Luck of the draw

by Liz Chipchase
Time to read: 4 minutes

Liz Chipchase describes her experience as a healthy volunteer in the cancer screening trial which saved her life.

When my brother and I met up for lunch on an early summer’s day in 2017 neither of us had any idea that rogue cells were already transforming and dividing inside us. In my case it was the cells lining my oesophagus that were cancerous while a tumour was busy developing in my brother’s pancreas. He always claimed I was the lucky one in our family and, at least in this case, he was right.  The 5-year survival rate for stage 3 oesophageal cancer is 15%, the corresponding figure for pancreatic cancer is only 7%.

And my luck held. A few weeks after our lunch my GP’s practice invited me to take part in the BEST3 trial. This was designed to test whether cells collected by a novel sampling device, the Cytosponge or ‘pill on a string, could identify if patients being treated for acid reflux had Barrett’s Oesophagus, a condition that sometimes develops into cancer. Within two weeks of swallowing a Cytosponge  I was told  the result was positive and, just six weeks later, I was having an endoscopy so biopsy samples could confirm this result.

By mid-October I received the bad news; I had oesophageal cancer.  Unaware of how advanced the cancer was I spent the next three weeks contemplating what might lie ahead: an oesophagectomy, chemotherapy, a much earlier death than I had ever anticipated? During that time further biopsies were collected and I was soon told the cancer was at an early stage, confined to the cell layer lining the oesophagus and could to be removed by the very non-invasive process of endoscopic resection. A first resection was carried out in early December and, since some of the cancerous cells proved stubborn, I had a second resection four months later. All subsequent biopsies proved normal and exactly a year after taking part in the trial I felt confident enough to organise another family lunch to celebrate.

My brother came to that lunch but wouldn’t eat much. He wasn’t feeling well, had digestive problems and was about to visit his GP. This led to a hospital referral where initial tests and scans showed his symptoms were caused by a blocked bile duct. Further scans brought the bad news that the blockage was caused by pressure from a pancreatic tumour. His symptoms were treated by fitting a biliary stent and he was told it was likely that the tumour could be surgically removed. Then, after waiting for further scans, he was given the shattering news that his tumour was inoperable as it was too closely associated with blood vessels. This, he told me later, was the very worst moment of his illness, despite all that was to follow.  It was a relief when in December 2018 he finally began chemotherapy, intended to precede radiotherapy, and he signed up for a trial designed to test the effects of different combinations of treatment (SCALOP-2).  I think he felt that at least something was being done to hit back at the cancer and perhaps the trial would help someone in the future.

Then he received some good news. Scans taken after the chemotherapy showed the tumour has regressed enough to make an operation feasible. In mid–June he underwent a Whipple procedure, a complicated operation whose complexities recently featured in an episode of the BBC programme: Surgeons: At the Edge of Life. After two days in intensive care he spent a further fortnight in hospital before returning home to recuperate. After two months he was strong enough to face another round of chemotherapy. This dominated his life for some five months with many lengthy journeys to hospital and delays to treatment because of his low blood cell count, together with all the fatigue and pains associated with chemotherapy. By January 2020 he had received 9 of the recommended 12 infusions of GemPac and, as he and his blood cells could stand no more, the treatment was discontinued. Two months later Covid-19 was widespread and, with his immune system compromised, he has been shielding for most of this year. Now he’s feeling more hopeful, recent scans have been encouraging and he has recovered enough energy to start working in his garden.

Sadly, most cancer patients will have shared my brother’s experience rather than mine. Early diagnosis can lead to simpler treatments and better results but the difficulty lies in detecting a disease before symptoms are apparent. While the Cytosponge is an excellent example of a technique for identifying patients at risk of developing oesophageal cancer, a host of other cancers remains undetectable at an early stage. I was, therefore, delighted when funding for an International Alliance of Cancer Early Detection was announced a year ago.  By focusing the thoughts of a wide range of researchers and clinicians on early detection, and by enabling the sharing of their expertise, new ways of identifying early signs of cancer may become available. If and when this happens luck will no longer play such a large role in cancer care.

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