Peritoneal Surface Malignancies

Peritoneal surface malignancy is a term for tumors that have spread from a primary organ to the abdomen — specifically, the peritoneum, which is the lining of the abdominal cavity. Peritoneal malignancies can also occur as metastases in appendiceal or endometrial cancers or develop from peritoneal mesothelioma or other primary cancers.

Managing peritoneal surface malignancies can be complex. This is in part because the peritoneal cavity has fewer blood vessels than other parts of the body, and blood vessels are the path that traditional intravenous chemotherapy uses to reach metastatic tumors. Since traditional systemic therapies like this are less effective against peritoneal metastases, City of Hope offers leading-edge regional therapies that deliver treatment directly to the tumor site.

City of Hope Delivers Peritoneal-Directed Therapies Nationally

At City of Hope, our highly skilled, multidisciplinary team offers state-of-the-art treatments unavailable at most hospitals. As a patient, you will receive individualized treatment tailored to maximize tumor eradication and optimize functional outcomes.

Mainstays for the treatment of peritoneal surface malignancies at City of Hope include cytoreductive surgery, intraperitoneal chemotherapy and systemic therapy. We are also one of the few centers to offer cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy (HIPEC). Our decades of experience in this technically demanding treatment — and our expertise in carefully selecting the right patients for this option — ensures you have access to the best possible care for patients with peritoneal surface malignancies. 

A High-Volume HIPEC Center

City of Hope performs more HIPEC procedures than any other medical center in Los Angeles County. We are also one of the few centers to offer HIPEC in conjunction with minimally invasive surgery. The delivery of hyperthermic chemotherapy to the abdominal cavity has several advantages, including:

  • The ability to target tumors precisely
  • Being able to use higher doses of chemotherapy without damaging surrounding cells
  • The use of heated chemotherapy, which can impair a tumor’s ability to repair DNA damage

City of Hope’s Groundbreaking PIPAC Program 

City of Hope also offers the nation’s first pressurized intraperitoneal aerosolized chemotherapy (PIPAC) program. If cytoreductive surgery is not an option, patients may qualify for one of two Phase 1 clinical trials studying the use of PIPAC in gastrointestinal and gynecologic malignancies. One of these trials is in collaboration with Mayo Clinic and Northwell Health. These trials are seeking to establish the safety and feasibility of PIPAC both as a single treatment and in combination with systemic therapy. 

“City of Hope has a long history as a leader in delivering intraperitoneal chemotherapy. With PIPAC, patients whose disease cannot be surgically removed or who might not be candidates for major surgery could now undergo a short, laparoscopic surgery and then go home to recover within a week.” 

Thanh Dellinger, M.D., associate professor, Division of Gynecologic Oncology

PIPAC Program Overview

PIPAC enables the direct delivery of chemotherapy into the intraperitoneal cavity, which allows for better absorption of chemotherapy into peritoneal tumors. However, PIPAC has several other potential benefits:

  • The use of aerosolization and pressurization allow chemotherapy to penetrate deeper and be better distributed across the abdominal tissue.
  • PIPAC procedures are shorter and less invasive than many others, meaning patients are discharged faster.
  • The treatment uses only 10%-20% of the traditional dose of chemotherapy. This makes PIPAC less toxic to the body.
  • PIPAC treatments can be repeated relatively frequently. This gives our care team an opportunity to review the tumor’s response and adapt treatment strategies.
  • It can be used to treat patients with high disease burden, including those with colorectal and gastric cancer.  

Our current trials include:

Genetic Testing for Our Patients

City of Hope also offers comprehensive germline testing, regardless of medical or family history. In germline testing, tumor tissue is analyzed by ultra-comprehensive, whole-exome and whole-transcriptome tumor sequencing with a best-in-class test for somatic mutations. This thorough molecular profiling allows our care team to create a highly individualized treatment plan for every patient. It can also provide essential insight into previously unrecognized genetic or inherited issues.  

Access to Investigational Treatments

When you come for treatment at City of Hope, you can access our leading-edge investigational therapies and surgical approaches. Enrolling greater than 800 clinical trials annually, our faculty members are leaders in translational research and committed to bringing our patients the most promising new treatments.

In addition to the PIPAC studies described above, certain patients with peritoneal malignancies may be eligible for the following clinical trials: 

Our Peritoneal Surface Malignancies Team

Gastrointestinal Cancers

Thinzar Lwin
Thinzar Min Lwin, M.D., M.S.
Surgical Oncologist

Thinzar Lwin, M.D., is an assistant clinical professor in the Division of Surgical Oncology in the Department of Surgery.

Meet Surgical Oncologist I. Benjamin Paz, M.D.
I. Benjamin Paz, M.D.
Surgical Oncologist

I. Benjamin Paz, M.D., is a nationally renowned surgical oncology surgeon, with expertise in breast cancer, gastrointestinal and rectal cancers, and tumors involving the bone and soft tissues.

Mustafa Raoof
Mustafa Raoof, M.D., M.S.
Surgical Oncologist

Mustafa Raoof, M.D., M.S., is a surgical oncologist and an assistant professor in the Department of Surgery and in the Department of Cancer Genetics and Epigenetics.

Yanghee Woo, M.D.
Surgical Oncologist

Yanghee Woo, M.D., is director of the Gastroenterology Minimally Invasive Therapy Program.

Gynecologic Cancers

Thanh H. Dellinger, M.D.
Thanh H. Dellinger, M.D.
Gynecologic Oncologist

Thanh H. Dellinger, M.D., is a gynecologic oncologist focusing on ovarian cancer, cervical cancer, uterine cancer, robotic surgery and fertility sparing cancer treatments.

Ernest S. Han, M.D., Ph.D.
Ernest S. Han, M.D., Ph.D.
Gynecologic Oncologist

Ernest Han, M.D., Ph.D., is a gynecologic oncologist with specialized training in minimally invasive and robotic-assisted surgery.

Stephen Lee
Stephen J. Lee, M.D.
Gynecologic Oncologist

Stephen Lee, M.D., is a gynecologic oncologist focusing on ovarian cancer, uterine (endometrial) cancer, cervical cancer, and robotic surgery.