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At the beginning of Episode 612, I Like You So Much Better When You're Naked, we see Dr. Miranda Bailey lecturing to the OR Gallery as a pump floods liquid into the unconscious patient's abdominal cavity (formally called intraperitoneal hyperthermic chemotherapy). Not only is the liquid hot, but it also consists of chemotherapy drugs that will wash through the intestine and target dangerous cancer cells. After learning about the technique from Bailey, Dr. Teddy Altman later decides to use it on her own patient, the opera singer who cannot face the idea of possibly losing a lung to pleural mesothelioma...
So, what exactly is "heated chemo" supposed to do?
Heated chemotherapy is a heated sterile solution containing a chemotherapeutic agent, usually heated to the temperature of forty to forty-two degrees Celsius (111.2°F). Surgeons initially started using this fluid as a treatment for abdominal cancers, but more recently, they have begun implementing it to fight some specific lung cancers (in our case, pleural mesothelioma). Studies have shown that delivering a high dose of chemotherapy drugs directly to the location of the cancer improves patients' prognosis without further damaging surrounding tissue.
And why is it hot?
By adding heat, the chemotherapy is more effective at destroying any cancer cells, with the benefit of not killing normal cells. Research has also indicated that the high temperature helps soften the tumor to a degree, so that the chemotherapy may reach the tumor cells more easily.
How do surgeons use it during their procedures?
First, surgeons resect the visible tumor from the patient in the OR. Then, due to the possibility that additional cancer cells still may be left behind in the body, they start the heated chemo lavage procedure. They place about three catheters into the body cavity (either the abdomen or chest), hooked to a pump. This pump (also called the "chemo pump") connects to a machine, and when they turn on the machine, heated chemotherapy flows through and into the body cavity. They circulate the fluid, literally by agitating the patient's abdomen, letting it wash for about an hour, letting the excess heated chemotherapy drain back out of the body through three other catheters, exiting the patient.
What are the difficulties for this type of treatment?
One of the primary issues with heated chemotherapy is the aspect of maintaining the correct dosage of the lavage liquid (the right dosage of the chemotherapeutic agents within the fluid). Also, if a patient's illness indicates him or her as a candidate for this type of treatment, it is very likely that he or she will have an extensive and arduous recovery. After the surgery where hot chemo has been used, the patient usually needs intravenous chemotherapy and radiation to the chest for around three to four months.
Cases have recently shown that heated chemotherapy may indeed increase a patient's prognosis significantly; for example, one patient only expected to live for another nine months when diagnosed, but after heated chemotherapy? Five years later, the woman still lives a happy and comfortable life. As we hope for our passionate opera singer Aaron...
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