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How thousands of rectal cancer patients were saved from urinary incontinence and invasive surgery thanks to new research

A landmark study saved thousands of rectal cancer patients from invasive surgery to get a permanent colostomy bag.

Researchers believe that genome testing could benefit many others as well.

Each year in the UK about 2000 rectal cancer patients receive chemotherapy, radiation therapy and surgery, of which about 500 have a complete response to chemotherapy and radiation therapy.

Traditionally, this group of patients has been treated with surgery, which requires a permanent stoma – an opening in the stomach that bypasses the colon – which can significantly affect quality of life.

But with the help of the new Watch and Wait study, researchers have developed a system to closely monitor some rectal cancer patients, which could mean they will live longer, possibly forever, without an ostomy.

Dr Diana Tate, Consultant in Clinical Oncology at the Royal Marsden Hospital in London, developed the Postponement of Surgery study in 2006, creating a pathway that enables these patients to avoid surgery.

“This is a very important study,” the doctor said. Irene Chong, Research Fellow at the start of the study and now Consultant in Clinical Oncology at Royal Marsden. I.

“Standard practice is to offer patients chemotherapy and radiation therapy before surgery for many types of cancer, but we have noticed that some patients respond very well to treatment.

“A few years ago, these patients would have had major surgery, but when pathologists looked under a microscope, they found no cancer cells left over from radiation and chemotherapy.

“And when you give results to a patient who has a bag left, they ask why they needed surgery when chemo and radiation left them cancer-free.”

Dr. Chong credits the work of pioneering surgeon Prof. Bill Heald, former Vice President of the Royal College of Surgeons of England, who questioned whether a significant number of patients with rectal cancer required major surgery. This, in turn, led to the study of deferred surgery.

Dr. Chong said: “We do not promise patients that they will never be operated on because there is a proportion of patients whose cancer grows back, but we know that there are patients who have avoided an ostomy bag 10 years later and families and families fully working life.

“Originally we thought it would be for older patients who cannot have surgery because they have many health problems and it would be risky for them to have surgery, but we quickly realized that many younger patients are very eager to have surgery. this trial version and signed up very quickly.

All patients were closely monitored for years to see if the cancer was growing again. The results of the study, one of the oldest studies of its kind with the longest follow-up, will be published “soon,” possibly by the end of the year, the doctor said. Chong.

“This is a collaborative approach with international colleagues that builds confidence that we can take better care of our patients. This is the most important thing,” she said.

Dr Chong is now turning his attention to genomic testing to determine why some patients respond well to non-invasive treatments while others do not. Her work is now funded not only by the Royal Marsden Cancer Charity, but also by the Institute for Cancer Research in London.

“With next-generation technology, we can now sequence 25,000 genes very quickly and study mutations in cancer. This allows us to see what this cancer looks like at an early stage and to see the differences between patients who have had a complete response for many years and patients whose cancer has returned,” said the doctor. Chong.

“We also take a biopsy when the cancer grows back so we can compare and contrast DNA and RNA changes, which gives us insight into the genes that cause radiation resistance.

“If we find a gene that causes resistance and is potentially treatable with drugs, we could consider using this result and start trials to combine this particular drug that targets this mutation with radiation therapy” to see if it could it helps develop resistance. .

“The more confidence we have that someone is doing well with non-invasive treatment, the more information is provided to the patient, who can make a much more informed decision about whether or not to use this approach.”

“The operation would be very restrictive”

Richard McGinley
Richard McGinley said he was very lucky that he responded so well to radiation and chemo after he was diagnosed in August 2021 (Photo: Richard McGinley)

Richard McGinley was initially told he might need major surgery and a permanent double stoma after he was diagnosed with rectal cancer in August 2021. The tumor had also grown around his prostate, so removal, along with part of his bladder, was considered. .

“The next month I started radiation therapy and chemotherapy. There was discussion at the time: “Leave this treatment alone in order to be able to better operate on the tumor.” They also wanted to see how I would respond to the treatment,” said the 43-year-old HR manager and program director from North London. I.

“I went to Dr. Irene Chong, one of my oncologists, and after a good response, we started discussing the postponement program. I had an MRI, a blood test, a colonoscopy to look at things from all angles. Now I am at a stage where every for three months I go for checkups and talk to all the consultants.

“I might have what they call ‘anxiety’ when exam time is coming up, but the alternative would be to have my rectum removed and a double stoma placed, which would remove everything, including healthy tissue. It would be a major operation.”

Richard said that not having surgery allowed him to live “as normal as possible”. In two years, checks should become less frequent, so that everything is clear.

“I am lucky and lucky that I responded to the treatment, but I also know that every time I go for a check-up, the doctors do a full scan of the entire area for cancer cells and markers in my blood. They are not limited to judgments about everything. It’s a real level of comfort.”

According to Richard, the operation would have had a “huge” impact on his life, both physically and mentally.

“That would be very restrictive. Think about how to carry the bag, how to change it, what clothes to wear with the bag. Now I am on holiday by the pool and enjoying swimming and I am not sure if I would have done it if I had the operation.

“I would be grateful if I could stay alive, but you want to live a comfortable life and I think this program has done that for me.”

Source: I News

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