Fast-track op to save patients with deadly pancreatic cancer

AS a keen runner, Kate Rigby was well versed in the rigours of longdistance races, having completed more than 15 half-marathons since taking up the sport in 2006.

But as she made her way around her latest half -marathon in February last year, a race she’d run many times before, something felt wrong.

‘I’d trained as normal and was hoping to have a good race and get a decent time, but when I started running, I was overcome with extreme tiredness,’ says Kate, 69. ‘I even had to stop and walk — something I have never done before.

‘I’d been feeling tired for three months before that, but just put it down to getting old.’

In the weeks following, Kate noticed her urine turned a dark mahogany colour. She also had backache.

‘Looking back, my body was clearly telling me to take notice, but I ignored the symptoms, putting it down to bad diet,’ says Kate, a former teacher who now works in corporate training.

‘It was simply denial. I’m fit, healthy and, at 5ft 1in and 8st 7 lb, I’m slim. I should have taken the symptoms more seriously.’

It was Kate’s daughter, Sarah, who convinced her to see a doctor after noticing the whites of Kate’s eyes had turned yellow — a sign of jaundice.

‘I was having dinner at Sarah’s house when she spotted this and rang her neighbour, who happens to be a consultant neurologist,’ says Kate. ‘She advised me to go straight to my GP.’

WITHIN days, Kate was diagnosed with pancreatic cancer, which affects around 500 people here every year.

Although it is not very common, according to the Irish Cancer Society (ICS), pancreatic cancer has one of the lowest 10year survival rates of all cancers, with less than eight in every 100 people surviving 10 years or more.

The ICS says that ‘while progress is being made in relation to the treatment of pancreatic cancer patients, survival rates are still too low.’

The charity says that while diagnoses are lower than other forms of cancer ‘the number of deaths per year almost equal the number of diagnoses with around 500 people dying every year’.

And for Kate, her diagnosis came after a particularly difficult time in her life.

‘I had lost my husband, Noel, the previous year and my younger brother, Richard, three months later and I felt emotionally drained. I didn’t have the capacity to deal with it,’ says Kate.

The pancreas, which forms part of the digestive system and is critical to the control of blood sugar levels, is located deep inside the body — so cancer often doesn’t cause symptoms in the early stages and prompt diagnosis is difficult.

Even as the cancer grows, the symptoms — which can include tiredness, abdominal and back pain, unexplained weight loss, loss of appetite, changes to bowel habits and, later, jaundice — can be vague.

Jaundice can occur if the pancreatic tumour presses on the bile duct, stopping the bile — a substance that helps break down fat — from passing through. If at the top of the pancreas, even a small tumour can press on the duct and be discovered early, but cancers that start lower down don’t press on the duct until they’ve spread, by which time the cancer has reached other organs. Jaundice complicates treatment, because traditionally medics have believed that operating on patients while they have it can trigger kidney failure.

So patients have to wait an average of 65 days while the jaundice is treated with surgery.

A stent — a small mesh tube — is inserted into the bile duct to stop the build-up of bilirubin, a brownish-yellow substance produced when red blood cells break down, which is normally excreted in bile and causes the jaundice.

This is dealt with normally before cancer surgery.

Experts believe this delay could be a factor in pancreatic cancer’s low survival rates.

Luckily for Kate, she was eligible for a pilot scheme trialling a new way of treating the disease, which reduces the average wait for surgery from two months to just over two weeks.

In the trial, instead of first having an operation to fit a stent, patients were sent straight into main pancreatic surgery to remove the tumour.

This showed that performing one operation and addressing the jaundice at the same time, by removing the cause of the blockage, led to fewer complications and readmissions.

The pilot, involving 32 patients and held at University Hospital Birmingham, has been hailed as an exciting breakthrough.

It increased the number of patients whose surgery was successful by 22% — up from 8%.

While the researchers say they can’t assume this would be matched if the procedures were rolled out to the public (because the controlled environment of a trial doesn’t take into account real-life variables) it still raises hopes that many more lives could be saved.

Consultant hepatobiliary and pancreatic surgeon Keith Roberts, who led the trial Kate took part in, said: ‘Pancreatic cancer is awful and we as a profession have struggled to improve the outcomes.

‘Patients have had to wait for surgery to remove their tumours because they typically present with jaundice and we have treated them for that first.

‘The operation to treat the jaundice is itself unpleasant and not without risk,’ he adds.

‘The bile duct is usually a sterile environment, but inserting a stent increases the risk of infection from the bowel.

‘This is before you consider the fact that waiting two months to have cancer surgery is not a nice thing to do — particularly when you’re dealing with one of the most aggressive cancers there is, where every day counts.’

BY FIRST working closely with hospitals to speed up referrals for patients, then reorganising how the surgery was carried out, Mr Roberts and his team reduced the average wait to just 16 days.

‘Surgery is the only treatment for pancreatic cancer that can save lives,’ says Alex Ford, a pancreatic cancer expert.

‘‘If we can ensure that hundreds more patients have their tumours successfully removed each year, it could be a huge breakthrough in treatment.

Within a week of having tests done, Kate’s tumour was removed, as well as her gall bladder and part of her colon.

After six months of chemotherapy, she is now in remission. And though she takes medication with every meal to aid her digestion, she is otherwise fit and well.

She plans to run another half marathon with Sarah and her other daughter Rachael in the near future in aid of Macmillan Cancer Support.

‘People, including friends in the medical profession, have been astounded by how quickly I received my treatment and how well I’ve recovered,’ she says.

‘I was very lucky that they only found microscopic evidence of the cancer spreading to one of my lymph nodes — a two-month wait for surgery could have made the outcome far worse as this cancer is so aggressive.

‘I’m so grateful for the care I received. I hope others can be as lucky as I have been.