Renowned Harvard-trained American cancer surgeon explains how he selects patients for metastatic stage 4 peritoneal cancer treatment. Patient selection is crucial for long-term success of cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) to treat metastatic colon cancer, ovarian cancer or gastric cancers that spread into the abdominal cavity. Peritoneal metastatic cancer patient selection for treatment. Dr. Anton Titov, MD. MRI, CT, PET CT are not accurate for low-volume peritoneal cancer detection. Dr. Paul Sugarbaker, MD. Exploratory laparotomy helps to identify extent peritoneal cancer metastases. There could be 1000 small metastases from ovarian cancer in the peritoneum. CT or MRI will not detect them. We can prevent peritoneal cancer metastases by treating cancer patients correctly at the time of their primary colon cancer or gastric cancer or ovarian cancer resection. Colon cancer, gastric cancer, ovarian cancer spread in the abdomen and peritoneal cavity. Peritoneal metastases in advanced stage 4 colon cancer treatment by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) [hot chemo bath, heated chemotherapy]. Medical second opinion clarifies colon cancer or ovarian cancer diagnosis. Dr. Anton Titov, MD. Medical second opinion confirms that cure is possible in metastatic colon cancer. Intraperitoneal chemotherapy treatment for advanced stage 4 cancer with metastatic lesions in the abdomen. Dr. Paul Sugarbaker, MD. Medical second opinion helps to select a precision medicine treatment for stage 4 ovarian cancer or stage 4 colon cancer or metastatic stage 4 gastric cancer. Get medical second opinion on advanced cancer with peritoneal metastases. Best peritoneal metastatic advanced cancer treatment by surgical operation and regional chemotherapy. Video interview with Dr. Paul Sugarbaker. Leading expert in peritoneal metastatic cancer treatment (cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC), hot chemo bath, heated chemotherapy. Patient selection for peritoneal cancer metastases treatment from colon cancer, ovarian cancer, gastric cancer. Dr. Anton Titov, MD. Correct selection of patients is very important for successful peritoneal metastatic cancer treatment. It is important to march a given patient and a given treatment. Because there are many variants of metastatic gastrointestinal cancer treatment methods. Cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy, HIPEC. How do you select appropriate patients for the Sugarbaker Procedure? Dr. Anton Titov, MD. How do you choose to treat peritoneal metastatic disease that spreads from cancers in the abdomen? How to make sure that you match the right patients with the right extent of peritoneal cancer treatment procedures? Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. We don't do it very well. There is a lot of work that needs to be done. We have to make certain that a patient with peritoneal metastatic cancer does not get a big operation and have a very low likelihood to benefit from surgery. It may surprise you that the most modern radiologic technology, MRI, CT, PET CT are very inaccurate for low volume cancer. [cancer with small-size but numerous metastases] I recently had ovarian cancer patient who had a normal CT of abdomen and normal PET CT and normal MRI. Dr. Paul Sugarbaker, MD. We found several hundred small cancer metastases spread around her abdominal peritoneal space. we would not have operated on her unless she had had a small cancer metastatic nodule at one of the port sites from her laparoscopic ovarian cancer procedure. Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. Unfortunately we have to operate sometimes without complete knowledge about what's going to happen during surgical operation. Dr. Paul Sugarbaker, MD. Perhaps one development in peritoneal metastatic cancer treatment this gave us some help is laparoscopy. Sometimes we have doubts as to whether the patient with peritoneal metastases from gastrointestinal or ovarian cancer is a good candidate for cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Dr. Anton Titov, MD. Then we will do exploratory laparoscopy on these peritoneal cancer patients to determine if cytoreductive surgery and HIPEC will help them or not. But determining accurately who is the best patient for cytoreductuve surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a problem now. The is another aspect of patient's selection, this will become increasingly important in the future. Dr. Paul Sugarbaker, MD. We are able now to identify [colon cancer, ovarian cancer, gastric cancer] cancer patients who will be at high risk for the development of peritoneal metastases in the future. Dr. Anton Titov, MD. We can prevent peritoneal cancer metastases by treating them correctly at the time of their primary colon cancer resection. Or by treating gastric cancer patients preventively for peritoneal metastases at the time of primary gastric cancer operation. Dr. Anton Titov, MD. There is an amazing progress of imaging technology, such as an MRI or PET CT to evaluate patients with metastatic cancer. But sometimes you have to use the classic surgical technique of exploratory laparoscopy and laparotomy in order to see what is going on in patient's abdomen and peritoneum. Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. Yes, sometimes we really have to go to exploratory laparotomy to see the extent of peritoneal involvement by metastatic cancer [colon cancer, ovarian cancer, gastric cancer]. It is not to say that these imaging technologies [MRI, CT, PET CT] are not accurate or sensitive to discover cancer. CT and MRI can be very sensitive for lung metastases, liver metastases or for retroperitoneal nodal metastases. CT, PET CT and MRI can identify cancer metastases less than 1 cm in size. But the size threshold for peritoneal metastasis is about 1 cm or 1.5 centimeters. you can have 1,000 of 1 cm or 1.5 cm peritoneal metastases and the CT, PET CT and MRI will all be normal. Dr. Paul Sugarbaker, MD. Despite a thousand metastases present in the abdomen of such peritoneal metastatic cancer patients. Dr. Anton Titov, MD. Which patients benefit from peritoneal metastatic cancer treatment by cytoreductive surgery / Hyperthermic Intraperitoneal Chemotherapy? Selection criteria.