3,000-volt jab that shrunk my ‘inoperable’ cancer by half
EVERY year, thousands of cancer patients are told they are unsuitable for surgery because their tumour lies too close to vital organs. Michelle Reid, 41, a human resources manager from Glasgow, was the first in Britain to undergo a new technique, as she tells RACHEL ELLIS.
THE PATIENT
EIGHTEEN months ago, I came round from a cancer operation to be told by the surgeon that it had failed and there was nothing more he could do for me.
I’d gone into hospital to have two tumours removed from my liver, but when they opened me up, they found six. Of particular concern was one situated right next to my heart.
The cancer was spreading, and the surgeons felt cutting it out wouldn’t stop it, so decided to do nothing. It was devastating and I was really frightened.
I’d been diagnosed with adrenal cortical cancer — cancer of the adrenal glands, which sit next to the kidneys — in July 2008, just after my 38th birthday and a few months after the birth of my only child. Doctors told me it was a very rare type.
I went straight in for surgery, and that first operation was a success, but subsequent courses of radiotherapy and chemotherapy failed to keep the cancer under control and soon more tumours began to appear.
So after this second operation had failed, I had no idea what I’d do next. The doctors said they’d try another course of chemotherapy, but I had no faith in that. I was desperate.
A friend recommended I contact Dr Edward Leen, a cancer specialist at the Hammersmith Hospital in West London, so I emailed him my scan results. Immediately he said he could help.
MY FIRST treatment with him was radiofrequency ablation therapy, where they heat the tumour to kill the cancer cells. It successfully destroyed some of the tumours in my liver, but he said it was just too risky for the tumour next to my heart, which was now six centimetres wide.
Thankfully, Dr Leen had another option — a new machine called Nanoknife, which destroys tumours by applying an electric current. This makes the tumour cells burst and die. Because the tumour isn’t heated, he could use it without damaging my heart.
Dr Leen told me it was a new procedure, with little known about its long-term success. I would be the first in the UK to try it, but I didn’t think twice. I had nothing to lose.
I travelled to London for the procedure last March and was given a general anaesthetic. It took about 45 minutes and when I woke up I was in no pain. There were two small puncture marks where the needles had been inserted in my abdomen.
I was allowed home the next day, but it took me a few days to fully recover from the anaesthetic. Scans have shown that the tumour by my heart is now three centimetres wide, and is continuing to shrink. It’s great news. Since then, I have had a second Nanoknife procedure, last September, to keep the smaller tumours in my liver under control.
I have also changed to a new chemotherapy pill called sunitinib which I take every day and this seems to be keeping the cancer under control — no new tumours have appeared since the last NanoKnife treatment — and I feel well.
THE SPECIALIST
Dr EDWARD LEEN is professor of radiology at Imperial College London NHS Trust Hospitals and at the Princess Grace Hospital, London. He says: WHILE surgery is generally the best option for cancer patients, some tumours are inoperable because they sit next to major organs.
Over the past 20 years, a common treatment for such patients has been radiofrequency ablation therapy.
This involves heating up the tumour using high frequency electrical energy and literally ‘cooking’ it until the cancer cells die. But while this treatment has helped many thousands of patients, it does have limitations.
The body’s natural reaction to heat is to cool the area by increasing blood flow to the region heated.
So if a tumour is situated near a large blood vessel, the blood may act as a cooler to the radiofrequency, meaning we cannot reach the temperature required to kill the cancer cells.
Furthermore, if the tumour is near other vessels or the bowel, these can rupture from the heat which can be life-threatening; if it’s near the lining of the lungs or liver this can be very painful.
So for those with awkwardly placed tumours, the only treatment doctors can offer to stop the cancer spreading is chemotherapy. However, it is now widely accepted that chemotherapy works better if as much of the tumour as possible is removed first. So for those who are unable to have surgery, the prognosis is poor.
Nanoknife, a brand new kind of cancer treatment introduced in the UK last March, circumvents these problems.
Instead of heating up the tumour, a high-voltage electric current is passed through it. This perforates the membranes of the tumour cell, so the contents leak out and die.
Using an electric current rather than heat reduces the risk of impact on the surrounding cells.
By perforating the cells, it also potentially allows chemotherapy — generally administered after the operation — to work more effectively on the cancer cells.
Patients undergoing the Nanoknife procedure are given a short general anaesthetic and are temporarily paralysed using a muscle-relaxing drug called pancuronium to prevent them from spasm during the electric shock.
If the muscles are relaxed, the electric shock causes no harm to the patient.
ONCE in the operating theatre, two fine needles — about one to two millimetres in diameter — attached to the Nanoknife machine are guided through the skin using ultrasound or CT scans, to the site of the tumour. There is no opening up of the patient.
A 3,000-volt electric current is then passed between the electrodes, through the tumour and a one centimetre area around it to make sure all the cancer cells are destroyed, for less than two minutes. Patients are kept in overnight to monitor their blood pressure and pulse.
For most with advanced cancer, the procedure will be followed up by a course of chemotherapy.
So far, 49 patients have undergone this procedure at the Hammersmith and Princess Grace Hospitals.
The only side effect reported by patients is discomfort if the needle goes through muscle, causing minor internal bruising.
In patients who have had more than one treatment, like Michelle, some may experience flu-like symptoms — the body’s normal reaction when it is trying to get rid of a large amount of dead tissue.
Although this is a new technique, it is already approved for use in the U.S. and UK.
Last year an Australian study published in the Journal Of Vascular Interventional Radiology showed the treatment completely destroyed 83 per cent of primary liver tumours.
Michelle’s tumour shrank to half its size within six weeks. This is a major improvement on radiofrequency ablation, where the lesion takes six to 12 months to shrink.
It takes less time to do, has fewer side effects and patients can have it multiple times if the cancer returns.
If extended to other hospitals around the country, Nanoknife could help thousands of cancer patients. However, more research still needs to be done before it can be made widely available.
THE treatment costs about £10,000. NHS patients are currently being treated as part of a clinical trial.