When a patient of Dr. Ryan Holbrook, a surgical oncologist with Cancer Care Northwest, of Spokane, came to him two months ago, her condition was grim.


The 74-year-old woman had kicked colon cancer years earlier, but the disease was back. This time it had spread to other parts of her body.


Holbrook performed surgery, removing her ovaries, uterus, two sections of her colon, and part of her abdominal wall, liver, and gallbladder. After removing as many of the cancerous tumors as possible, he treated her with whats called intraperitoneal (IP) chemotherapy, which involves injecting drugs directly into the abdominal cavity and onto the patients organs and then immersing them in the chemotherapy solution for an extended period.


Two weeks ago, Holbrook saw that patient again in his office at the Deaconess Health and Education Building. Shes in remission and feels great, Holbrook says.


She would have been dead by now if the cancerous areas hadnt been removed and she hadnt been treated with IP chemo-therapy, he says.


Doctors developed IP chemotherapy about 10 years ago to treat pseudomyxoma peritonei, a form of cancer commonly called jelly belly, Holbrook says. The disease has that nickname because its tumor cells secrete a jelly-like mucus in the abdominal cavity, he says. As those cells and their mucus accumulate, the abdominal area becomes filled with the mucus, and digestion is hindered.


Sometimes you get in there, and its like someone poured goo all over the organs, Holbrook explains.


Surgical oncologists trained to use IP chemotherapy first remove, or debulk, as Holbrook calls it, the tumors and the mucus. They then circulate through the abdominal area a chemotherapy solution that has been warmed to about 103 degrees Fahrenheit. For 90 minutes, the oncologist swooshes, or stirs, the solution over the organs with his hands while the patients abdomen remains open, he says.


Because its warmed, the tissue the solution contacts softens up and opens up and the medicine is absorbed three to four millimeters into the tumors, Holbrook says.


After the patient is closed up, more chemotherapy solution is circulated through the body via drains inserted into the abdominal cavity. Each day for five days, the medicine is pumped in through three tubes that protrude out through the skin. The tubes are closed off and the chemotherapy solution flows throughout the abdominal cavity for 23 hours. For an hour each day, the used solution is drained out and its replaced with new medicine.


Broader uses


Now were starting to use IP chemotherapy for other carcinomatosis situations, he says. Were starting to open this up for more patients. In carcinomatosis, malignant tumors spread to other parts of the body.


Traditionally, if you have carcinomatosis from colon cancer, you might have three to nine months to live, Holbrook says. Doctors from the Netherlands and South Carolina reported at the Society of Surgical Oncologys annual meeting in March, though, that once patients have been treated with IP chemotherapy, their three-year survival rate was more than 50 percent, he says.


Holbrook learned the technique about four years ago by compiling information he had gleaned from other physicians at cancer conferences. At first, he only used IP chemotherapy two or three times a year, and just on patients with pseudomyxoma peritonei. So far this year, he has performed about nine such treatments, some of which were on patients with other types of carcinomatosis.


By and large, people are doing pretty well with it, Holbrook says.


He adds that some of his patients have died since undergoing IP chemotherapy, but instead of dying in a few months, for most of them it was a year or two later, and their quality of life was pretty good.


Because IP chemotherapy works only after a surgeon removes as many tumors as possible, the treatment has forced surgical oncologists to work more closely with medical oncologists, who use conventional chemotherapy to treat cancer. Radiation treatment is never paired with IP chemotherapy, he says. Still, tapping into medical oncology has brought Holbrook, a surgical oncologist, closer to his partners at Cancer Care Northwest.


I spend a lot of time understanding the behavior of tumors and working with other specialists, Holbrook says. IP chemotherapy has fueled the coming together of our group. Its all about trying to understand how it works, together.


IP chemotherapys use is limited to cancers in the pelvic and abdominal region, he says. Neither the technique nor the drugs are so advanced that they can cure cancer.


In fact, cancer likely will strike Holbrooks 74-year-old patient again, he says.


But if its two or three more years she lives, shes thankful to have that time with her grandkids, Holbrook says.