The 3D scan helping surgeons treat ‘inoperable’ tumours ME AND MY OPERATION
NEW computer software that creates a 3D image inside a patient’s body is transforming cancer treatment. Teacher Heather Davies, 59, who lives near Worcester, had a groundbreaking procedure, as she tells DAVID HURST.
THE PATIENT
THE first signs something wasn’t right were in May last year. I discovered a little blood in my stool and started getting tired. I couldn’t keep up with my husband John when walking and work became too much for me. I’m a supply teacher and started having to turn jobs down because I didn’t have any energy.
I also needed to go the loo more often. So I saw my GP, who referred me for further investigation. The consultant did some tests and I was told theyshowed I had bowel cancer. I was devastated: there is no history of it in my family, I have a healthy lifestyle and have never smoked.
My tumour was large — 7 cm (2¾ in) long. What’s more, the consultant told me surgery wouldn’t be possible — they wouldn’t be able to see the cancer and reach it because it was in an awkward place in my back passage, so my lower spine and bladder were in the way.
I had chemotherapy and radiotherapy to reduce the size of the tumour.
At that point, my consultant said with chemo I could live a couple of years, but my death was inevitable. However, there was a new treatment he’d heard about and recommended I saw the surgeon Simon Radley.
After examining me, Mr Radley said he’d be able to operate, using a procedure called Pelvic ImageGuided Surgery, where they would take MRI and CT scans of my body and use computer software to convert them into 3D images, so they could have a clear image of inside my body while they operated.
Mr Radley told me that as he’d be operating close to my sacrum — a bone at the spine’s base — there was a danger my nerve endings would be affected, I might find walking and bladder control difficult.
BUT I had no choice. If I didn’t have this procedure I would die.
So I had the operation at the Queen Elizabeth Hospital in Birmingham in January. I had private cover, but otherwise Mr Radley would have done it on the NHS.
It was a major operation, which took 12 hours, and I was in hospital for 5½ weeks afterwards. even so, I was able to start gentle exercises within a few days of the operation.
I’ve been home since March, and every day I feel stronger. For four weeks after leaving hospital I took paracetamol and trama-dol for pain relief, but I only take paracetamol two or three times a day. I have pain in the area where I had the operation, but it’s easing all the time.
I’ve seen Mr Radley twice since I’ve been home and the signs are that the cancer has completely gone.
I’m still having some issues with bladder control, but Mr Radley had warned me of this possibility. It seems to me to be such a small problem when I’ve been lucky enough to have had such a miraculous outcome.
THE SURGEON
SIMON RADLEY is a colorectal surgeon at the Queen Elizabeth Hospital, Birmingham. SOMe 40,000 people are told they have bowel cancer every year in the UK. Most bowel cancers develop from growths known as polyps.
Though polyps are usually non-cancerous, but, if untreated, the cells can change and start to grow in an uncontrolled way. Polyps generally don’t cause any symptoms, but when they become bigger or turn cancerous, the signs include a change in bowel habits — usually a looser and more frequent stool, bleeding from the bowel, abdominal pain, bloating, loss of appetite and unexplained weight loss.
Fatigue and breathlessness can be a problem, caused by anaemia as a result of the persistent blood loss.
If diagnosed early, bowel cancer can be treated successfully. However, many patients have no symptoms until the cancer is advanced. In this case, the fiveyear survival rate is less than 10 per cent and a cure is unlikely.
The main treatment is surgery, which involves removal of the affected part of the bowel and the surrounding lymph nodes.
However, in 35 per cent of bowel cancer cases the tumour is in the rectum, the lower part of the bowel. Surgery here is more difficult because the rectum is within the pelvis, a confined space that makes it hard for surgeons to see where they are operating.
The tumour may also be close to organs such as the bladder, prostate or uterus, or the sacrum, the last piece of the spine.
Surgeons tend to be nervous about operating near the sacrum or removing it because of the potential for nerve damage, which can affect bladder and limb function.
Pelvic Image-Guided Surgery is based on technology that was originally developed for the treatment of brain tumours. It’s also been used in orthopaedics, spinal surgery, facial and ear, nose and throat surgery.
I joined forces with Lee Jeys, an orthopaedic surgeon and bone tumour expert, to develop this surgery for the treatment of rectal cancer.
Traditionally, surgeons rely on their knowledge and X-rays taken during the operation to work out where to operate.
But with this technique, several days before surgery we take internal images of the patient using CT and MRI scans. We use sophisticated software to fuse these images and convert them into a 3D map of the patient’s body and the tumour, so we can plan how we will operate.
During surgery, the cutting instruments we use are fitted with trackers, and we use an infra-red system linked up to the computer so that the tips of the instruments show up on the 3D map.
The major advantage is that we can pinpoint precisely where the tumour is, meaning we avoid leaving any of it behind — thereby reducing the risk of the cancer recurring — and also ensure the minimum amount of healthy tissue is damaged.
The system warns us if we are cutting too close to nerves.
WHERE this technique has been used for bone tumours, cases of damage to healthy tissue have reduced from more than 25 per cent to less than 6 per cent.
Because of the area of the body we are operating on, there can be longer- term consequences related to bladder function — patients will need a catheter or tube, and this may be lifelong.
This is major surgery and patients can remain in hospital for four weeks or more.
There are risks of circulatory and respiratory complications as well as infection and bleeding after the operation.
Walking can be difficult initially after surgery, but most patients can eventually walk unaided after four to six weeks.
Ms Davies was the second person we have successfully performed bowel surgery on using this new technique. The procedure is not available anywhere else, but it may well become the standard technique in
the future.