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Can 'Hot' Chemo Treat Bowel Cancer?

Published on 16 March 2017 back to previous

More than 35,000 Britons are diagnosed with bowel cancer every year. 

Robert Holt, 71, a deputy manager for Oxfam from North London, has been treated with a new form of 'heated' chemotherapy given during surgery, as he tells SOPHIE GOODCHILD.  

THE PATIENT

Early in 2010, I started to feel exhausted without reason. Even after a good night's sleep, I'd be so tired in the day that I'd doze off at work.

After a few months, I went to my GP, who gave me a blood test, which showed I was anaemic, so he prescribed iron pills.

But I continued to feel tired. I went back multiple times for more tests over the following few months, but all came back normal.

Then, in early 2011, after other possibilities were ruled out, I was referred to hospital for tests.

A doctor used a thin tube with a camera on the end to examine my bowel and I also had a CT scan.

Ten days later, I went in with my wife Mary to discuss the results and the doctor said I had bowel cancer — the tumour was bleeding, which had led to anaemia and tiredness.

The diagnosis was certainly a shock, but I felt the only option was to get on with it and remain positive.

The tumour was in part of the bowel called the colon and was small, but it had spread to the lymph nodes, which meant that it could spread through the lymph system throughout my body — so I needed surgery and chemotherapy.

For the next three and a half years after this treatment, I felt fine and scans were clear.

But, in January 2016, a routine CT scan showed a new tumour in my colon.

I needed surgery again and different chemotherapy drugs. This was more punishing than the first round: my hair fell out and I had to stop work because of the side-effects.

But a scan after the 12-week treatment showed the tumour was the same size as before surgery, meaning chemo hadn't worked and, again, there was a risk the cancer would spread.

Then my consultant said he wanted to try a new approach, where they remove the tumour with surgery and then fill your abdomen with hot chemotherapy liquid to kill remaining cancer cells — this is known as a 'chemo bath'.

My consultant said that this made the chemo more effective, as a higher dose reaches remaining tumour cells, and there are fewer side-effects because the chemo doesn't make contact with other organs.

Though I'd be one of the first patients in Britain to be treated with it, I trusted my consultant and felt I had to try it. It was my only option.

I had the chemo bath last July under general anaesthetic. Afterwards, there was no pain, but I had the usual post-chemo feeling of having been knocked out.

I spent three weeks in hospital, but, by the time I was discharged, the tiredness had disappeared. 

I returned to work in October and, so far, the scans and blood tests show there's no cancer left, which is a relief.

I feel well and don't have any symptoms. Our daughter is getting married this year, so we're very much looking forward to that.

THE SURGEON

Jamie Murphy is a colorectal consultant at Imperial College Healthcare NHS Trust.

Symptoms of bowel cancer can include bleeding and changes in bowel habits, as well as weight loss.

But another potential sign is extreme fatigue triggered by anaemia, which is the result of the tumour bleeding.

Robert had cancer in the colon — this is a tube about two metres long that runs from the small intestine to the rectum.

The normal way to treat colon cancer is surgery, but, if it has spread, the patient will also need chemotherapy. 

However, for patients such as Robert, whose cancer has returned, it is considered incurable.

We can remove any visible tumours surgically, but we know from experience that there will be clumps of cancer cells on the surface of abdominal organs that we haven't removed.

These cancer cells are invisible and conventional chemotherapy is not very effective at killing cancer on the surface of abdominal organs as it travels in the general bloodstream and doesn't reach these areas.

The patient may be offered additional chemo to extend their life as it can stop the cancer growing, but it cannot kill it.

But now we can offer surgery followed by a form of chemotherapy called hyperthermic intraperitoneal chemotherapy (HIPEC), which can kill off the cancer cells more effectively and stop them returning.

Essentially, after we cut out the bulk of the tumour, a chemotherapy drug is pumped, in a highly concentrated and heated form, directly into the abdominal cavity, so that it makes direct contact with the cancer cells.

This differs from conventional chemotherapy, which is delivered into a vein and enters the bloodstream, meaning it reaches other organs and causes unwanted side-effects.

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