Hyperthermic intraperitoneal chemotherapy (HIPEC) is a technique that delivers high doses of heated chemotherapy directly to abdominal organs to kill cancer cells that may remain after the surgical removal of visible tumors. It is typically used in combination with cytoreductive surgery to treat advanced-stage abdominal cancers such as peritoneal mesothelioma, stomach cancer, appendix cancer, and colorectal cancer, as well as ovarian cancer. Smilow Cancer Hospital physicians are national leaders in the delivery of HIPEC therapy, with a deep understanding of the types of cancer it can be used to treat, the nuances of the therapy, and its effectiveness. Clinical trials using HIPEC therapy are also available. Hyperthermic (or heated) intraperitoneal chemotherapy, called HIPEC for short, is a treatment for cancers that begin in or have spread to the thin layer of tissue that lines the abdomen and abdominal organs known as the peritoneum. After a surgeon removes all visible tumors from the abdominal (peritoneal) cavity in a procedure called cytoreductive surgery (CRS), heated chemotherapy drugs are pumped into the abdomen where they bathe abdominal tissues for about 90 minutes before being drained and rinsed from the abdominal cavity. In many cases, the goal of the treatment is to cure patients of cancer by killing any cancer cells that remain after cytoreductive surgery. HIPEC is used to treat cancers in the peritoneum, including those that have spread—or metastasized—from the gastrointestinal tract, colon, appendix, and ovaries, among other organs, as well as cancerous tumors that started in the peritoneum. Cancer that originates in the peritoneum is very rare. However, each year, around 60,000 people in the United States are diagnosed with metastatic cancer that has spread to the peritoneum from elsewhere in the body. People with these cancers often experience debilitating symptoms, including abdominal and back pain, nausea, constipation, and fatigue, and can have a poor prognosis. However, HIPEC, combined with cytoreductive surgery, can improve the outlook for many people with these types of cancers, helping them live longer and with an improved quality of life. For some people, HIPEC can result in a long-term cure. In other cases, with HIPEC, doctors can manage incurable cancers as chronic illnesses rather than as terminal diseases. The benefits of HIPEC include: HIPEC delivers a concentrated and targeted dose of chemotherapy . In HIPEC, highly concentrated chemotherapy is delivered directly to the inner lining of the abdomen, where it comes into contact with and kills cancer cells. By contrast, traditional chemotherapy is a “systemic” treatment: It is infused into the blood and reaches cancer cells by traveling through blood vessels. Unfortunately, traditional systemic chemotherapy is often ineffective in treating cancers in the peritoneum. This is due, in part, to the peritoneal-blood barrier, which obstructs the delivery of chemotherapy. Few

Urologic diseases affect more than 20 million men, women, and children in the United States. Yale Medicine Urology, named one of the nation’s best urology programs by U.S. News & World Report, cares for adults and children with conditions that affect the bladder, kidneys, pelvic floor, penis, testicles, and urinary tract. Some urologic conditions are present at birth, and others develop over time. Whether for a routine checkup or highly specialized care, our urologists and caregivers provide the most advanced treatment, grounded in research. Our urologists are leaders in the fields of female pelvic medicine and reconstructive surgery, as well as men’s health. Our oncology team has made key research breakthroughs in the treatment of metastatic bladder cancer and kidney cancer. In addition, we offer specialized care for kidney disease, incontinence, stone disease, sexual medicine, neurogenic bladder, transgender care, and reconstructive surgery after trauma. We use the most advanced technology and procedures to give our patients the best care available. Our urologists offer Artemis MRI-ultrasound fusion for prostate biopsy, advanced imaging, laparoscopic and daVinci Si robotic surgery, Holmium Laser Enucleation of the Prostate (HoLEP), as well as UroLift and GreenLight laser procedures. Our doctors and the hospitals where we provide care rank among the best in the country. In addition to providing treatment at Yale New Haven Hospital, Smilow Cancer Hospital, Yale New Haven Children’s Hospital, Greenwich Hospital, and Lawrence + Memorial Hospital, we also have offices located in communities across Connecticut. Above all, at Yale Medicine Urology, we believe in the importance of the patient-doctor relationship. It is the cornerstone of what we do—provide compassionate, quality urologic care to every patient, every day. A multidisciplinary team of urologists, specialty-trained nurses, caregivers, and support staff will take care of patients and their families. The urologist leads the care team, providing a diagnosis and treatment recommendations, as well as performing surgery, if needed, and overseeing the patient’s recovery and postsurgical care. The nurse coordinator is the patient’s advocate and care manager throughout care. Studies show that using nurse coordinators can reduce the length of hospital stays and enhance patient outcomes. Practice nurses provide the day-to-day care during clinical appointments or hospital stays. They administer medications, track vital signs, review general test results, respond to patients’ specific needs, and report to other members of the team. They are available around the clock to answer questions and to help patients through their care. The intake specialist helps to ensure patients are ready in advance of their appointment and have all forms and records completed and sent in advance. Intake specialists are experts at understanding the patient appointment and transfer process. If faced with a diagnosis o

The Hepatic Arterial Infusion (HAI) Program at Smilow Cancer Hospital consists of a multidisciplinary team of nationally recognized physicians who are experts in diagnosing, treating, and providing care for patients with colorectal cancer , cholangiocarcinoma (bile duct cancer), and liver cancer . HAI is a specialized and targeted approach to deliver chemotherapy directly to the liver, primarily used in the treatment of advanced liver metastases from colorectal cancer, in addition to intrahepatic cholangiocarcinoma. Traditional systemic chemotherapy and immunotherapy may not provide enough concentration of the drug within the liver while minimizing exposure to the rest of the body. The procedure involves implanting an HAI pump (the size of a hockey puck) under the skin between the patient’s ribs and pelvis. The pump contains a catheter connected to the hepatic artery, the main blood vessel that supplies the liver with blood. This catheter allows for the direct infusion of chemotherapy drugs into the arterial blood supply of the liver. By administering chemotherapy directly to the affected organ, HAI will maximize the concentration of the drugs in the tumor tissue while minimizing their dilution and distribution throughout the rest of the body. The procedure typically lasts about three hours, and the pump will remain in the patient for several years. Patients will need to visit their doctor every two weeks to have the pump filled with chemotherapy, which takes approximately 10 minutes. Generally, patients will not notice the presence of the HAI pump, but should avoid rigorous physical activity, contact sports, or exposure to extreme heat, which could allow too much chemotherapy to enter the liver. The benefits of HAI include: Fewer side effects: The HAI pump allows for chemotherapy to be released directly into the liver, which is significantly more effective than traditional chemotherapy treatment. This chemotherapy remains in the liver and does not circulate throughout the patient’s body, thus limiting the side effects of treatment. Better outcomes: Chemotherapy is released into the liver continuously and is highly effective in reducing the recurrence of, controlling, or shrinking cancerous tumors in the liver. While uncommon, the HAI procedure does present a risk of complications, including infection, bleeding around the pump, or damage to the hepatic artery. Patients can be assured that our clinicians have extensive processes and procedures in place to ensure that risks are reduced before, during, and after surgery. Despite its benefits, HAI is not suitable for all patients. It is typically considered when the cancer is confined to the liver and systemic disease is limited. Patient selection is crucial, and our multidisciplinary team of medical oncologists, surgical oncologists, and interventional radiologists collaborate to determine the most appropriate candidates for this treatment.