EPIC: Early Postoperative Intraperitoneal Chemotherapy

When I had appendix cancer, I did not receive HIPEC treatment, I received EPIC, early post-operative intraperitoneal chemotherapy.   When I was searching for treatment, I’d read about HIPEC and wanted HIPEC, but it was hard to find, and I didn’t want my surgeon to be the one I knew of that offered HIPEC.  Both EPIC and HIPEC are chemotherapy that is put directly  into the abdomen after cytoreduction surgery.  You receive several EPIC treatments after surgery vs. the one HIPEC treatment that is done while you are in surgery for the cytoreduction surgery.  I’d hoped for HIPEC as I’d read that the heat itself can kill cancer cells, that the heated chemotherapy is more able to penetrate cancer cells, and that the heat also potentiated the chemotherapy, i.e. made it work better.  The surgeon I chose, though, use EPIC.

EPIC is sometimes done 4-5 days after the surgery, but I insisted my first treatment be done within 24 hours of my surgery.  Scar tissue and adhesions that can interfere with the circulation of abdominal chemotherapy can occur within 4 days after cytoreduction surgery.  I had a portacath in my abdomen to infuse the chemotherapy.  I’ve read that often the EPIC chemotherapy is drained from the abdomen after a certain number of hours, but we did not drain mine at all, we just let my body absorb the chemotherapy and the solution.  I had a total of 6 treatments.  Was interesting, I’m a nurse so learned how to do my peritoneal treatment at MSKCC.  I only had my first two treatments at MSKCC and the last 4 done with my oncologist at home.  As I am a nurse, I had to train my home office how to do the peritoneal treatments, they had never done them before!

EPIC worked for me, I have been cancer free for 19 years.  Memorial Sloan Kettering, where I was treated, is doing a study comparing EPIC and HIPEC to see how they compare.  The study is ICARuS.  You can read of it here.  It was started in 2013 and is expected to be completed in September of 2021.    MSKCC offers EPIC, but not HIPEC that I am aware of.   It will be interesting to see the results of the study.

Some specialists use 5 treatments of EPIC after HIPEC, so they use both EPIC and HIPEC.  Studies have been done comparing HIPEC also to HIPEC and EPIC both used.  One study I read said the complication rate is higher when both are used, but I haven’t yet read any studies that compare the survival rate of using both HIPEC and EPIC together yet.  Most specialists now treating appendix cancer are using HIPEC for the benefits of the heat.

Why HIPEC?

Right now, cytoreductive surgery and HIPEC are the treatment of choice for appendix cancers.  Cytoreduction surgery is the removal of ALL visible tumors in the abdomen.  HIPEC is Heated IntraPeritoneal Chemotherapy.  HIPEC is heated chemotherapy solution that is placed directly into the abdomen, not the IV chemotherapy that is given through a post or a vein.

I don’t know if you’ve heard of the “blood-brain barrier”?   Your body protects your brain by not allowing harmful substances to be delivered by the blood into the brain or into the central nervous system.  It prevents germs in the blood from being delivered to the brain and also blocks toxic substances from being delivered from the blood to the brain.  This can be a problem, because sometimes you might want a toxic substance from the blood to get in the brain, for instance chemotherapy to be able to get to a brain tumor.  This can make brain cancer difficult to treat.

There is something similar in the abdomen, the plasma (blood) peritoneal (inside of the abdomen) barrier, the plasma-peritoneal barrier.  This barrier also prevents harmful or toxic things in the blood from getting into the abdomen.  This make chemotherapy that goes into your blood via a port or vein not very effective against tumors in the abdomen.  But just as not much of the chemotherapy from the blood  goes into your abdomen, chemotherapy placed directly in the abdomen works better than the IV chemotherapy. Your abdomen gets the full effect of the chemotherapy placed directly in the abdomen as it passes the barrier.   Also, the barrier works in reverse, so toxic things in your abdomen don’t go back into your bloodstream. This means you can use chemotherapy in a stronger concentration when it is placed into the abdomen, because not much will get back into the blood stream because of the barrier.   I had no side effects from the chemotherapy placed in my abdomen.

This is a good article to read about the plasma-peritoneal barrier and HIPEC:

Breaking Through the Barricade

Butterflies

Sometimes we need to distract ourselves from cancer when we can.   From the treatment, the chemo, the lab tests and scans, and maybe even those around us who seem to just focus on our cancer now.

I’ve always found peace (and God!) in nature, when I’m out in the woods.  When I look at how nature works, it’s magical.

I wanted the butterfly for our logo as I used to raise monarch butterflies, from eggs!   I’m kind of passionate about butterflies!

I’d follow monarchs around at parks or in wooded areas and watch them land on milkweed leaves.  Then I’d find  one egg  it laid the back of a milkweed leave.  Here’s a picture (not my pics, from the net!)

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I’d bring the egg home with lots of milkweed leaves, and put it all in a 5 gallon aquarium or very big jar and watch the eggs hatch. I’d watch the caterpillars grow. (I had to get new leaves about every other day.)   They shed their skin as they grow larger.

       

One day, they have a fine piece of silk they secrete and they hang from the end of a branch or twig in the jar, and after awhile, their skins splits open and they just look like a gooey mess.  Their head and all of their skin falls off.  But a few minutes later, they are a beautiful chrysalis!  Below is a time lapse video of the process.

About 10 days after the chrysalis forms, it becomes clear and you can see the butterfly inside.  Shortly after it becomes clear, the butterfly emerges.

Watching the life from egg to butterfly was always a very profound  for me.  Most of the life of the caterpillar is very limited.   It only searches for leaves, eats and grows.  I has many legs but moves very slowly.   When I look at the whole field of flowers and trees, I think of the tiny view of the caterpillar.  Just the few milkweed plants in it’s very small circle of life.  It really has no freedom, doesn’t really seem to do anything for enjoyment.  It loses everything, it dies.  It’s head falls off and it’s skin falls off, and it just appears to become a blob of nothing. Does it understand that that is not the end of their life?

But to wait and watch, see the chrysalis form and see the butterfly emerge is amazing.   Usually the butterfly will stay in my finger until it’s wings dry, and then it takes off!  Now it is free and can travel great distances and see the world from so many different views.  It’s is beautiful and it can FLY!!  And it flies to beautiful flowers to drink sweet nectar.   In the end it travels up to 3000 miles following an instinctual path and it meets up with thousands of other monarchs in Mexico.

It reminds me that in this life we can be very limited, but one day, like the monarchs, we too will will be beautiful and free with an unlimited realm.  And we will be able to meet with so many others who have also become free!

I’ve raised enough monarchs I’ve gotten to see every stage of development.  It’s amazing to watch!

Hope I didn’t bore you with this, but think of it when you see our butterfly logo!!

 

Facebook Support Group

Hi All!

I did start a Facebook Support Group on our Facebook page!   Hope you will join!  I also plan to continue the Virtual Appendix Cancer Support group, more about that later!

The Facebook group is a private group, members will need approval from me to join, I will also moderate the group to make sure nothing offensive to others is posted.  The group is for patients and primary care givers. Only members will be able to see each others posts.

I am also planning to have a sign up for the Virtual Support group.  You will sign up with your email, and I will email you dates and times the group will meet.   I will let you know when the email sign up is available!

Have a great day!

Carolyn

Facebook

Hi everyone!

Just to let you know, I do have a Facebook account associated with this organization.  I’ve actually had it for several years,but as I don’t use Facebook personally, I’ve not used it much for the organization.  Don’t laugh, it had been so long since I used it, I forgot the user name and password…tried every email address and password I’d ever used, but could not access my administrator rights.  Have you ever tried to communicate with Facebook the company?   It’s about impossible.   I’d wanted to delete the old page and start a new one I could use for this organization, but I couldn’t delete it either (didn’t have admin access).  In the end my web site designer actually got ahold of real people from Facebook, and after I sent them a copy of my passport and all of the Articles of Incorporation and Business Entity reports showing myself as president, Facebook granted me admin rights to the page!!  So we are back on Facebook!

I would like to be able to communicate with you.  I added a forum to this web site, but that never went over.  But almost everyone I know uses Facebook to communicate with the world!!  So I am going to start using Facebook also to communicate with all of you.   The link is:
https://www.facebook.com/AppendixCancerConnection/

I started the virtual support group, which I really love because I can see and talk to you, but do you think we should also have a Facebook support group?  We’d be able to answer each others questions and to share what we have learned on our journeys at our convenience.  Maybe then the Facebook support group could meet virtually once a month or so?  Let me know!  I really would like feedback from you.   You can email me at carolyn@appendix-cancer.org or text me at 219-776-9913.

One more thing, I was recently interviewed by Cure Magazine for an article they did about appendix cancer.  Will post a link to the article when they send it to me!

 

Appendix Cancer Support Group

Hi All!

We had the second Appendix Cancer Support group today, but only one participant beside myself.  We did have trouble using GoToMeeting so got a late start.  I hope none of you were there and unable to connect?  If so, PLEASE let me know!  I may go ahead and try to get us a Zoom account, that worked well last time.

I need input from you.  How many of you would like to join our support group?  It’s a great thing!  Please email me at
carolyn@appendix-cancer.org if you would like to be part of the support group, and then maybe I will post a list of dates and times to find the best time for everyone.  If you email me, let me know the best time range for you. You can also text me at 219-776-9913.

Let me know!
Carolyn