial.
What this page cannot tell you
It cannot tell you whether you, or the person you are reading for, should have this operation. That depends on scans, a fitness assessment and a tumour board, where surgeons and oncologists look at the case together. It also cannot tell you how long anyone will live after it. No page can do that honestly.
If a scan report mentions peritoneal spread and no one has explained it, call the helpline. Someone will talk it through with you.Questions we are asked
Common questions about HIPEC
Is HIPEC an operation or a chemotherapy?
Both, in one sitting. The surgery comes first and takes most of the day. The heated chemotherapy is washed around the abdomen at the end, while you are still asleep. Plan for the operation, not only for the chemotherapy.
Will I feel the heat or the chemotherapy?
No. You are under general anaesthetic for the whole operation, including the wash. The anaesthetist keeps your body temperature steady with cooling blankets while the fluid circulates. What you feel afterwards is the recovery from a large abdominal operation.
Does HIPEC cause hair loss?
Usually not. Because the drug stays mostly inside the abdomen, far less of it reaches the rest of the body than with drip chemotherapy. Hair loss and low blood counts are much less common. The main after-effects come from the surgery: tiredness, a sore wound and a slow return to normal eating.
Can it be done by keyhole surgery?
Not usually. Removing deposits from every corner of the abdomen needs a long open cut so the surgeon can see and reach everything. Keyhole is sometimes used for the first look, to check how much disease there is before deciding. Ask your surgeon what is planned in your case.
Will I still need ordinary chemotherapy afterwards?
Often yes. HIPEC treats the lining of the abdomen only. Many plans include chemotherapy through a drip before the operation, after it, or both, to deal with cells that may have travelled elsewhere. Your medical oncologist and surgeon plan this together.
How do I know if the cancer has spread to the lining?
A CT scan often shows it, and the report may use the words peritoneal deposits, nodules, omental thickening or ascites, which means fluid in the abdomen. Scans can miss small deposits, so surgeons sometimes do a short keyhole look first. Ask what those words mean for your plan.
Is HIPEC done in Hyderabad?
It is done at a small number of specialist centres in India, including in Hyderabad. It needs a surgical team trained in this operation, a perfusion machine, an intensive care unit and a tumour board. Ask any centre how many they do each year.
What should I bring to the first appointment?
Every scan and report you have, including the biopsy report, the original CT or PET-CT images, and a list of the chemotherapy already given, with dates. Bring the family member who will help with decisions. The surgeon needs the whole story to say whether this operation is even on the table.
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Sources
- NICE — Cytoreduction surgery with hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis (IPG688)
- Cancer Research UK — Pseudomyxoma peritonei
- Macmillan Cancer Support — Chemotherapy
- National Cancer Institute — Chemotherapy to treat cancer
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
Cytoreductive surgery plus HIPEC: the two halvesWhy the surgical half matters more than the washWhy the chemotherapy is heatedWhat the heat actually doesWhich cancers are treated with HIPECWhere the evidence is strong and where it is thinWho is eligible for HIPEC?What the team weighs before offering itDeciding on cancer surgeryQuestions to take to the first appointment
Talk to us
Has a report mentioned peritoneal spread?
Send it to us or call the helpline. A surgical oncologist will read it with you and explain what the options actually are. One helpline serves every CION centre.