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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.