Symptoms vary depending on the specific cancer but can include abdominal pain or discomfort, unexplained weight loss, loss of appetite, nausea or vomiting, changes in bowel habits and blood in stool, and swelling or a mass in the abdomen.

Treatment options will vary based on numerous factors of a patient’s diagnosis, such as the cancer’s aggression, whether it has spread, and characteristics of the patient. Most cancers of the abdomen are highly treatable when caught early, and treatment will usually include some combination of chemotherapy and surgery. Depending on the diagnosis, a physician may also recommend radiation therapy, immunotherapy, and clinical trials. Read more about your treatment options based on your diagnosis.

Navigating health insurance can always be a challenge, and doing so when facing cancer treatment is no exception. Proactivity and advocacy are key to making sure that you are well-informed about what your insurance provider will cover and ensuring that you are aware of the process necessary for the insurance company to approve the cost of your care.

First, thoroughly review your insurance policy. It is crucial to understand what treatments and services are covered, from surgeries and chemotherapy to specialized procedures like Cytoreductive Surgery and HIPEC. Being aware of the specifics, such as whether your plan covers experimental treatments or clinical trials, will help you anticipate what to expect as you move forward.

Before beginning any treatment, it is wise to seek pre-authorization from your insurance provider. Many insurers require this step, especially for high-cost treatments, and getting approval upfront can prevent unexpected expenses later. Working with an insurance advocate, often available through your treatment center, can also be helpful. These advocates can help you navigate the complexities of your coverage, assist in understanding your benefits, and support you in appealing any denied claims.

Choosing in-network providers is another critical aspect. Treatment from in-network doctors, hospitals, and labs is typically covered more extensively, reducing your out-of-pocket costs. After receiving care, request an itemized bill and review it carefully for errors that could lead to higher expenses. If your insurance doesn’t cover a significant portion of the treatment, don't hesitate to negotiate with your healthcare providers for a lower rate or to set up a payment plan.

As you manage your care, keep track of your out-of-pocket spending. Once you reach your plan’s out-of-pocket maximum, your insurance should cover 100% of covered services for the rest of the year, which can provide substantial financial relief. If a claim is denied, remember that you have the right to appeal. With the support of your healthcare team, gather all necessary documentation to make a strong case.

And keep documentation throughout the entire process, from the first exam, through treatment, to the last follow-up appointment. This may include documentation provided from your care team, bills, payment receipts, authorizations or claims documentation, and explanation of benefits (EOBs) from your insurance provider.

Diagnosis typically involves a combination of medical history evaluation, physical examination, imaging tests (like CT scans, MRIs, or ultrasounds), blood tests, and sometimes biopsy. Your surgical oncologist may also recommend an exploratory laparoscopy to get a closer look inside the abdomen.

Common imaging tests include:

• CT Scan: Provides detailed cross-sectional images of the abdomen.

• MRI: Offers high-resolution images and is useful for soft tissue evaluation.

• Ultrasound: Uses sound waves to create images, often used for initial evaluation.

• PET Scan: Detects cancerous cells based on their glucose metabolism.

Blood tests can help identify tumor markers, assess liver function, and detect anemia or other abnormalities that might suggest cancer. Specific markers like CA 19-9 or AFP can be elevated in certain types of abdominal cancers.

A biopsy involves taking a small sample of tissue from the suspected area to examine it under a microscope. It’s necessary to confirm the presence of cancer cells and determine the type and grade of the cancer.

Doctors determine a cancer’s stage through a combination of imaging tests, biopsies, and sometimes surgical exploration to assess the size of the tumor, involvement of nearby lymph nodes, and spread to other parts of the body.

HIPEC allows for a higher concentration of chemotherapy to be delivered directly to the tumor site inside the body, which can be more effective and have fewer systemic side effects compared to traditional intravenous chemotherapy.

Cytoreductive surgery (CRS) is the aggressive surgical removal or destruction of cancer. It is performed through an incision down the midline of the abdomen and may include removal of parts of or the entirety of organs including: the spleen, gallbladder, liver, peritoneum (lining of the abdominal cavity), uterus, fallopian tubes/ovaries, and bowel. Following CRS, heated chemotherapy is circulated directly into the abdominal cavity to kill any remaining microscopic cancer cells - this is referred to as HIPEC.

CRS/HIPEC is an aggressive treatment for cancers that have spread around the abdominal cavity, but it is considered the standard of care treatment for many advanced abdominal cancers. Whether a patient is a candidate for CRS/HIPEC will depend on numerous factors - including the cancer’s aggression, where it has spread, whether tumors can be surgically removed or not, as well as any comorbidities of the patient - so consult a physician with expertise in the procedure.

Surgical oncologists who specialize in peritoneal surface malignancies perform CRS/HIPEC. The complexity of the procedure requires an experienced surgeon to increase the likelihood of achieving a complete cytoreduction (removal of all visible tumor) and decreasing the chances for complications. One multi-center study concluded that CRS/HIPEC requires a steep curve of 140 procedures performed, which is significantly higher than more common surgical procedures to be considered an expert. In addition, The Chicago Consensus Guidelines require a minimum of 12 CRS/HIPEC procedures performed per year per surgeon to be considered a CRS/HIPEC center of excellence.

It is important to remember that CRS/HIPEC is an extensive surgery that requires not only an experienced surgeon, but also the combined expertise and knowledge of a multidisciplinary team, including physician assistants, skilled / critical care nursing, nurse navigators, physical therapists, dietitians, radiologists, pathologists, geneticists, and other cancer specialists to achieve the best outcomes.

Refer to our list of questions to ask a surgeon (links to Questions for HIPEC surgeon page) so that you can vet your care team with confidence.

In the weeks leading up to surgery, focusing on a balanced diet rich in high-quality proteins, calorie-dense foods, and anti-inflammatory ingredients can significantly strengthen your body. Incorporating lean meats, fish, eggs, and plant-based proteins, along with healthy fats from nuts, avocados, and olive oil, ensures that your body has the necessary building blocks for healing and immune support. If appetite or nausea is a concern, small, frequent meals can help maintain energy levels, while hydration remains essential to support kidney function and overall health.

Working with a dietitian to tailor your nutritional plan can also be helpful, as they can recommend specific foods and supplements like omega-3 fatty acids, vitamins, and protein shakes to meet your needs. Managing side effects from any pre-surgery treatments and avoiding extreme dieting or fasting is also important, as your body needs sufficient energy reserves to cope with the demands of surgery. Additionally, psychological support can be valuable in managing stress, which can affect eating habits.

Alcohol can interfere with nutritional absorption and immune function, so it’s best to limit or avoid it. Smoking should also be avoided as it can impair wound healing and recovery.

Following surgery, you will not be able to drink much caffeine for some time. So consider weaning caffeine intake for two-to-three weeks ahead of surgery to prepare your body and avoid symptoms of caffeine withdrawal.

By taking a comprehensive approach to nutrition and well-being, you can better prepare your body for the challenges of CRS/HIPEC and enhance your chances for a smoother recovery.

It is not uncommon for patients to lose between 15-30 pounds as a result of the CRS/HIPEC procedure and through the early phases of recovery. Gaining lean weight ahead of surgery can help prepare your body for the recovery process.

Protein is essential for healing and immune function, and incorporating more protein in your diet is a good way to gain healthy weight. Aim to include high-quality protein sources in your diet, such as: Lean meats (chicken, turkey), fish and seafood, eggs, dairy products (yogurt, cheese), plant-based proteins (beans, lentils, tofu). Consider protein shakes or supplements if you're struggling to meet your protein needs through food alone.

Surgery and recovery increase your body's energy needs. Focus on eating calorie-dense foods if you're having trouble maintaining your weight or if you’ve lost weight recently: nuts and nut butters, avocado, full-fat dairy, healthy oils (olive oil, coconut oil), smoothies with added calories (e.g., protein powder, peanut butter).

Every facility will have their own policies, but it is not uncommon for your care team to have the patient at the hospital the day prior to the HIPEC procedure for a variety of surgery preparations. These will include visits by your Surgeon and Physician Assistants, Dietician or Nutritionist, and Anesthesia. You may also have visits from Physical Therapists, Ostomy or Wound Care Nurses, and other services such as pastoral care. Patients will also have bowel prep to do prior to surgery, which may be done in the hospital.

Most patients typically spend between 12-15 days in the hospital, including a day or more in the intensive care unit (ICU) following the CRS/HIPEC procedure.

Your care team will have you up and walking around as soon as possible after surgery. Walking short distances frequently and maintaining good posture can be very helpful for your body to regain its prior mobility. Returning to normal activity will take time - many patients resume normal activity after about two months - so be patient.

• Bring documentation from throughout your journey to have on hand for reference as needed.

• Resting in a hospital can be very difficult, so bring sleep aids that work for you: such as a sleep mask, small noise machine, and a comfortable pillow.

• Bring communication devices and chargers to stay in touch with loved ones.

• Bring lip balm to help avoid dry, cracked lips.

• Perhaps most importantly, bring loose-fitting clothing that will fit comfortably over your surgical sites and abdomen. This might include loose-fitting underwear, bras that fasten in the front, and comfortable sweatpants.

If you live more than one-and-a-half hours from the center that will perform your CRS/HIPEC procedure, it is recommended that you stay in town an extra week after discharge. The first three-to-four weeks after surgery are frequently the time when patients need the most attention. Dehydration and low appetite with poor oral intake are common and may need readmission for hydration. Due to misunderstandings by many physicians regarding peritoneal carcinomatosis, many physicians will refuse or have very negative outlook on patients with peritoneal carcinomatosis, which is why it is important that your surgical oncologist is the one to follow you closely during this initial period.

It is important that you and your surgeon have open communication with all of your local treating physicians to ensure a clear understanding of the follow-up plan. The patient and referring/treating physician should receive a clear plan and all of the information regarding your surgery, including the operative report, hospital stay, and follow-up plan. The surgical team should be available to respond to any questions that arise once patients return to their hometowns.

Regardless of where you live, you should be followed every three-to-six months until five years after diagnosis, and yearly until year ten. If you cannot return to your surgical oncologist for follow-up appointments for any reason, it will be important to have a clear follow-up plan by a local physician aware of the outcomes and treatment results of CRS/HIPEC.

If you are scheduled to receive postoperative chemotherapy, it is very important that you and your surgeon have a discussion with your medical oncologist to make sure that the plan of treatment and response to a potential recurrence is aligned between all specialties.

Recovery can vary, but patients may experience side effects related to the surgery and chemotherapy. It’s important to follow post-operative care instructions and attend follow-up appointments to monitor recovery. The recovery period can vary depending on the individual and the extent of the surgery. Patients may need several weeks to months to fully recover.

Recovery from CRS/HIPEC can take a long time. The hospital stay is usually 12 to 15 days; however, it takes up to 2 months for most patients to return to regular activity. Many patients do not feel “back to normal” until 6 to 12 months after the procedure. Therefore, it is important to try to be as healthy as possible before going into surgery. Eating a well-balanced diet, maintaining weight, and building strength and stamina will help you recover faster.

In addition to getting physically prepared for HIPEC, it is also important to be mentally prepared. Recovery is a marathon, not a sprint and maintaining resilience and a strong support system will be essential. A dedicated support team of family and/or friends to help you throughout your recovery will be crucial for success. No one can do it alone.

Your care team will have you up and walking around as soon as possible after surgery. Walking short distances frequently and maintaining good posture can be very helpful for your body to regain its prior mobility. Your stay in the hospital will also likely include physical therapy, both before and after surgery. This is helpful to teach you how to slowly resume activity without injuring yourself - the body is delicate and sensitive after a major surgery - and to ease you into mobility without overdoing it.

After you leave the hospital, it is wise to consider continuing physical therapy. Consult your oncologist about a referral and check with your insurance about whether physical therapy will be covered once you leave the hospital. At home, you can also do periodic, light stretching to help keep your body in motion and ease the pain of recovery. Light yoga is another example of light exercise that can be done at home to help the body return to normal mobility and re-strengthen after surgery.

Ostomies are not required in most cases, with between 0-25% of HIPEC procedures resulting in cases that require an ostomy. However, it depends on the location of tumor and extent of bowel involvement, especially when the whole colon is involved. Ostomies can be temporary or permanent. Temporary ostomies are used when reconnecting the bowel at the time of surgery is at high risk for leaking due to stress from surgery. Once you have healed, your surgeon will bring you back for another operation to close the ostomy and reconnect the bowel. This smaller procedure is usually performed 3 to 6 months after the CRS/HIPEC.

Permanent ostomies are performed for several reasons. First, they can be performed in a palliative setting for symptom control to bypass a part of the bowel that is obstructed by tumor. Second, it can be performed if there is tumor that is deep in the pelvis involving the rectum. Finally, an ostomy may be required because the amount of bowel that had to be removed to get rid of all the tumor made the remaining bowel too short to be reconnected or the amount of remaining colon is not enough to absorb enough water from the stool to prevent diarrhea and too frequent bowel movements (known as short gut syndrome). In this instance, it may be better for the patient to manage an ostomy instead of having to go to the bathroom multiple times per day.

Requiring colostomy or ileostomy is often one of the biggest concerns of patients as it requires a significant change to everyday life. However, the technology behind ostomies has greatly improved and you would never know that many people have one. They even make special bathing suits to accommodate ostomies. The decision to perform an ostomy can be discussed with your surgeon before surgery and can help your doctor when having to make choices in the operating room. In many centers, a specialized nurse will meet with you ahead of surgery to mark the best locations on your abdomen for an ostomy to avoid folds in your skin or where the waist of your pants normally hit. If you end up needing an ostomy, this nurse will meet with you again postoperatively to teach you how to care for and use it in your everyday life.