Medical Oncologist
CION Cancer Clinics
Why the chemotherapy is heated | CION Cancer Clinics
The chemotherapy in HIPEC is heated because warmth makes the drug work harder on the surface of the abdomen. Heat on its own stresses cancer cells, helps the drug soak a little deeper, and makes several chemotherapy drugs more active. The fluid is kept only a few degrees above body temperature, and you are asleep throughout. This page explains what the heat does, how it is controlled, and what it cannot do. 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
17+specialists on panel
15,000+patients treated
35+centres across Telangana & AP
4.8★ / 800+Google rating
On this page
- Why is the chemotherapy heated in HIPEC?
- What does the heat actually do to the cancer cells?
- How is the temperature kept safe?
- Words you will meet, in plain language
- What people assume about the heat, and what is true
- What the heat cannot do, and what this page cannot tell you?
- Common questions about the heat in HIPEC
The short answer
Why is the chemotherapy heated in HIPEC?
The chemotherapy is heated because warmth makes the drug work harder on the surface of the abdomen. Heat on its own damages cancer cells, helps the drug soak a little deeper into tissue, and makes several chemotherapy drugs more active than they are at body temperature. The fluid is kept only a few degrees above normal, warm rather than hot.
How warm, and for how long
The fluid is usually held between about forty-one and forty-three degrees Celsius, and circulated for around an hour to an hour and a half. A machine warms it and pumps it in through one set of tubes and out through another, so the temperature stays steady across the whole abdomen. Probes inside the abdomen tell the team the real temperature at the tissue, not only at the machine.
Why it is done during surgery and not afterwards
During the operation the abdomen is open and every surface has just been cleared, so the warm fluid can reach the places where microscopic cells remain. Once the abdomen is closed and healing begins, scar tissue forms within days and walls off those surfaces. A wash given later would pool in some places and miss others.
You are asleep for all of this. The heat is felt by the tissue, not by you.Three effects
What does the heat actually do to the cancer cells?
Heat and drug work together. Each does something the other cannot.
Heat damages cancer cells directly
Cancer cells cope less well with warmth than healthy cells do. A surface held above body temperature for an hour stresses the cancer cells on it, and some die from the heat alone.
Heat lets the drug soak in a little deeper
Warmth opens up the surface of the tissue and the small blood vessels in it, so the drug gets a few cell layers further than it would cold. It is still a very shallow depth, which is why visible deposits must be removed first.
Heat makes some drugs more active
Several chemotherapy drugs damage cancer cells more efficiently when warm. The drugs chosen for HIPEC are chosen partly for this reason.
The team chooses the drug by
- The cancer type
- Your kidney function
- Chemotherapy already given
What heat does not do
It does not burn the cancer away, and it does not reach through a deposit you can see. Heat is a helper for the drug and for the surgery, not a treatment on its own.
Not sure whether this applies to you?
Ask an oncologistIn the theatre
How is the temperature kept safe?
The fluid is warmed first
Before the drug is added, plain fluid is circulated through the abdomen and brought up to the target temperature. Only once every probe agrees is the chemotherapy added.
Probes watch the tissue, not the machine
Temperature sensors are placed in different regions of the abdomen. If one region runs cooler, the surgeon moves the abdomen or the tubes so the fluid reaches it evenly.
You are cooled from the outside
Warm fluid inside the abdomen would raise your whole body temperature. The anaesthetist counters this with cooling blankets and cooled drips, watching your core temperature throughout.
The drug is drained and rinsed away
At the end, the fluid is pumped out and the abdomen is rinsed with plain fluid, so very little chemotherapy stays behind once the wound is closed.
On your operation notes
Words you will meet, in plain language
- Hyperthermic
- Warmer than the body. In HIPEC it means the fluid, not you. Your own temperature is held close to normal.
- Perfusion
- The circulating of the warm fluid in and out of the abdomen through a pump. "Perfusion time" is how long the wash ran.
- Inflow and outflow temperature
- The temperature of the fluid going in and coming out. The difference between them tells the team how much heat the tissue is absorbing.
- Closed and open technique
- Whether the abdomen is closed around the tubes during the wash, or left open and covered. Both are used. Neither changes what you feel.
- Core temperature
- Your own body temperature, measured deep inside. The anaesthetist keeps it from climbing while the warm fluid is circulating.
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
Commonly believed
What people assume about the heat, and what is true
"The heat burns the cancer out of the abdomen."
The fluid is only a few degrees above body temperature, about as warm as a hot bath. It does not burn anything. It stresses cancer cells and helps the drug work. The surgery, not the heat, removes the disease you can see.
"Hotter would work better, so a good centre uses more heat."
Above the usual range, healthy tissue is damaged and bowel joins heal poorly. The target range is a balance, not a maximum. A centre that runs it steady and even is doing it well.
"I will have a high fever for days afterwards."
Your core temperature is held near normal during the wash and settles quickly. A fever in the days after surgery is a sign of something else, usually infection or a leak, and the team will look for the cause rather than blame the wash.
"Because it is heated, the chemotherapy is stronger, so side effects are worse."
Because the drug stays mostly inside the abdomen, the usual drip side effects such as hair loss and low blood counts are far less common. The after-effects that matter come from the surgery itself, and from the drug's effect on the kidneys.
Being straight with you
What the heat cannot do, and what this page cannot tell you?
Heat does not make HIPEC suitable for every cancer or every person. The wash, warm or not, reaches only a shallow layer of the surface. It does nothing for a deposit the surgeon could not remove, nothing for cancer in the liver, lungs or bones, and nothing for a person who is not fit enough to recover from the surgery that comes first.
The evidence is stronger for some cancers than others
Heated chemotherapy has been studied most for a rare tumour of the appendix called pseudomyxoma peritonei, for peritoneal mesothelioma, and for selected ovarian and bowel cancers. For bowel cancer, a large trial found that the surgical clearance carried most of the benefit and the heated wash added less than hoped. Which cancers HIPEC is used for is covered on its own page in this series.
What this page cannot tell you
It cannot tell you whether you, or the person you are reading for, should have this operation, and it cannot tell you how long anyone will live after it. Those questions belong to a tumour board, where surgeons and oncologists look at your scans and fitness together.
If your centre offers HIPEC, ask which drug and temperature they use and why. The answer should be specific to your cancer type.
Did you know
The idea of using warmth against cancer is very old. What is new is the pump, the probes and the surgical clearance that let the warm drug reach every surface evenly for a set time. The heat is the easy part. The surgery is the hard part.
Questions we are asked
Common questions about the heat in HIPEC
How hot is the chemotherapy fluid?
Only a few degrees above body temperature, about as warm as a hot bath. It is held in a narrow range for about an hour. It is warm enough to stress cancer cells and help the drug, and not hot enough to burn healthy tissue. Your team watches it with probes throughout.
Will I feel hot or feverish afterwards?
Usually not. The anaesthetist cools you from the outside during the wash so your own temperature stays near normal. If you develop a fever in the days that follow, tell the team straight away. It is more likely to be an infection or a leak than the wash, and it needs checking.
Is heated chemotherapy stronger than normal chemotherapy?
It is more concentrated where it touches, and the warmth makes it more active. But it reaches only a very shallow depth and stays mostly inside the abdomen. So it is stronger on the surface and weaker everywhere else, which is the whole point.
Can the wash be given cold, or at body temperature?
Chemotherapy can be put into the abdomen at body temperature through a port after surgery, and this is used for some cancers. It is a different treatment with a different schedule. HIPEC specifically means heated, during the operation, on freshly cleared surfaces.
Does the heat damage my organs?
At the usual range, no lasting damage is expected. The kidneys are the organ most affected, more by the drug than the heat, so fluids are given generously and kidney blood tests are watched closely afterwards. Bowel joins are made carefully because healing can be slower after a wash.
Why not just give chemotherapy through a drip instead?
Because the lining of the abdomen has a thin blood supply, and drip chemotherapy reaches it poorly. Washing the drug over the surface puts far more of it where the cancer is. Many plans use both: the wash for the lining and the drip for the rest of the body.
Which drug is used, and does the heat change the dose?
The drug depends on your cancer type and your kidney function, and the dose is worked out for your body size. Your surgeon will tell you which one is planned. The dose is set for the heated wash, so it is not the same as a drip dose of the same drug.
How do I know the temperature was kept right?
The perfusion record lists the inflow and outflow temperatures and how long the wash ran. It sits in your operation notes. You are entitled to ask your surgeon what the target was and whether it was held, and a good team will show you.
Meet the Specialists
17+ senior cancer specialists. One panel for your case.
Trained at AIIMS, Tata Memorial, and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them — together.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
Want a specific doctor for your case? Mention them when booking.
Book Free ConsultationBook an appointment with our specialist
Share your name and number — we'll call you back within 30 minutes to schedule your consultation.
Sources
- NICE — Cytoreduction surgery with hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis (IPG688)
- National Cancer Institute — Hyperthermia to treat cancer
- Cancer Research UK — Pseudomyxoma peritonei
- Macmillan Cancer Support — Chemotherapy
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: what heated chemotherapy in the abdomen actually isStart here if the word is new to youCytoreductive surgery plus HIPEC: the two halvesWhy the surgery matters more than the heatWhich cancers are treated with HIPECWhere the evidence is strong and where it is thinAnaesthesia for cancer surgeryWhat the anaesthetist does while you are asleep
Talk to us
Has HIPEC been mentioned for you or a parent?
Send us the scan report or call the helpline. A surgical oncologist will explain what the options are and what to ask your centre. One helpline serves every CION centre.