Treating Appendiceal Cancer with HIPEC

In August 2018, Shiloh Hamilton, 33, experienced unusual abdominal symptoms while at work. She suspected appendicitis. When her shift was over, she calmly walked downstairs to the emergency department.

Shiloh was a registered nurse at a hospital in Topeka, Kansas. She had recently completed her nurse practitioner program and was studying for the board exam. But a real-life experience was about to teach her more than she could learn from any book.

The ED surgeon agreed that Shiloh’s appendix was the source of her pain, but he thought it could be low-grade appendiceal cancer. He had seen a similar case during his residency on the East Coast. He removed Shiloh's ruptured appendix and then referred her to The University of Kansas Cancer Center. 

“I had never even heard of appendix cancer before,” she says.

Small organ, serious health issues

After recovering from her appendectomy, Shiloh traveled to Kansas City, Kansas, where she met with surgical oncologist Mazin Al-kasspooles, MD. "Appendiceal cancer is quite rare," he says, "and its treatment can be complex."

Shiloh’s official diagnosis was low-grade appendiceal mucinous neoplasm. A healthy appendix naturally produces a sticky mucus substance. When cancer is present, an abundance of this mucus is produced. If the appendix ruptures, as it did for Shiloh, the mucus lands on the surfaces of other organs in the abdomen where new tumors begin to grow.

“When cancer spreads in this manner, it’s called peritoneal surface disease,” says Dr. Al-kasspooles. “It requires an advanced procedure that our hospital is uniquely qualified to deliver.”

Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy is an aggressive treatment that has been around since the 1980s. The technique involves both removal of all visible signs of cancer as well as the delivery of a heated chemotherapy solution throughout the abdomen.

Shiloh would not need traditional IV chemotherapy. HIPEC works better for microscopic and widespread surface cancer cells.

The only HIPEC center in Kansas

Dr. Al-kasspooles has performed hundreds of CRS-HIPEC procedures since the early 2000s. It's available at only the most advanced cancer centers in the country.

“We have surgeons, nurses, ICU staff and other specialists who understand how to manage these patients," he says. “We are a high-volume center that can perform CRS-HIPEC safely and effectively.”

Shiloh worried about how her daughters, Abigayle, 8, and Amelia, 5, would handle the idea of surgery. “Dr. Al-kasspooles answered all my questions and explained things to my family using lay terminology,” she recalls. “He was very patient with them.”

On November 5, Shiloh checked into Cambridge Tower A for the CRS-HIPEC procedure. She was impressed by everyone on the cancer care team, from Dr. Al-kasspooles to her anesthesiologist to her nurses.

Shiloh’s husband, Nathan, faithfully drove her to every appointment and visited her in the hospital. The couple also enjoyed generous support from their extended family.

“Dr. Al-kasspooles told me I might have nausea and fatigue after surgery, but I might not have hair loss. He was right,” says Shiloh. “I got out of the hospital early – after just 7 days."

Back to life, family, career

CRS-HIPEC eliminated all evidence of cancer from Shiloh’s body. Two months after surgery, she was able to begin her new career as a nurse practitioner.

“Shiloh was lucky. She had the mildest form of appendiceal cancer,” explains Dr. Al-kasspooles. “She was also lucky her local surgeon knew about CRS-HIPEC.”

Patients treated at National Cancer Institute-designated centers such as The University of Kansas Cancer Center have a 25% greater chance of survival than those at other cancer centers.

“Appendiceal cancer is a rare disease,” says Shiloh, “but if you have it, this is the place to go.”

About a year after her CRS-HIPEC surgery, Shiloh remains cancer-free. She has developed some gastroenterology issues that required a change in her diet. “Nothing that stops me from doing all my normal, day-to-day things,” she says.

In fact, Shiloh says she would sign up for the procedure again, if Dr. Al-kasspooles recommended it.

“I’m healthy, working and able to enjoy being with my family,” she says. “It’s a blessing.”