Director, Surgical Oncology, Fortis Escorts, Okhla, New Delhi
Part 2 of 11 in Advanced Treatments in Gynaec Oncology
HIPEC: How Heated Chemotherapy Is Changing Outcomes in Advanced Ovarian Cancer
Ovarian cancer is usually found late, because the ovary sits in a part of the abdomen roomy enough for a tumour to grow substantially before it causes symptoms. By the time most patients are diagnosed, the disease has often reached stage 3C or 4, spread across the lining of the abdominal cavity in ways a single operation cannot fully address. Hyperthermic intraperitoneal chemotherapy, HIPEC, was developed for exactly this problem, and it has reshaped what a stage 3C or 4 ovarian cancer diagnosis means for a patient's prognosis.
What HIPEC actually does
HIPEC is performed immediately after cytoreductive surgery, once a surgeon has removed every piece of tumour visible to the naked eye. Chemotherapy is heated to 41 to 43 degrees Celsius and circulated through the abdominal cavity for 60 to 90 minutes, through a machine that continuously pumps the heated agent from the body, through the device, and back. The heat and direct contact target the microscopic disease left behind, cancer cells too small to see or cut out, that a standard operation cannot reach.
A therapy two decades in the making
Cytoreductive surgery combined with HIPEC has been performed at Fortis for 15 to 20 years, but it is only in the last decade that it has moved to the forefront of ovarian cancer treatment. Studies cited in the masterclass show it improves not just progression-free survival but overall survival in patients diagnosed at stage 3C or 4, a group that previously had comparatively few effective options once the disease had spread this far.
Only six cancers qualify, and cervical cancer isn't one of them
HIPEC has a defined, narrow set of indications: peritoneal cancer, appendiceal cancer, ovarian cancer, colon cancer, rectal cancer, and some stomach cancers. Within gynaecologic oncology specifically, only ovarian and endometrial cancer qualify. It has no role in cervical cancer at any stage, including stage 2 disease, where the standard approach remains surgery for early-stage disease and chemotherapy with radiation, sometimes alongside immunotherapy, from stage 2B onward.
Cost and availability
HIPEC surgery costs approximately $11,000 to $12,000 at centres such as Fortis in India, which offers cytoreductive surgery with HIPEC as a standard treatment pathway for ovarian cancer patients who present with advanced disease, rather than as a last-resort or experimental option.
This guide is based on a live Jivo Masterclass — Dr. Archit Pandit taught doctors across Africa on June 22, 2025.
FROM THE LIVE Q&A
Dr. Mizi Kashwka (Zambia)
What is the cost range for laparoscopic surgeries for gynaecologic oncology cases, and does the hospital offer chemoradiotherapy, IMRT and VMAT?
Dr. Archit Pandit
Dr. Pandit said laparoscopic cancer surgery, including radical hysterectomy and hysterectomy, typically costs between $5,000 and $5,500, while procedures for endometriosis such as myomectomy range from $5,000 to $6,500. Fortis offers the full range of radiation oncology, including 3D-CRT, IMRT, IGRT, 3D-ARC, CyberKnife and tomotherapy, as well as brachytherapy, and has access to targeted therapy, immunotherapy and, at one centre in India, CAR-T cell therapy.
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Frequently Asked Questions
What is the utility of high-intensity focused ultrasound (HIFU) therapy for gynaecologic malignancies, is it available at your institution, and what does it cost?▼
Dr. Pandit said focused high-frequency ultrasound therapy is generally used for small fibroids rather than malignancy, which is his own area of focus, but confirmed Fortis does perform it, at a cost of $4,500 to $6,500.
What advancements has Fortis made for African patients with gynaecologic malignancies, and what are the most recent and frequent surgical treatments and their estimated costs?▼
Dr. Pandit said no treatment is specific to African patients as such, but pointed to cancer vaccination, for cervical, genital, vaginal and vulval cancers, as an area worth spreading in Africa. On surgery, he named HIPEC as the most significant advancement, now used for ovarian cancer along with peritoneal, appendiceal, colon, rectal and some stomach cancers, transforming outcomes over the last 10 to 15 years for patients previously diagnosed too late for treatment. He also pointed to robotic and laparoscopic surgery for retroperitoneal lymph node dissection, endometriosis and radical hysterectomy, and to sentinel lymph node dissection, which avoids removing the full set of pelvic lymph nodes. Surgical costs range from $5,000 to $7,000, and HIPEC surgery costs $11,000 to $12,000.
Since HIPEC is used from stage three onward, is it possible to use HIPEC or another technology to operate on a stage two cervical cancer patient?▼
Dr. Pandit said no, HIPEC is not used for cervical cancer at all. It is limited to six cancers: peritoneal, appendiceal, ovarian, colon, rectal and some stomach cancers, and of the gynaecologic cancers, only ovarian and endometrial cancer qualify. Cervical cancer is treated with surgery in its early stages, and with chemotherapy, radiation and sometimes immunotherapy from stage 2B onward.
How can general practitioners from Africa access surgical training courses at Fortis?▼
After clarifying the question was about medicine-side doctors rather than surgeons, Dr. Pandit said they can join as observers, since hands-on training in India is reserved for foreign doctors who are themselves surgeons or gynaecologists. Observers get an overview of cancer care spanning preventive health checkups, medical oncology and surgical oncology, and can join the hospital's tumour board, the round-table meeting where the full team reviews each case against the current world literature.
What can be done to improve overall healthcare delivery to doctors and patients across Africa?▼
Varun, the session host, said this reflects the underlying model of the collaboration: connecting Indian specialists using current-day technology and treatment processes with doctors across Africa to help achieve better medical outcomes, and offered to continue the conversation with Dr. Sunday directly after the session.
In This Series: Advanced Treatments in Gynaec Oncology
- 1.Advanced Treatments in Gynaecologic Oncology
- 2.HIPEC: How Heated Chemotherapy Is Changing Outcomes in Advanced Ovarian Cancer
- 3.From Open Surgery to Robotics: The Shift in Gynaecologic Cancer Surgery
- 4.The Four Gynaecologic Cancers Every General Practitioner Should Know
- 5.HPV Vaccination and the Prevention of Cervical Cancer
- 6.Four Red Flags That Should Prompt a Gynaecologic Oncology Referral
- 7.Diagnostic Advances in Gynaecologic Oncology: Genetic Testing, PET-CT and AI
- 8.Targeted Therapy and Immunotherapy in Gynaecologic Cancers
- 9.Cost of Gynaecologic Cancer Surgery and Treatment in India
- 10.Complex International Cases in Gynaecologic and Surgical Oncology
- 11.Cross-Border Referral: How African Doctors Can Collaborate with Indian Gynaecologic Oncology Centres