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.

Radiotherapy centre - woman with cancer embracing adult

Support Therapies To Help Cancer Patients With Recovery

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Cancer treatment is improving all the time, but for the best results, action needs to be prompt and aggressive. Doctors will advise either a course of chemotherapy, surgery to remove the tumour, treatment at a radiotherapy centre, or often a combination of the above for the best chances of survival. 

While these intense treatments are necessary to shrink the size of the tumour or eradicate it entirely, they need to be undergone in conjunction with other support therapies, as patients need more than just medication to get over their cancer experience.

As radiotherapy, chemotherapy and surgery can be depleting, it is important to have the right support in place to build patients back up, both physically and mentally, so they can make a full recovery. 

Additionally, it means the years they have added to their lives through the invasive treatments can be worthwhile, as they have been able to keep their bodies fit and healthy and have managed to mentally cope with the trauma of facing their mortality. 

What are support therapies?

Unlike chemo or radiation therapy, which kill the cancerous cells in the body, support therapies look after the patient when they are undergoing this intensive treatment. 

This helps them respond to medication better and enables them to feel mentally and physically strong during this difficult time.

Mental health support

One of the most important forms of support for cancer patients is being able to talk to a counsellor about what they are going through. 

It can be an extremely anxious time for patients, who naturally think the worst, so it is usual to feel very apprehensive and stressed.

Many people also fall into depression, as they may lose hope after multiple treatments or struggle to cope with the harsh side effects of chemotherapy, which can include sleep problems, sickness, and fatigue. 

Other symptoms, such as anaemia, infections, hair loss, nausea, weakness, loss of appetite, mouth sores, and memory problems, can also be difficult to deal with, leaving some patients feeling extremely low. 

Cancer is very difficult to deal with emotionally, from receiving the diagnosis to completing treatment and everything in between. 

Not only are patients instinctively scared, but not being able to feel like their usual self, being angry that this happened to them, holding guilt their loved ones have to go through this too, and feeling lonely and that nobody can relate, can be particularly difficult to handle for many. 

So it is important to speak to a therapist about the trauma, and any raw emotions it brings up. 

It is also a difficult time for the rest of the family, which is why having sessions together can be helpful as well. 

Nutritional guidance

Cancer, as well as the curative treatments, can take a big toll on the body. Therefore, the best way to boost recovery is to look after it as much as possible. 

Diet plays a huge part in this, as it is essential to get the right nutrients to fuel the body properly, so it can regain strength and recover fully and quickly. 

Having nutritional support is, therefore, sensible, as experts can provide dietary guidance to make sure the patient is getting the vitamins, minerals, proteins and carbohydrates they need. 

They also help to manage weight, making sure patients do not lose too much if they are being sick or lose their appetite, as malnutrition is often seen among cancer patients, leaving them weak and unable to fight infections.

Conversely, they can guide people to lose fat at an appropriate rate, if this is deemed beneficial for their recovery. 

Nutritionists and dieticians can also advise what foods to eat to boost the immune system, which is essential as this will be extremely low after the treatments, and what meals may be easier to stomach if vomiting and nausea is a problem. 

The National Cancer Institute recommends:

  • Eating high-protein foods to make sure protein targets are met.
  • Swapping solid foods for milkshakes, smoothies or soups if swallowing is difficult. 
  • Consuming small meals throughout the day, as this is easier to stomach.
  • Having foods that are bland, gentle on the stomach, and easy to digest. 
  • Eating dry foods, such as toast and crackers, particularly first thing in the morning when nausea can be worse.
  • Having food at room temperature, instead of hot or cold. 
  • Avoiding skipping meals, as this will make sickness feel worse.
  • Rinsing your mouth after eating and in between meals. 
  • Sitting upright after vomiting to avoid it happening again. 
  • Sipping water throughout the day. 
  • Eating soft foods if mouth ulcers are a problem. 
  • Avoiding citrus, acidic, salty, or spicy foods. 

What type of food patients will be able to hold on will depend on them individually, but as long as they make sure their diet is full of whole grains, vegetables, fruits, protein, healthy fats, dairy or a dairy substitute, and water this will help improve their recovery and make them feel more energised and stronger.

Mind-body therapies

Many people really benefit from mind-body therapies, as this enables them to relax during a difficult time, improve their overall wellbeing, and reduce side effects.

These include the likes of meditation, art therapy, music therapy, yoga, tai chi, hypnotherapy and other relaxation techniques. 

The benefits of these include reducing anxiety and stress, feeling less anxious or depressed, being able to cope with chronic pain better, feeling more relaxed, being able to express their feelings, improving self-confidence, and helping with fatigue. 

Yoga has also been found to help patients to sleep, with insomnia being a common symptom, help patients feel stronger mentally and physically, and make them feel less tired. 

Acupuncture

Some patients find acupuncture very helpful when they are undergoing cancer treatment, as this can relieve some of their unpleasant side effects and relieve pain. 

Those who have a weakened immune system or a low number of platelets due to their treatment should avoid acupuncture, despite its benefits, as they are at greater risk of infection and bleeding. 

However, those who are able to receive the therapy might find it helps boost their flow of energy and, as it releases endorphins, it can relieve pain and improve patients’ moods.

radiotherapy - Nurse Puts a Dropper

‘Preventative Chemo’ Explained Amid Kate Middleton Diagnosis

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The British Royal Family shocked the world recently by releasing a video statement from the Princess of Wales, Kate Middleton, revealing she had been diagnosed with cancer and was now undergoing a course of preventative chemotherapy. 

While the 42-year-old did not specify what type of cancer she had, she explained it had been discovered following major surgery in January this year. 

Despite the surgery being successful, tests found that cancer had been present in her body, and to eliminate any chance of it recurring she needed to receive cancer treatment. 

Although many people who have themselves had a cancer diagnosis in the past might know what preventative chemotherapy is, for others, here is an explanation of this course of treatment. 

Preventative chemotherapy explained

Preventative chemotherapy is not actually a medical term, and oncologists are most likely to refer to it as adjuvant chemotherapy instead. However, the Princess of Wales most likely used the former phrase as it is more self-explanatory. 

Adjuvant chemotherapy involves using chemotherapy drugs to eradicate any of the remaining cancer cells that might still be in the body. 

The surgeon, for instance, might not have successfully removed all of them when they extracted the tumour, or the cells might have spread to other parts of the body without yet being detected. For instance, sometimes tests fail to pick up on microscopic cancers, so it is better to be safe than sorry in these incidences.

It is, therefore, used to prevent the cancer returning, as the cytotoxic drugs can attack any remaining cells and destroy them, wherever they are in the body. 

Preventative chemotherapy is not used in every case, but only when the medical team believes the risk of recurrence is high. 

Doctors choose the best treatment path for each patient, whether that is chemotherapy, radiotherapy or another procedure, weighing up the risk and benefits of each action. 

If they believe there is still a risk there could be cancer cells in the body that are able to spread, it is likely they will advise on a course of chemotherapy to remove this risk and achieve a better prognosis for the patient. 

What type of cancers does preventative chemotherapy work best for?

Whether medical experts choose to go ahead with adjuvant chemotherapy also depends on the type of cancer present in the body. 

It is more successful with particular types of cancer, such as breast and colon cancer, for instance.

They will also consider other factors, such as the stage of the cancer, the number of lymph nodes involved, the hormone receptivity, and changes within the cancer cell.

Someone whose cancer is at the very early stage might not need adjuvant chemotherapy as the cancer has not had a chance to spread yet. So it is more likely to be given to a patient whose cancer has spread to nearby lymph nodes.

If there are a lot of lymph nodes involved, there is a greater chance cancer cells would have been left behind after surgery to remove the tumour. 

How many treatments will it involve?

The number and course of the treatment will be specific to the patient, as the type of cancer, its stage, and the overall health of the person could affect how the chemotherapy is administered and how many procedures are required.

Generally, chemotherapy will be undertaken for between four to six months, with their treatment being split into cycles. For example, patients might have to undergo six cycles, with a few days of chemo and some days of recovery before the next one. 

In many cases, one course of treatment should be sufficient to remove the risk of cancer in the body. However, this depends on how well the patient has responded to the chemotherapy. 

What are the side effects?

Just like other chemotherapy treatments, patients will face a number of unpleasant side effects. 

As it targets healthy cells, as well as the cancerous ones, it can take a huge toll on the body. Subsequently, the following side effects are common:

  • An increased risk of infection
  • Anaemia
  • Brain fog, poor concentration and declining memory
  • Diarrhoea or constipation
  • Mouth ulcers
  • Reduction of appetite
  • Nausea and vomiting
  • Hair loss
  • Hearing loss
  • Pins and needles in limbs
  • Reduced sex drive
  • Infertility
  • Sensitive skin or rashes
  • Dry, brittle nails
  • Fatigue 
  • Breathlessness
  • Nosebleeds or bleeding gums 

What is the recovery time?

Patients who are undergoing preventative chemotherapy can expect it to take a few months before they fully recover. Not only do they have to wait for the side effects to calm down, but they are also likely to still be recovering from their surgery. 

After waiting for the course of chemotherapy to finish, they will need some time for their body to gain strength again before they can feel their usual selves. Having cancer will also have a huge impact on their mental health, so it is important patients look after their emotional, as well as their physical, wellbeing.

radiotherapy centre - doctor and testicular cancer patient

How Does Cancer Spread To Other Parts Of The Human Body?

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A course of radiotherapy is undertaken through extensive, cautious planning to ensure that it has the greatest effect possible to relieve pain, prolong life and improve the quality of everyday existence.

When someone enters a radiotherapy centre to undergo consultation and treatment, each case will have some unique elements to it, and whilst treatments such as stereotactic radiosurgery are focused predominantly on removing tumours and lesions based in the brain, this does not mean they necessarily originated there.

Cancers can spread in a process known as metastasis from one part of the body to the next, and understanding how this process works is important for understanding its implications on treatment.

Primary And Secondary Cancers

Oncologists will make an important distinction between a type of cancer and where it currently is in the body, which is important to avoid confusion when discussing a person’s condition.

For example, if someone has breast cancer that spreads to the brain, it will still be called breast cancer even though it is not located in the breast. The cells in the brain that are cancerous are breast cancer cells, not brain cancer ones

This concept is known as primary and secondary cancer. A primary cancer is one that originates in the place where the tumours are found, whilst a secondary cancer is where that cancer has spread elsewhere.

This is an important distinction to make because there are many different types of cancer, each of which has different methods of diagnosis, treatment and prevention that need to be used to manage it effectively, particularly when it comes to medication and chemotherapy used alongside radiotherapy.

Generally, a secondary cancer of the brain is found by examining an existing primary cancer, but there are times when the primary cancer no longer exists in the body, either by being removed or destroyed by past treatment, or being too small to be easily detected.

Whilst there are cases where oncologists can determine the type of cancer from the types of cells that comprise them, there are some cases where doctors cannot completely verify the original location or doing so would require intense tests that may not change the planned treatment. 

These are known as cancers of unknown primary and happen either due to a small primary cancer, a primary cancer that has already been destroyed by the immune system, or complexities with treatment that mean that certain tests cannot be used.

How Cancer Spreads

Cancer spreads through the body through either the blood or lymphatic system, which regulates and filters other bodily fluids.

A primary cancer growth spreads largely by breaking apart. Cancer growths are often unstable, and cells can break away or be stimulated to travel elsewhere.

From there, they find a way into the bloodstream, where they are swept along by the blood or other fluid until they get stuck in a tiny capillary. The cell then moves through the wall of the blood vessel and enters nearby organ tissue. 

If they have the right nutrients and conditions to grow, the cancer cells will form a tumour in the new location.

This is a very difficult process and whilst a lot of cancer cells will break off and enter the bloodstream, few will complete the process of forming a secondary cancer.

The blood flow itself can be powerful enough to destroy cells, whilst white blood cells in the blood can kill some of the cancer cells it finds.

Alternatively, cancer cells can spread through lymph vessels close to the primary tumour. This allows them to flow into lymph glands designed to drain damaged cells and excess bodily fluids.

If they survive this process, they can sometimes form tumours in a lymph node, and a swollen lymph node can sometimes be a marker for cancer, although lymph nodes can also swell due to the effects of infection.

Can Any Cancer Spread To The Brain?

Theoretically, any cancer can have a secondary growth in the brain, although some cancers are more likely to than others due to how relatively common they are.

These include:

  • Breast cancer.
  • Lung cancer.
  • Bowel cancer.
  • Kidney cancer.
  • Melanoma (a type of skin cancer).

Because these are common cancers, and their effects are well-known, secondary brain cancer can often be treated, particularly if it is found quickly.

Radiation therapies such as Gamma knife work as well for secondary brain cancer as they do for primary ones, and they can be used in combination with targeted drugs, chemotherapy and surgery to relieve pain and long-term effects.

How might intensity modulated Radiotherapy help you?

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Patients who have had a cancer diagnosis may soon find they are discussing a range of treatment options that includes radiotherapy. But while most lay people will have some idea of what radiotherapy is and how it works – usually because they know somebody who has been treated that way – not many will know about the different versions of the treatment.

What the lay person generally knows is that radiotherapy involves using radiation to kill off cancerous cells and tumours, not by zapping them like some laser, but by damaging their DNA so their cells cannot divide and grow.

However, because radiotherapy involves doses of radiation that can also harm DNA in healthy cells and tissues, with a range of side-effects, plus the fact that a more concentrated and accurately directed beam that is better focused on the target area brings better results, specific kinds of radiotherapy treatment can achieve more.

How IMRT Works

Intensity Modulated Radiotherapy, or IMRT, is a case in point. This is a treatment delivered using linear accelerators controlled by computers, which will deliver a very precise level of radiation to a tumour or even a particular part of the tumour.

The radiation is delivered in small volumes and comes from different angles, highlighting the reality that while scans and images may come out in 2D, tumours exist in 3D and hitting the right spot each time means delivering each dose to the exact spot where it is most needed. Often this is done by using multiple beams simultaneously delivered from different directions.

To ensure this can be done with accuracy, 3D tomography is used in the preparation for the procedure. This will enable the tumour to be mapped out in 3D and the specific areas that need the most intense and precisely calibrated doses of radiation to be identified and their positions pinpointed.

The scanning for this is done by MRI and the calculated dose is worked out by computer, bringing to bear the latest and most advanced complementary technologies to help ensure this form of radiotherapy is delivered in the most adroit and precise manner, something almost unimaginable when radiotherapy was first used in the 1900s.

What IMRT Procedures Involve

All this makes the treatment a lot more complex than other ways of delivering radiotherapy, which necessitates more checks and preparation for treatment, while the treatment itself will last for longer.

However, because there is such a contrast in the dosage received by tumours (where it needs to go) and by surrounding healthy tissue (where you don’t want it to go), it also enables stronger doses of radiation to be deployed in attacking tumours, making it more likely to be highly effective.

What all this means is that some specific forms of cancer are better treated with this kind of radiotherapy, with the patient having to lie still in a particle accelerator while the doses are delivered over a period that may range from 15 minutes to an hour. For those prone to claustrophobia, it can be unpleasant, but life-saving.

New Research Breakthrough For IMRT

The benefits of IMRT may be about to grow as new research has shown how it can be used to achieve a ‘gold standard’ of treatment for those suffering cancers of the head or neck and help avoid dysphagia, a condition where a person has difficulty swallowing.

A trial at the Royal Marsden Hospital in London, co-ordinated by the Cancer Research Trust, set out to compare the side effects of dysphagia-optimised intensity modulated radiotherapy (DO-IMRT) with standard forms of IMRT.

A key side-effect issue that can occur in this case is that the delivery of radiation to the muscles involved in swallowing can cause dysphagia. Some patients may need to have a permanent feeding tube inserted.

The study compared how often newly-diagnosed throat cancer patients treated with each form of IMRT suffered dysphagia. The result, published in the Lancet, was that of the 112 patients, half of whom received DO-IMRT and the others standard IMRT, there was a clear difference in the ability to swallow.

Among the DO-IMRT group, 62 per cent were able to eat at least some food that needed chewing and 85 per cent felt comfortable eating in public. In the other group, the respective figures were 45 per cent and 75 per cent. All this happened while there was no significant difference in the three-year survival rate between the two groups.

This discovery means that, in future, IMRT for patients of neck and head cancers can be delivered in an even more precise manner, in order to further limit its side effects without having any negative impact on patient outcomes.

How to help patients enjoy Christmas during cancer treatment

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Cancer treatment takes a physical toll on patients, leaving many with fatigue, nausea, vomiting, and difficulties eating and drinking.

This is hard at any time of the year, but particularly over the Christmas period.

While they might want to join their family and friends with the festivities or enjoy a Christmas like they’re used to, feeling so physically unwell can throw their plans into disarray.

If you want to help a loved one who is going through chemotherapy or radiotherapy treatment throughout December, here are some ways you can still give them a Christmas they can enjoy.

Watch lots of Christmas movies

One of the most common side effects of cancer treatment is fatigue, so do not expect your loved one to be up to much over the festive period.

Instead of going to parties, family gatherings, carol concerts or Christmas markets, you can join them in watching lots of festive films on TV.

This will allow them to still feel involved in seasonal activities while also being able to catch up on much-needed rest.

They can feel part of the festivities without having to leave their living room, and by keeping them company, they can avoid feelings of loneliness that often arise at Christmas.

Think carefully about food

Although most people love all the foods and treats they can indulge in at Christmas, eating can be very difficult for people who are undergoing cancer treatment.

They might have a sore mouth if they have had radiotherapy to their head or neck, which can make it feel as though their mouth is burned or very dry. They might also have mouth ulcers, or discomfort when trying to eat or swallow.

In these cases, it is important to avoid spicy or salty foods, as these can make the pain worse.

At the same time, they might have a reduced sense of taste or their appetite may have disappeared.

Many people feel nauseous after treatment, vomit or have diarrhoea or constipation, in which case they will not want to eat all the rich foods they would have normally loved at this time of the year.

If your loved one is suffering with their eating, try to find something they can stomach or find comfortable to swallow. This might mean drinking instead of eating, having five or six smaller meals instead of big ones, or only nibbling on snacks.

Give them a small taste of their favourite Christmas foods on the days they are feeling better so they do not feel left out, but keep their diet plain and simple the rest of the time.

Go for festive walks

They might not have the energy for high-octane Christmas activities, but it is still important they do some exercise, as this can improve their appetite and boost their energy levels.

Taking small walks with them will not only help them feel better, but it can make them feel festive looking at the Christmas lights or wrapping up warm against the chill.

You could even give them cosy socks, heated gloves or fleece hats that will help them remain comfortable even if it is freezing cold outside.

Limit visiting times

Visitors love to pop in over Christmas, especially if they want to send their best wishes to the patient.

However, it can be very tiring having lots of people around, particularly if they feel like they should be hosting their friends and family over the season.

That is why it is a good idea to remind loved ones they should keep their visits short and sweet. They should also not expect to be served upon or entertained while they are there.

Those who do visit should also be reminded of appropriate gifts to bring, instead of alcohol, chocolates, or flowers, which can carry fungal spores that are dangerous for those with a suppressed immune system.

Some options are cosy clothes or blankets; stress relievers, such as eye masks or scented pillows; audio books; or a basket with items such as scent-free skin creams and lip balms, magazines, tea or candles.

Although having a conveyor belt of guests is tiring, it can remind cancer patients of how much they are loved. It can also make them feel more involved in Christmas festivities, as long as they are given enough time to rest before and afterwards too.

This Christmas might not be quite like their usual ones, but by creating some pleasant moments each day, you are helping them get through the difficult season and, ultimately, aiding their recovery in the long-term.