radiotherapy centre - male patient lying down under a gamma camera

Who Was The First Person To Be Treated With Radiotherapy?

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For over a century, people who have cancers, lesions and growths have been advised to go to a radiotherapy centre, where one of the most advanced medical treatments ever invented is used with utter precision to reduce, remove and destroy potentially cancerous cells.

It is the ultimate example of the iterative nature of medical advances, as this cutting-edge technology allows for treatments such as the Gamma Knife to be used effectively to treat brain tumours without causing harm to a particularly delicate part of the body.

As its inventor Lars Leksell once noted, there is no level of precision too precise for the brain.

However, radiotherapy is at least half a century older than the Gamma Knife, and the idea of using radiation to treat disease is almost as old as the discovery of radiation itself.

One Year Later

On 8th November 1895, Wilhelm Roentgen discovered X-rays largely by accident, and within a year of a discovery so groundbreaking it invented the field of radiology, it would also be the inspiration for another new field of medical treatment.

He published his original paper a month later on 28th December 1895. A week later, a newspaper in Austria reported the discovery of a new type of radiation, and within weeks of this, doctors were already experimenting with the potential for X-rays not just for diagnosis but for treatment.

Emil Grubbe claimed to be the first person to attempt to treat cancer with X-rays, although the evidence on this is somewhat disputed. Meanwhile, Leopold Freund and Eduard Schiff suggested within a month of the announcement that X-rays could be used to treat diseases such as lupus.

However, the first major treatment using radiation and one of the most influential medical cases in the field of radiotherapy was by French doctor Victor Despeignes, who showed just how effective radiation could be in the treatment of disease if used correctly.

This remains the case even if Dr Despeignes was very wrong about why he thought it would work.

Accidentally Correct

In the middle of 1896, the Lyon-based doctor was visited by a man with an abdominal cancer tumour the size of a baby’s head, and he endeavoured to do what he could to save the man’s life using what were at the time somewhat experimental means.

At the time, conventional medical knowledge claimed that cancer was a parasitic infection rather than a mutation of cells, and so he believed that the antibacterial effects of radiation could be effective at killing the cells

He was right, but not for the right reasons.

Using a Crookes’ tube and half a dozen Radiguet batteries, Dr Despeignes agreed to use radiation to try and kill the cancer, alongside three other treatments at the same time, starting on 4th July 1896.

The man was given a diet of milk and condurango, he was injected with artificial serum and provided a combination of morphine, opium and chloroform to relieve the pain.

These, in combination with twice-daily half-hour radiation treatments, did seem to help relieve the pain for the patient and halved the size of the cancerous tumour, but unfortunately, 20 days after the start of treatment, the 52-year-old man died.

It was far from a controlled experiment, with the issues with artificial serum already known at the time, the dangers of two opioids and chloroform established in the century since, and condurango is an exceptionally controversial choice of ingredient to use.

At the time advertised as a cancer cure and a digestive medicine, condurango could have potentially caused a side effect if the man had a latex allergy.

Because of this, it was easy to look at the positives of the case. The fact that such a huge tumour was reduced by half so quickly was seen as a massive success, and the pursuit of radiotherapy would increase as a result.

It is likely to be the first-ever treatment of cancer with radiation that produced a positive effect, but even if there was an earlier case, Victor Despeignes was the first to be widely reported. Dr Freund’s case the same year was only published in 1901 even if it was first done in 1896.

It created a huge amount of interest in the medical community for radiotherapy and the first successful treatments followed before the end of the 19th century, even if the understanding of how radiation worked and why it affected cancer cells would take a few more years to truly be understood.

However, these early treatments helped to establish the principle, and the following century would turn radiotherapy into a vital, front-line treatment for cancer.

radiotherapy centre - Doctor with x-ray image

What Patients Can Do To Enhance Cancer Treatment Outcomes?

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Modern cancer treatments can be very effective and over half of cancer patients in England and Wales now survive for ten or more years after receiving their diagnosis. Thanks to being seen quickly, technology advancements, and increasing awareness over symptoms, more and more people are living a full and healthy life after their cancer.

While treatments, such as radiotherapy, chemotherapy, and surgery, have high success rates, it is also important that patients do what they can to improve their chances of survival. 

Here are some things they can try to enhance the outcome of their treatment. 

Help your body recover

The side effects of chemotherapy and radiotherapy can often be very difficult to manage, and can include hair loss, fatigue, diarrhoea, constipation, nausea, vomiting, loss of hearing, digestive complaints, a greater risk of infection and anaemia.

Bruising, mouth ulcers, insonia, skin and nail changes, impact on the nervous system, poor kidney function, a lower sex drive, an increased risk of blood clots, reduced fertility, tingly hands or feet, and lack of appetite are also commonly experienced among cancer patients.

As your body is going through such a huge ordeal, with healthy cells being damaged or destroyed as well as the cancerous ones, it is important to help it recover as much as possible. 

This involves taking care of yourself, or if you are unable to, making sure someone can look after you instead. 

A nutritious diet, staying hydrated, having plenty of rest, and taking exercise when you feel up for it can all do wonders to help your body recover from treatment, and get you back to feeling more like yourself. 

Eat well

One of the most important things to do after cancer treatment is to eat a well-balanced diet, so you can be sure your body is getting the nutrients and energy it needs. This means reducing processed foods, such as ready meals, puddings and packaged items, and eating a more wholesome diet. 

Although lots of patients lose their appetite, feel sick, or have mouth ulcers when they are recovering, which can all put them off eating, it is essential to get enough protein, carbohydrates, vitamins and minerals to fuel your body when it is at its weakest. 

It is also sensible to limit alcohol, as this could affect the treatment, and potentially make the side effects worse. For instance, if you have mouth sores or have been vomiting regularly, drinking alcohol can make this very uncomfortable and exacerbate symptoms. 

Stop smoking

Smoking is the biggest cause of cancer, and is responsible for at least 15 types. Therefore, it is not wise to carry on smoking after being diagnosed, as it could encourage the cancer to come back or put you at a higher risk of developing another form of cancer.

Even the occasional cigarette increases your chances of getting cancer, with each one containing 5,000 different chemicals. 

Cancer Research UK warns “there is no safe level of smoking”, so those in recovery should stop immediately and lower the risk of developing a tobacco-related illness. 

Keep your weight stable

Despite the widespread awareness of the risks of obesity, more than a quarter of adults in England fall into this category, and an additional 37.9 per cent of people are overweight.

However, being overweight or obese is the second biggest cause of cancer in the UK, as the extra fat in the body sends signals to cells to divide more often, which can result in cancer.

Therefore, it is a causing factor in more than one in 20 cases, with the risk of developing cancer being higher the heavier you are and the longer you have been overweight. 

That is why it is essential for patients who were either obese or overweight before their treatment to try and maintain a healthy weight instead. By eating well, doing exercise, and being more active in daily life, they can start to lose the extra pounds and reduce their risk of developing cancer again. 

Follow-up appointments

As well as taking good care of yourself and possibly making changes to your lifestyle, it is essential to continue with follow-up appointments. If the treatment is successful, the patient can go into partial or complete remission, which means the signs of the cancer have been reduced or have completely disappeared.

However, cancer can always come back, with most doing so within five years of having treatment. This is why it is essential that patients not miss their regular scans or tests to check whether it has returned.

It is also important they consult with the radiotherapy centre if they are concerned about any symptoms or abnormalities in their body that they believe could be a sign they are no longer in remission.

Radiotherapy for brain tumour - swimmer athlete doing crawl stroke

Swimmer’s Tumour Diagnosis Highlights Radiotherapy Role

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Brain tumours come in many forms and the methods of treating them can vary in all sorts of ways. For some, the tumour is non-cancerous and can be managed, but for others the most serious treatment is needed to prevent an inevitable death from brain cancer.

While some can have all or part of a tumour excised through invasive surgery, this is not always possible, because the tumour can often be located on a part of the brain where the use of surgical instruments would cause fatal damage to the surrounding tissue. At this point, only non-invasive options remain, such as radiotherapy.

Swimmer Reveals Diagnosis

An individual who now finds himself in this situation is Scottish swimmer Archie Goodburn. The 23-year-old, who represented Scotland in the 2022 Commonwealth Games and narrowly missed qualification for this summer’s Olympic Games in Paris, has gone public with his diagnosis of three large oligodendrogliomas, a form of cancer affecting both the brain and spinal cord.

He began having unusual symptoms in December last year, revealing via his Instagram account: “They would leave me with a loss of strength and a numb sensation on my left side, a deep feeling of fear, nausea and extreme deja vu. I now know that these were in fact seizures.”

Once the Olympic trials were over, he had an MRI scan and established the cause of his problems. The diagnosis itself was bad enough, but so too was the news that the nature of the tumours made them inoperable.

However, they can be effectively treated by a combination of chemotherapy and radiotherapy. This was a point that Mr Goodburn was quick to note in his post, stating: “The silver lining to this diagnosis is that oligodendrogliomas generally respond better to radiotherapy and chemotherapy than many other serious brain tumour types.”

Oligodendrogliomas Explained

Oligodendrogliomas account for around three per cent of all brain tumours. They are primary tumours that originate in the brain rather than spreading from elsewhere in the body, a factor that makes it impossible to safely excise them.

It is very rare for anyone to be cured completely of these tumours, so their prognosis depends primarily on the kind of oligodendrogliomas the patient is suffering from, while the exact symptoms will depend on which part of the brain they are growing on.

Grade II is a slow, moving tumour and the average survival time after diagnosis is 12 years. An anaplastic grade III tumour is much more aggressive and the typical post-diagnosis survival time is only 3.5 years.

In his post, Mr Goodburn said the tumours are “slow growing and are likely years old,” which appears to indicate they are grade II, giving him a better chance of longer-term survival.

Radiotherapy may be particularly effective in slowing down and even shrinking the tumours, and it may be that it does more than simply extend life in this case, as research is taking place into other therapies that may have a transformative effect in due course.

A New Hope?

Writing about these, the swimmer noted that in his case the tumours “express a mutation of my IDH1 gene that is shared with some forms of leukaemia.” with IDH inhibitor drugs seeing “phenomenal developments” in recent years, which offers the possibility of the emergence of transformative treatments that could radically improve his prognosis.

This highlights a major hope for many people who are suffering from brain tumours, even ones that cannot be operated on. Radiotherapy can do more than just reduce symptoms and buy time to allow patients to live for longer. In some instances, they may allow people to survive long enough to benefit from an emerging new therapy.

Whether this will be enough to cure the tumour completely in the case of Archie Goodburn or at least enable him to live normally and continue his competitive swimming career will depend on the success of attempts to advance IDH inhibitors, but it does show that there is at least hope.

Why Patients Should Take Courage

Furthermore, it shows that if you are a patient who is facing the prospect of radiotherapy, whether by gamma knife or any other method, the side effects you may suffer, ranging from tiredness and skin irritation to emotional effects and a loss of appetite, will be worth it.

Depending on the kind of tumour, the treatment may bring a full cure, combine with other treatments (including in cases where surgery is an option) to deal with the problem, or at least give you many more years of life that might not have been possible before the development of modern radiotherapy.

In addition, it may just be that you could benefit from gaining extra years so that you can benefit from the emergence of new treatments.

radiotherapy centre - man does magnetic resonance therapy

Three Different Types Of Stereotactic Radiotherapy Explained

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Stereotactic radiosurgery (SRS) is one of the best treatments for cancer, as it focuses radiation directly into the tumours to kill the invasive cancerous cells. 

To find out more about the different types of SRS and how they work, read on. 

What is SRS?

Instead of removing a tumour through surgery, SRS works by projecting radiation into the targeted area.

It is normally used to treat rumours that are hard to access through surgery, such as the brain. When targeting other areas of the body, it can sometimes be known as stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy (SABR). 

This treatment damages the affected cells by targeting the beams into one area, making them unable to grow by closing off blood cells and, ultimately, causing them to break down. 

SRS, which uses 3D imaging to target the radiation beams, does not impact the surrounding tissue, which means healthy cells can remain intact as much as possible. 

Thanks to its ability to avoid damaging the area surrounding the tumour, it comes with reduced side effects compared with other types of cancer treatment, which is why it is becoming an increasingly popular choice. 

Some of the complications that are associated with SRS, however, are fatigue for the first few weeks; headaches, vomiting and nausea due to swelling in the brain if that is the area being treated; and irritation at the site. 

What are the three main types of SRS?

SRS varies depending on the type of treatment, whether it is gamma knife, proton beam therapy, or linear accelerator SRS.

Gamma knife 

Gamma knife radiosurgery is perhaps the most famous of all three, as it is an effective way of targeting brain tumours. 

It works by targeting around 200 beams of grammar rays into small or medium-sized tumours. This type of procedure can also be used to treat brain lesions. 

In most cases, a head frame is used, which fastens to the skull and prevents the patient from moving their head during the treatment, making sure the beams are targeted to the right area. 

They also typically have to wear a mask with hundreds of holes in over the head frame, which further helps direct the radiation beams. 

The length of the procedure varies depending on the problem and its location, with simple treatments taking just a few minutes while more complicated ones can take several hours. 

Proton beam radiotherapy 

Another form of stereotactic radiosurgery is proton beam therapy, which uses high energy protons to target the tumour. 

The procedure, which is painless for patients, works by reducing the size of the tumour through a dose of protons that provide a burst of energy when they stop. Therefore, if they are targeted at a tumour, this is where they explode and end up destroying the cancer. 

It is typically used in highly complicated brain, head and neck cancers where it is essential the surrounding healthy tissue is not impacted to prevent serious complications to the patient. 

Treatment tends to last around an hour and needs to be repeated daily over five days for six weeks. 

As with other types of radiosurgery, the side effects tend to be restricted to the site of the treatment. For instance, your skin might become sore or you may lose some hair. Additionally, patients often feel tired for a few weeks after. 

Linear accelerator (LINAC)

Linear accelerator radiosurgery is often known as LINAC, and treats cancers by targeting X-rays or photons to affected areas. 

Instead of radioactive material like Gamma Knife radiosurgery or protons like proton beam therapy, it works by using X-rays instead. 

LINAC is typically used to treat patients who have larger tumours or whose affected area is too big to target with Gamma Knife. 

It can, therefore, be used to treat areas of the body other than the brain, including breast, oesophagus, rectum, stomach, uterus, prostate, bladder, liver, bones, head and neck. It works by the machine moving around the site to target the tumour from different angles.

A course of treatments typically lasts between one and five sessions. The side effects from LINAC are usually temporary and tend to include skin changes, such as itching or irritation, as well as fatigue. 

There might also be other symptoms, including digestion issues or difficulty swallowing, depending on what area is being treated.  

The type of SRS your oncologist at the radiotherapy centre will suggest will depend on the location of the tumour, its size, its grade and severity. 

radiotherapy centre - Radiotherapy Oncology at Theageniο Hospital

How Could Radiotherapy Help Treat A Serious Eye Disease?

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An unmistakable trend in the evolution of treatments available at a radiotherapy centre is that technological advances will not only allow for more effective treatments but will allow existing and highly effective techniques to be used in previously unthinkable areas of the body.

By far the most fascinating recent example of this is the study that explored the potential for one of the most groundbreaking and revolutionary radiotherapy treatments ever developed and widely used to transcend the brain and be used to treat perhaps the only other part of the body that requires even more precision.

This allows for one of the most common eye diseases in the world to receive an effective, accurate treatment that could help reduce the need for constant, uncomfortable treatments that are not always easily accessible.

Stopping Rapid Vision Loss

Two of the most common eye conditions that can lead to a permanent loss of eyesight are known as age-related macular degeneration (AMD). True to their name, it is a pair of conditions that are common whilst ageing that progressively affect the centre of a person’s vision.

There are typically two kinds, both of which affect hundreds of millions of people in the world. The first, known as “Dry” AMD, is caused by the build-up of drusen, a fatty substance that collects in the back of your eyes and causes eyesight degeneration over several years.

By contrast “Wet” AMD often progresses very quickly, and within weeks and sometimes even days it can cause significant loss of sight in an eye, something that can easily become permanent.

This is caused by tiny blood vessels that grow to an abnormal size in the back of the eyes and affect vision that way.

With Dry AMD, there is no medical treatment as of yet, but with Wet AMD, the primary course of treatment is the use of anti-Vascular Endothelial Growth Factor medication, often known as anti-VEGF injections or simply eye injections.

They work by blocking the production of the VEGF that causes blood vessels to grow and work for nine out of ten people who try them, even causing an improvement of vision in nearly a third of people who have the treatment.

However, there are two problems that make it less than ideal as a treatment despite how effective it is.

The first is that whilst its effectiveness can vary depending on how quickly VEGF activates in the eye, it is typically done at least every three months but can be as often as every month.

This is compounded by the fact that the eye injection needs to be applied directly to the eye. Whilst numbing compounds and a lot of care is taken to make sure it does not hurt, it is still quite uncomfortable, and some people defer treatment out of fear of the long-term cycle of injections.

As well as this, it can also be quite an expensive treatment to receive privately, with some estimates claiming it can cost £800 per injection, something that adds up quickly if they are needed monthly.

For a long time, radiotherapy was suggested as a solution, but it was difficult to find systems that could be as precise or accurate enough to be used within the eye.

Lars Leksell once said that no tool is too precise when it comes to brain treatments, but for a long time, even some of the most precise brain treatments such as Dr Leksell’s own Gamma Knife were not easily adapted for use in the eye.

However, a variation of the stereotactic radiosurgery method he pioneered did produce results in the landmark study, as it lowered the number of injections required compared to more conventional treatments for Wet AMD.

It worked, much like it does for brain lesions, by using multiple smaller beams that converge at a precise point, maximising the effect whilst limiting exposure to radiation.

This not only saves money on injections but is also more comfortable and lowers the risk of people withdrawing from treatment which could be vital to save their sight. The treatment’s cost itself is significantly lower than the cost of a single injection.

In one particularly notable success story, one person underwent radiosurgery and did not need another injection for two years, and as of June 2024 has not had an injection since.

The treatment itself is still in an early stage. The trial, whilst promising, also only involved 411 participants, which is far too small a sample size given how common the disease is. A wider trial would be required to confirm that these were statistically significant and not just the effect of an outlier.

radiotherapy centre - breast cancer radiotherapy

When Were Linac Machines First Utilised For Radiosurgery?

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In a radiotherapy centre, there are generally two types of precise radiosurgery technologies available that are tailored to treat particular conditions.

The first, oldest and best known is the Gamma Knife, Lars Leksell’s stereotactic radiosurgery technique that uses multiple smaller beams precisely aimed to destroy tumours and lesions without any harm to surrounding tissue, in keeping with his philosophy that no tool used on the brain can be too precise.

However, Gamma Knife remains one of the leading treatments in precision radiotherapy and has been since its first use Sophiahemmet in 1968 and had been experimented with since at least 1949, the path to the use of Linac machines has been somewhat bumpier, and took longer for its use in radiosurgery to be truly appreciated.

Parallel Developments

The first linear particle accelerator (or Linac for short) was proposed in 1924 by Gustaf Ising and built four years later by Rolf Wideroe, but it was not until after the Second World War that the high-frequency oscillators needed to make Linacs useful for X-rays and radiotherapy possible.

The first Linac installed for clinical purposes was in Hammersmith Hospital, London in 1952, primarily used for conventional fractionation.

Fractionation is, in many respects, the opposite of radiosurgery, and is the use of multiple sessions of radiotherapy over the course of multiple weeks, which maximises the effects of the radiation on tumours whilst protecting healthy cells as much as possible.

In the absence of precision caused by difficulties in keeping Linac beams focused in the early 1950s, this was the best way to take advantage of the benefits of radiotherapy with the tools available, back when radiosurgery was limited to the brain through the Gamma Knife process.

Once Gamma Knife became widely available starting in the 1970s, it became the front-line treatment for brain tumours and other similar conditions in the brain, whilst Linac was primarily used fractionally for long-term radiotherapy, combined therapies with chemotherapy or for palliative purposes.

By the 1980s, however, as technology matured and more was learned about the role of radiosurgery in various treatment pathways, neurosurgeons started to look into the potential for using Linac machines to help treat certain types of epilepsy or arteriovenous malformations.

The first step towards this was the work of J. Barcia-Salorio, a neurosurgeon from Spain who was the lead writer of a 1982 paper suggesting that a potential alternative to invasive surgery would be the use of photon radiosurgery, either using radiation generated from cobalt or using a Linac.

This effectively meant starting from scratch when it came to developing an effective, accurate radiosurgical system, aided by advances in computerised tomography not available back when Lars Leksell was working on the Gamma Knife but had just started to mature in the 1980s.

The first system that took Dr Barcia-Salorio’s conceptual ideas for a Linac radiosurgery system was in 1984 in a paper by O. Betti and V. Derechinsky, both based in Buenos Aires, Argentina

Their system used a frame similar to Dr Leksell’s, albeit using Talairach space rather than Dr Leksell’s own coordinate system, and combined that with intense cross-firing Linac photon beams that converge at the same point to provide an intense dose of targeted radiation without affecting the tissue in the way.

It highlighted that Linac technology had advanced to the point that it was precise enough to at least consider using it as a versatile alternative to the Gamma Knife, and after the 1984 paper, a number of radiosurgery experts started to look into solving the remaining issues surrounding Linac’s precision.

The big leap forward came with the work of Ken Winston and Wendell Lutz, who refined and improved the stereotactic positioning apparatus used and developed a method to measure component accuracy that was previously unavailable but served to benefit radiosurgery as a whole.

The first ever patient to be treated with a Linac-based radiosurgery machine was at Brigham and Women’s Hospital in Boston, part of Harvard Medical School in February 1986.

From there, Linacs have evolved further and become highly capable for both fractionalised radiotherapy and radiosurgery, both with a single focused beam or using the stereotactic process.

Typically, the difference is versatility, as Linacs typically require modification in order to be effective for radiosurgery, whilst Gamma Knife was designed from the start to be used for radiosurgery.

However, image guidance tools, N-localisers and advanced treatment planning tools have helped to make Linac machines more suited for radiosurgery and put the patient’s needs at the centre of any potential treatment pathway choice made by a radiographer.

Radiotherapy hospitals UK - multiple sclerosis

How Radiotherapy Can Tackle Multiple Sclerosis Symptoms

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improving outcomes for patients, reducing side-effects and expanding the number of treatments available at radiotherapy hospitals in the UK.

The extent to which this is the case is not always appreciated. Many people will be aware that it is possible now to treat various head and brain cancers. Some might even have heard of devices like the gamma knife. However, some will not know that radiotherapy can also be used in treating some non-cancerous conditions.

Not Just Cancer

Multiple sclerosis (MS) is an example of that. Anyone with MS may find they sometimes need to explain at length to those who ask just what the condition is. Many, for example, will not know that it is an autoimmune disease that specifically attacks myelin, the coating that protects your nerves.

As any sufferer knows, this can be a progressive condition that may display its first hints in your 20s but usually starts to display significant symptoms in the 30s, 40s, and 50s. Around 130,000 people in Britain have the condition.

Of these, 85 per cent have relapsing remitting MS (RRMS), which means the condition improves and then worsens many times, rather than primary progressive MS (PPMS), which is when the condition gradually gets more severe. However, some of those with RRMS will eventually of on to suffer secondary progressing MS (SPMS).

The problem with the loss of myelin is it means the nerves are exposed to damage that may not otherwise occur, which means the normal flow of signals that flow through the central nervous system from the brain to the rest of the body can be disrupted. This can lead to a deterioration of things like vision, memory, balance and emotions.

While most sufferers may be relieved when the condition eases at times and allows life to become less of a struggle, the knowledge that there will come a subsequent time of worsening symptoms will always cast a shadow. That is why it is important not to just accept it as a life sentence.

How A Gamma Knife Can Help MS Sufferers

There are various treatments, including gamma knife therapy offered by Mr Jonathan Hyam, our specialist in this area. Gamma knife therapy can be used to combat a symptom known as Trigeminal neuralgia. This condition produces severe pain in the trigeminal nerves, which carry signals from the brain to the face, making it one of the most painful MS symptoms.

Research has shown this treatment can be substantially effective in pain reduction, which could make dealing with it much less of a challenge for MS sufferers, particularly those in the 15 per cent who have PPMS as well as those with SPMS.

This kind of therapy can be complemented by a range of other treatments and steps that patients and their doctors can undertake to ease the consequences of MS in a range of different ways.

These can include steps like an intense chemotherapy known as HSCT – a form of powerful chemotherapy, as well as physio, disease-modifying drugs and also lifestyle changes such as better exercise, improved diet and stopping smoking.

Could A Diagnostic Development Help Achieve More?

While MS may not be as straightforwardly progressive as a disease like cancer, an early diagnosis does make it easier to treat the condition, with early steps having the potential to ensure that suffering is minimised in the years ahead.

However, the diagnosis is often achieved indirectly and belatedly, with many sufferers only discovering they have the disease when they start to suffer symptoms and visit the doctor thinking they have something else.

For this reason, any new diagnostic tool that can provide advance warning of MS could make a major difference. Whether through gamma knife therapy or other treatments, clinicians may be able to do far more in such circumstances.

New hope has just emerged in this important area. A blood test developed by the University of California at San Francisco could be a game-changer, revealing biomarkers at an early stage that can identify MS many years before any symptoms emerge.

Noting the significance of this for treating the condition earlier, Michael Wilson MD, senior neurologist at the university and one of the main authors of the paper on the test, said: “Over the last few decades, there’s been a move in the field to treat MS earlier and more aggressively with newer, more potent therapies,”

He added: “A diagnostic result like this makes such early intervention more likely, giving patients hope for a better life.”

This means that while there is much that can be done now to help MS sufferers using a gamma knife, there may be more still in the years ahead.

radiation centre - breast cancer

Breast Cancer Screening – Everything Patients Need To Know

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Many people are nervous about having a breast screening, mostly as they are worried what the results might show, and because they are not sure of what the process involves. 

Finding out about the procedure before stepping into the doctor’s office can make patients feel far more at ease, as they will not be faced with anything unexpected. 

Poor uptake in breast cancer screenings

When it comes to breast cancer screenings, although almost two million women attended their appointment in 2022-23 in England, 35.4 per cent who were invited did not. This is likely to be down to fear of the unknown and potentially hearing negative stories about the breast screening process. 

This increased to 46.3 per cent of women who received their first invite to a check, which comes after their 50th birthday. 

Of those who did attend, 18,942 women in England were found to have a cancerous lump in their breast, which might not have been discovered without the screening having taken place.

This shows just why attending a breast screening appointment, which is offered to women between the ages of 50 and 70 in England, is important, as it can detect something sinister that would have gone unnoticed and been able to spread. 

Health minister Maria Caulfield noted: “It is vital that women come forward for breast screening when invited, as early cancer diagnosis can make all the difference.”

She called for everyone to attend their appointment, adding: “It could be lifesaving.”

What are the barriers to breast screening?

Although the benefits of attending breast screenings are widely known, the figures show that many women are still reluctant to get themselves checked out. 

There are many reasons for avoiding screenings, including finding it difficult to book or reschedule their appointment. Some might not be able to take time off work for the screening, particularly if they are a full-time carer.

A lot of people struggle to travel to the breast screening venue, especially if they live in rural areas where public transport is limited. 

Additionally, some women might not receive an invite to a screening if they are not registered with a GP or have recently moved. 

There is also a stigma in some communities about revealing oneself and some women might not feel comfortable taking their clothes off in front of others. 

For many women, not knowing what to expect from their appointment can make them feel nervous and apprehensive about attending. 

They might not know what they should wear, for instance; whether they will be seen by a male or female member of staff; if the procedure is painful; and how long the whole thing could take. 

Their uncertainty about the event can deter them from coming, which could lower their chances of surviving if they are unfortunate enough to have a cancerous lump.

Deborah Tomalin, director of screening at NHS England, spoke about her experience of discovering breast cancer at her second check at 53. 

She stated: “I completely understand going for breast screening can feel daunting – some people might worry that it will be painful or be embarrassed to take your clothes off, but I can reassure you that the actual mammogram takes just a few minutes and any discomfort does not last long and the staff all look after you so well.”

Ms Tomalin added: “It really can save your life.”

What happens at a breast screening?

Knowing what to expect from a breast screening can alleviate anxiety about the procedure. For a start, it should only take around 30 minutes in total, during which four X-rays, or mammograms, are taken, two of each breast.

These will be carried out by female mammographers, who patients can talk to if they have any concerns before the X-ray.

Before the process, the patient will need to undress from the waist up and put a hospital gown on to preserve their modesty. They will also need to remove any necklaces and nipple piercings, and avoid using spray deodorant or talcum powder on the day of the appointment.

The mammographer will then place the breast on to the machine. For a few seconds, it will be squeezed between two plates while the X-rays are taken, which may be uncomfortable. The same thing is repeated for the other breast, so that images of both are taken. 

This is the end of the screening and the patient can then dress themselves again. They will then receive the results in the post a few weeks later. 

If any discomfort or pain is experienced during the mammogram, it is important to tell the mammographer who can stop it. 

It is also worth telling the staff of previous bad experiences with a screening, informing them of any nervousness or embarrassment, or any words they should not use as this will only increase anxiety. 

Receiving an abnormal result

Typically, four per cent of women are asked to return for more tests after their mammogram, as abnormalities have been found. This might not necessarily mean there is cancer, but another test, called a magnified mammogram, will be able to show clearer images of the problem areas. 

The hospital might even want to take cells from the abnormal area and run tests on them to determine whether they are cancerous or not. 

If it is discovered that the lump is breast cancer, patients need to consider their treatment options. Typically, this is done with surgery to remove the tumour, chemotherapy to attack the cancerous cells, or radiation therapy, which uses radiation rays to destroy the cancer cells. 

In terms of radiotherapy at a radiation centre, this can be delivered through external or internal radiation. The former targets the breast from outside of the body, while the latter involves placing a radiation device inside the breast tissue after surgery. This will deliver radiation on and off to the area for short bursts of time.

Treatment options will vary depending on the type of breast cancer, the size and the stage. 

Radiotherapy, for instance, could be used after surgery to reduce the risk of recurrence and kill any potential remaining cells, or it could be delivered to ease symptoms after the cancer has spread to improve quality of life; it could also be suggested in combination with chemotherapy to really attack the tumour. 

The patient’s oncologist will know the best course of action to take so their breast cancer is treated in the most effective way.

radiotherapy centre - radiotherapy initiation

Long Cancer Waiting Times Increase The Risk Of Spreading

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The importance of getting an early cancer diagnosis has been made public for years, encouraging people to get checked out by their doctor as soon as they become suspicious of a lump or any changes in their body. 

NHS missing cancer services targets 

Despite this, waiting lists for diagnosis and treatment are still long, with the NHS frequently missing their own targets. This means lots of individuals are not being treated early enough to have the desired results. 

Therefore, they are at a greater risk of the cancer developing and spreading around their body, making it harder to cure. 

According to the latest results on NHS cancer services, it only just met its target for a faster diagnosis standard. Its goal is for 75 per cent of patients to be diagnosed or have cancer ruled out within 28 days of an urgent referral.

However, it only just made this, with 78.1 per cent either being given a diagnosis or being told their symptoms are not due to cancer in the one-month period. This is the first time it has met its target after it was first introduced in October 2021. 

NHS England also has a goal that 85 per cent of patients should begin their first treatment within two months of being given an urgent referral. However, in February 2024, this was the case for only 63.9 per cent of people.

What’s more, 91.1 per cent of cancer patients began treatment one month after their doctors created a plan for them. While this figure is high, it is lower than the 96 per cent goal. 

Executive director of policy at Cancer Research UK Dr Ian Walker said: “Behind missed targets are patients – friends, family and loved ones who are facing unacceptable long and anxious waits to find out if they have cancer and when they can begin treatment.”

He noted that the NHS “does not have enough equipment or staff to see, test and treat everyone in time”. 

What difference does a few weeks make?

For patients who have to wait weeks to find out whether they have cancer, and how severe it is, any delay can feel unbearable. 

It can also have a significant impact on their long-term health, as failure to start treatment as soon as possible can mean the difference between eradicating the cancer entirely and slowing down its spread. 

One study, published in the British Medical Journal, reported that a four-week delay of cancer treatment was linked with a higher risk of mortality for seven types of cancer, including bladder, breast, colon, head and neck, and lung cancer.

Just waiting an extra month before starting treatment can increase the risk of dying from the cancer by six to eight per cent. 

Increase in demand on cancer services

While NHS England is already crumbling under the weight of cancer referrals, this problem is only set to get worse. A recent report from the International Agency for Research on Cancer together with the World Health Organisation predicted that cancer cases in the UK will rise by 37 per cent over the next 26 years. 

This is despite 40 per cent of cases being preventable if better lifestyle choices were made, such as not smoking, avoiding sun exposure, exercising, maintaining a healthy weight, not drinking alcohol in excess, and eating a balanced diet. 

Smoking alone is a risk factor for 15 types of cancer, while four to eight per cent of cancers are caused by obesity. 

Government figures show that the number of people who are classified as obese is rising, with 25.9 per cent of adults estimated to be obese. This is a rise from the previous year when the figure was 25.2 per cent. 

The number of obese people in England could be even higher now, due to the convenience of processed foods, and the cost-of-living crisis making the weekly food shop more expensive. This has driven many into buying low-cost, low-nutritious and high-calorie foods instead of healthier options. 

Priority given to aggressive cancers

Priority is usually given to more aggressive cancers, giving patients a greatest chance of survival by treating them before the cancer spreads even more. 

However, this can leave other people’s tumours to grow in the meantime, if they are not allowed to start their treatment at a radiotherapy centre in a timely manner. 

Some patients also need prehabilitation before they can even start their treatment, which may include a period of time increasing physical activity, reducing alcohol intake, losing weight, stopping smoking, and eating more healthily to help their body cope with surgery or respond to chemotherapy or radiotherapy. 

This could mean they have to wait longer, delaying their treatment even further.

radiotherapy centre - radiotherapy

Was The Effectiveness Of Radiotherapy Found By Accident?

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Anyone who steps into a radiotherapy centre will receive an intensive consultation, a carefully planned treatment and guidance throughout its entire duration, benefitting from over a century of research, development and the evolution of advanced techniques.

Some of these developments, such as the pioneering work into stereotactic radiosurgery by Lars Leksell, came from years of painstaking work and the perfectionist mindset required to develop treatment tools for the brain.

However, other developments come as the result of more accidental discoveries, such as the X-ray being found by Wilhelm Rontgen in 1895 largely by accident and creating the field of radiology in the process.

The beginnings of radiotherapy are similarly serendipitous, with pioneering scientists discovering the potential therapeutic properties of X-rays and radioactive materials largely by accident.

From Rontgenotherapy To Radiotherapy

Within a year of Mr Rontgen’s discovery, the potential for X-rays to be used not just for diagnosis but for therapy was being explored by a wide variety of doctors in a range of fields.

The very first attempted radiotherapy treatment was by the French doctor Victor Despeignes, who used it to try and treat a 52-year-old man with a tumour said to be the size of a baby’s head.

Mr Despeignes was correct but for the wrong reasons; he believed that cancer was a parasitic infection and since earlier experiments had found that X-rays could kill bacteria, he tried it in a living patient.

The patient was given two 30-minute treatments alongside a cocktail of pain relief medication (morphine, opium and chloroform), a diet of milk and condurango (at the time used to treat stomach illnesses) and artificial serum injections.

This unnamed patient died three weeks later, but the cancerous tumour had shrunk to half of its size and he had felt significantly less pain. Given the other treatments being used, it was unclear whether the radiation had been the primary cause of this at the time, however.

Around the same time, Chicago-based doctor Emil Grubbe allegedly became the first doctor in the United States to use radiation to treat cancer, apparently after a doctor noticed a burn on his hand and suggested that this power could be used to destroy diseased tissue.

Whilst they had their uses in radiotherapy, X-rays at the time were limited in what they could and could not treat, and so early radiologists looked for ways to improve or localise the process, and a discovery by Marie and Pierre Curie provided considerable hope.

Radium In Pocket

In 1896, Henri Becquerel discovered the principle of radioactivity in uranium, and when the Curies discovered polonium and radium in 1898 it was found that a property that Mr Becquerel believed was only in uranium could be found in other elements as well.

All three people would share the 1903 Nobel Prize for this discovery, but Mr Becquerel would also stumble upon the potential for radioactivity for therapeutic purposes and by extension inventing radiotherapy.

Unlike his initial discovery of radioactivity in uranium, this discovery was made largely by accident. Whilst experimenting, Mr Becquerel would place a tube of radium in the pocket of his waistcoat, where it would stay for several hours before he took it off.

A week later, he went to see dermatologist Ernest Besnier, complaining of severe inflammation of his skin at the same spot where the radium had been kept in his waistcoat pocket.

Mr Besnier believed it was caused by the radium, and after experiments by the Curies confirmed this hypothesis, suggested that it could be used for therapeutic purposes in the same way X-rays had been up to that point.

Whilst it could not be as precisely targeted as more modern radiotherapy techniques, radium was seen as a beneficial treatment compared to X-rays due to its ability to target specific areas that X-rays simply did not possess.

The Curies would ultimately publish 32 separate papers exploring the effects of radioactivity, the most important to the field of radiotherapy being the discovery that tumours and lesions were destroyed faster when exposed to radium than healthy cells.

This principle is at the core of radiotherapy, why it is so effective and why it is still widely used today as a first-line treatment for cancer.

Unfortunately, neither Pierre Curie nor Mr Becquerel would see the true potential of radiotherapy realised in their lifetime.

Mr Curie was tragically killed on 19th April 1906 after being run over by a horse-drawn cart. Mrs Curie would continue his work until she died in 1934. Mr Becquerel would die of a heart attack in 1908.