Professor Andy Hayes, a consultant general surgeon and surgical oncologist at The Royal Marsden and star of Channel 4’s Super Surgeons, on the treatment of sarcoma: a rare and highly challenging type of cancer
Most people think of cancer as something that arises in an organ, like the breast, bowel or stomach, but the majority of our body is made up of things like muscles and fatty and fibrous tissues. Few people have heard of cancer in these areas because they are so rare, but when they do occur, we call them sarcomas.
The Royal Marsden is the leading centre for cancer in the UK and home to a world-renowned sarcoma unit, one of the largest in Europe. We utilise a multi-disciplinary team of specialist clinical oncologists, surgical oncologists, consultant histopathologists, radiologists, research nurses and clinical nurse specialists. At The Royal Marsden Private Care, we have eight specialist consultants that see patients with sarcomas. I see NHS patients and have private clinics at both Chelsea and Cavendish Square.
Sarcomas are extremely rare and can arise anywhere in the body outside of the organs. There are around 100 known types of sarcoma. It is this variety, and the rarity of sarcoma, that makes their treatment very challenging and clinically interesting. Even after working in this field for 25 years, I still occasionally come across tumours or operations that I haven’t seen before.
In the most recent series of Super Surgeons I had a patient, Anthea, who had a diagnosed sarcoma in her forearm. She was only 18 and this cancer was threatening to end her dreams of becoming a midwife, as she was told by her local NHS trust that her arm may need to be amputated.
I knew that I could help her using resources only available at The Royal Marsden, so when she came to me for a second opinion, we reviewed her treatment options. Using isolated limb perfusion (ILP), a specified chemotherapy that only targets one part of the body, we were able to reduce the size of the tumour, making surgery a possibility and increasing the chance of retaining the majority of the use of her arm.
The forearm is a really complicated part of the body because it works this wonderful piece of equipment – the hand. In Anthea’s surgery, there was a fine balance between doing enough to make sure the tumour was removed and not so much that it would cause her to have a real disability from the surgery.
Anthea’s operation would be much less likely to work if we weren’t able to complete the ILP. The removal would have been too damaging to her arm and mobility and would have left a strong likelihood of regrowth. It was a combination of treatments – the ILP and the operation – that made Anthea’s care a success.
Due to the rarity of sarcomas, patients don’t recognise the symptoms when they occur. For the patients I see, getting a diagnosis is often a completely leftfield and unexpected thing because we don’t think about abnormalities of our arms or legs in the same way we would a lump in the breast. This is one of the biggest problems with sarcomas, and the result is that I often see patients when the cancer is already advanced. But we want to change that. Early diagnosis is key, and we would like people to be more vigilant about the symptoms so that they can go to their GP if they’re concerned, resulting in an earlier referral.
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