Beat bowel cancer — with no need for a colostomy bag

ME AND MY OP­ER­A­TION TAR­GETED RA­DIO­THER­APY FOR BOWEL CANCER

Daily Mail - - Good Health - THE PA­TIENT

A NEW, less in­va­sive form of ra­dio­ther­apy is now rec­om­mended for bowel cancer by the health watch­dog. Ju­dith Blount, 49, a busi­ness­woman from Der­byshire, un­der­went the treat­ment, as she tells SO­PHIE GOOD­CHILD.

JUST over a year ago, I no­ticed there was blood in my stools, and went to see my GP. She ex­am­ined me but didn’t find any swellings which could be can­cer­ous, so pre­scribed tablets for piles. But the bleed­ing con­tin­ued, so two months later, I had a colonoscopy — in which a flex­i­ble tube with a cam­era on the end is in­serted into the back pas­sage — which iden­ti­fied a growth on the wall of my rec­tum.

The spe­cial­ist said it was prob­a­bly a be­nign growth but re­ferred me for more tests.

Two weeks later, those tests showed it was cancer — I was speech­less be­cause I had a healthy life­style, and no his­tory of cancer in my fam­ily.

The cancer was in the rec­tum, the last sec­tion of the large bowel. Although the tu­mour was small and had not spread, I broke down in tears.

The worst part was be­ing told I would need my en­tire rec­tum re­moved and have to wear a colostomy bag for the rest of my life. I was dev­as­tated be­cause it would have such a ma­jor im­pact.

Af­ter­wards, a friend told me he had seen a new treat­ment on TV called Papil­lon, which is done with­out surgery or a bag. I re­searched it and found it was a type of ra­dio­ther­apy which kills cancer us­ing low en­ergy X-rays, in­stead of the high en­ergy X-rays of con­ven­tional ra­dio­ther­apy, which can dam­age healthy tis­sue.

The only way to limit the dam­age is to re­duce the dose, which is less ef­fec­tive at killing the cancer. These low- en­ergy X-rays pen­e­trate tis­sue only to a depth of around 5mm, enough for a small cancer but not enough to dam­age other tis­sue.

I dis­cussed Papil­lon with my con­sul­tant, who said it was an op­tion, but em­pha­sised surgery would be needed if the treat­ment did not de­stroy all the cancer. I had noth­ing to lose and there was a chance I’d avoid hav­ing a colostomy bag.

I was re­ferred to Jamie Mills at Not­ting­ham Univer­sity Hos­pi­tal, who said the suc­cess rate of Papil­lon for my type of cancer was 95 per cent.

I gave up work be­fore start­ing treat­ment — my first ses­sion was in Oc­to­ber. I had three ses­sions and wore pa­per shorts with a flap at the back and bent over a treat­ment couch.

I was awake through­out but didn’t feel any­thing. The doc­tors ap­plied a lo­cal anaes­thetic gel and a cream to re­lax the sphinc­ter mus­cles to make it eas­ier to insert the ap­pli­ca­tor, which took a minute and a half to do its work. I felt slightly sore for two days af­ter but had no other side-ef­fects.

Af­ter my fi­nal Papil­lon ses­sion, I went back to work. The doc­tors pre­scribed five weeks of ra­dio­ther­apy and a twice- daily chemo­ther­apy tablet to kill any cancer that was left.

The rec­tal cancer has gone and I am no longer pass­ing blood. I have re­cently done the Derby 10km run and am back trav­el­ling as nor­mal. For me, Papil­lon was the best op­tion and avoided the life - chang­ing ef­fects of a colostomy bag.

THE SUR­GEON

Jamie mills is a con­sul­tant clin­i­cal on­col­o­gist at Not­ting­ham Univer­sity Hos­pi­tals NHs Trust BOWEL cancer is of­ten mis­di­ag­nosed as con­di­tions such as IBS or piles be­cause some symp­toms are the same.

life­style fac­tors like eating ex­ces­sive amounts of red or pro­cessed meat can in­crease the risk. Other trig­gers in­clude a fam­ily his­tory and be­ing aged 50 or older, but some­times the cause is un­known, which was the case with Ju­dith.

The bowel is the part of the di­ges­tive sys­tem that goes from the stom­ach to the anus and is di­vided into the small and large bow­els. Bowel cancer is cur­able if caught early.

Tiny can­cers can be re­moved dur­ing a colonoscopy when a thin flex­i­ble tube is passed into the bowel and a wire burns off the growth.

For larger growths, the tu­mour is cut away sur­gi­cally along with the sur­round­ing sec­tion of tis­sue to en­sure no cancer is left be­hind. Af­ter­wards, the sur­geon tries to sew the re­main­ing parts of the bowel to­gether.

How­ever, one in ten pa­tients who have surgery will need a colostomy bag be­cause their cancer is low down the rec­tum and close to the anus.

Not enough tis­sue will be left to re-join the bowel so sur­geons get around this by mak­ing an open­ing from the rec­tum to the ab­domen for waste to pass through into a bag at­tached out­side. Many pa­tients find adapt­ing to these bags dif­fi­cult be­cause you have to cope with leaks, avoid foods that can cause di­ar­rhoea and it can af­fect their abil­ity to travel.

we have been us­ing a form of ra­dio­ther­apy known as Papil­lon, an al­ter­na­tive to surgery which re­duces the like­li­hood of a per­ma­nent colostomy bag.

Most hos­pi­tals of­fer only ex­ter­nal ra­dio­ther­apy, an ef­fec­tive treat­ment for reach­ing deep- seated tu­mours but which dam­ages healthy tis­sue so isn’t al­ways best for small tu­mours (less than 3cm wide) on the rec­tum sur­face.

Papil­lon — named af­ter the French pro­fes­sor who pop­u­larised the tech­nique — uses a metal rod in­serted through the rec­tum un­til it touches the tu­mour, where it then de­liv­ers low- en­ergy X-rays to kill the cancer cells with­out dam­ag­ing nor­mal tis­sue. Doc­tors can de­liver a much higher dose of X-ray ra­di­a­tion — the equiv­a­lent of five weeks of ex­ter­nal ra­dio­ther­apy in a sin­gle Papil­lon ses­sion.

Any sur­gi­cal pro­ce­dure car­ries risks and comes with com­pli­ca­tions such as bleed­ing, in­fec­tion and stroke. So older or un­fit pa­tients or those with ex­ist­ing heart con­di­tions wouldn’t be suit­able for surgery, and Papil­lon would be a bet­ter op­tion.

Younger rec­tal cancer pa­tients who don’t like the idea of surgery or colostomy bags can ask to be con­sid­ered, too.

Like an X-ray, the treat­ment is pain­less apart from some discomfort around the rec­tum where the ap­pli­ca­tor is in­serted, and there is bleed­ing in around a quar­ter of cases.

Be­fore in­sert­ing the X- ray ap­pli­ca­tor, we mea­sure the size of the tu­mour with another tube and select the right size ap­pli­ca­tor. The ap­pli­ca­tor is then in­serted via the tube un­til it is in con­tact with the tu­mour — it is at­tached to the X-ray ma­chine via a metal rod which emits low-en­ergy X-rays.

These go through the tube and di­rectly de­stroy the cancer on the other side, break­ing up the DNA in the cells un­til there is not enough for the cells to re­pair them­selves, so they die. This takes about a minute and a half.

with an early- stage small tu­mour in the rec­tal lin­ing, surgery has a 95 per cent cure rate and Papil­lon be­tween 90 to 95 per cent.

Papil­lon is less ef­fec­tive for larger can­cers or ad­vanced rec­tal can­cers be­cause it can­not pen­e­trate into the deep lay­ers and be­cause larger tu­mours need more pow­er­ful treat­ment such as surgery.

All types of bowel cancer are treat­able with surgery, whereas Papil­lon is only for the rec­tum be­cause the straight rod used can­not pass through the bends of the bowel.

The fact that NICE has now rec­om­mended its use for pa­tients with early-stage rec­tal cancer means I ex­pect to see more take-up.

It is a valu­able ad­di­tional treat­ment and in­creases the op­tions for pa­tients.

ANY DRAW­BACKS?

‘SURGERY is the gold stan­dard treat­ment which car­ries the low­est risk of the cancer re­turn­ing,’ says Alexan­dra Ste­wart, a con­sul­tant clin­i­cal on­col­o­gist at the royal Surrey County Hos­pi­tal.

‘If pa­tients are fit for surgery but choose to have Papil­lon treat­ment, they must be will­ing to un­dergo more in­ten­sive sur­veil­lance to en­sure the cancer has not re­turned be­cause there is still not enough data on whether it is ef­fec­tive in re­duc­ing cancer re­cur­rence.

This means ex­am­i­na­tions and MRI scans ev­ery three months for two years. There is a slightly higher risk of the cancer re­turn­ing — 10 to 15 per cent with Papil­lon ver­sus 5 per cent with surgery. If the cancer does re­turn the pa­tient will need stan­dard surgery and then have a colostomy bag fit­ted.’

PAPIL­LON costs £6,000 on the NHs and £9,000 pri­vately.

No side-ef­fects: Ju­dith Blount

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