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Forty‐five year old Ruth Willrich has been given a new lease of life after having 75% of her liver removed as part of her cancer treatment at Spire Southampton Hospital. Despite being told that she may only have five years left to live, Ruth has remained upbeat and positive throughout three operations and a series of embolisations– something that one of the world’s leading laparoscopic liver surgeons, Mr Neil Pearce, believes has helped her progress and undoubtedly added years to her life.

 

Ruth, who lives in Lyndhurst in the New Forest, first experienced tightening and mild pain around her stomach ten years ago. She was pregnant at the time, so put the discomfort down to indigestion – a common pregnancy ailment. After the birth of her daughter, the pain didn’t go away, but was intermittent and didn’t cause Ruth too much concern. However, in 2007, she began experiencing cramps and mild pain. Ruth’s father had suffered with a hiatus hernia and encouraged her to go and see her GP, but she wasn’t keen having always felt anxious around doctors, and didn’t want to waste their time. In the summer of 2009, Ruth finally gave in to friends and family requests for her to go and see a doctor. “My sister was worried because she felt my personality seemed to be changing; my sense of adventure and enthusiasm had gone. I was also feeling extremely tired, so I went to see my GP expecting him to suspect – as I did – that I had a hernia.”

 

Ruth was referred to Lymington NHS Hospital for a gastroscopy, where an endoscope was inserted via her mouth and into her oesophagus and stomach. She was then sent for an ultrasound scan, which revealed there was something on her liver. She says: “It stunned me a bit, but obviously at that stage I didn’t know what the problem was – it could have been anything from cirrhosis or a cyst to cancer. I felt confused and concerned. I had been feeling stressed and permanently tired, but simply put this down to the fact that I worked hard in a challenging sales environment and juggled being a mother and employee with enjoying a full social life. I certainly didn’t feel ill.”

 

Ruth was referred to consultant hepato‐biliary surgeon, Mr Neil Pearce, who is lead‐surgeon at Southampton’s neuroendocrine tumour team ‐ one of the five leading laparoscopic liver centres in the world. Mr Pearce advocates an innovative multi‐disciplinary approach to ensure each patient’s treatment is tailored to his or her specific needs, and this practice is mirrored for his private patients at Spire Southampton Hospital. Ruth says: “Being diagnosed with cancer was devastating. However, I decided I was bored of feeling sorry for myself after about three days; at least I now knew what was wrong and could start getting treatment. I’d always had private medical insurance and was transferred to Spire Southampton Hospital.” It is quite unusual for a private hospital to have the infrastructure, facilities and expertise to provide such a broad range of cancer treatments. Spire Southampton Hospital is one of only a handful of private hospitals in the UK which provides comprehensive cancer care services including diagnostic procedures, complex cancer surgeries, radiological interventions, advanced radiotherapy and oncology services.

 

Neil Pearce explains that Ruth’s initial diagnosis was that she probably had one of the more common bowel cancers with what initially looked like an inoperable pattern of disease. However after specialist review of her scans and meeting her, it became apparent that she had a neuroendocrine cancer, which changed our whole approach to her treatment. He says: “Neuroendocrine tumours (or NETs for short) are fairly rare, affecting only around 3,000 people in the UK each year. In addition, Ruth suffered with carcinoid syndrome, a condition which occurs in around a quarter of patients when the neuroendocrine tumour releases hormones into the bloodstream. “Neuroendocrine tumours are often slow growing, and the usual treatment in many hospitals in the UK is to use medication to reduce symptoms. For instance, using something like Octreotide will create a blocking action to reduce the effects of the hormone release from the tumour resulting in the patient feeling better – even though the cancer is still there. “At Southampton, I lead a multi‐disciplinary group of consultants and other clinicians who are all experts in their field. This includes consultant liver, pancreatic and bowel surgeons, endocrine physicians and interventional radiologists. In addition, gastroenterologists, cardiologists or ENT surgeons are also involved, depending on the patient’s particular situation. Together we tackle all aspects of the disease using a combination of treatments timed for the maximum benefit for each individual patient. Our aim is to add to our patients’ lives, both in terms of prolonged survival and their quality of life by controlling the symptoms that the tumours would otherwise have produced. “In some instances, this multi‐disciplinary approach can remove all trace of the cancer. More often, it results in removing 90‐95% of the tumour burden.”

 

During Ruth’s first operation Mr Pearce removed almost half of her liver; she was admitted to Spire Southampton Hospital for four nights before returning home. Ruth returned to hospital three months later for another four night stay to have half of her remaining liver removed. Ruth also had a series of chemo‐embolisations which were carried out by consultant radiologist, Dr Brian Stedman. During the procedures, Dr Stedman inserted a micro‐catheter ‐ or thin tube ‐ into the main blood vessel in Ruth’s groin and, using a scan to guide him, slowly fed the tube up into the blood vessels in her liver. He then injected tiny beads called micro‐spheres into the blood vessels directly feeding the few remaining tumours.

 

These microscopic particles block the blood supply to starve the tumour of nutrients and oxygen thereby killing cells and shrinking the tumour‐ a procedure known as embolisation. In addition, the beads Dr Stedman used also contained a chemotherapy drug which was released directly onto the tumour to further reduce it and kill more cancer cells. Ruth had already had a series of investigations to try and find the primary tumour, but these had not been able to show where it was. Mr Pearce explains that sometimes with neuroendocrine tumours the primary can be very small, but it remains important to find it and remove it whenever possible. Therefore, once Ruth’s secondary neuroendocrine cancer had been treated, she was given a capsule endoscopy during which she swallowed a capsule containing a tiny camera. This captured images as it travels through her stomach, intestines and bowel and the results confirmed, as her doctors had suspected, that this was where Ruth’s primary cancer lay.

 

In February Ruth returned to Spire Southampton Hospital to have a third operation – this time under the care of consultant colorectal surgeon, Mr John Knight. Mr Pearce was present during the two and a half hour bowel surgery, during which Mr Knight searched through Ruth’s intestines three times before the tumour ‐measuring less than 1cm – was found and removed. Mr Pearce says: “In the majority of cases, we cannot eradicate every minute trace of cancer. Ruth is currently having an injection of Octreotide once every four weeks which will reduce any symptoms from the tiny amount of remaining tumour as well as reduce its rate of growth. We are continuing to monitor her with CT scans every three months, and she will hopefully now have several years of good disease control without the need for additional treatments. However if the tumours do come back we can repeat the chemo‐embolisation procedure, carry out more surgery or offer one of our many other treatment methods in order to continue to keep her disease under control for a very long time.

 

“In addition to her treatments I am confident that Ruth’s incredibly positive mental attitude has added substantially to her long‐term prognosis‐ partly by enabling her to cope with all the procedures she has had over the last year, but also because of the beneficial effects on her immune system of her being such a positive individual. These effects are hard to quantify, but many studies over the years have shown that patients with a wide variety of tumours do better if they have a positive mental attitude, rather than being defeatist in the face of what sometimes may seem like insurmountable difficulties. Being optimistic helps us to work together to bring a positive approach to treatment and the best long‐term results.”

 

Despite knowing that her life‐expectancy is still limited, Ruth remains upbeat: “Nobody could help being anything but positive with Neil and his team. We’ve actually had a lot of fun and jokes along the way, and it’s refreshing to have been treated by such advanced, professional people who are also so down‐to‐earth and human. Thanks to these guys and their determination, incredible work and attitude, I have renewed energy. I’m now out in the New Forest all the time walking and with my daughter, and we go out doing things that I wouldn’t have even contemplated two years ago. “I knew that the operations and treatments wouldn’t save my life, but they have improved my quality of life, and given me a few more precious years. They have helped me and my family make the most of the time we have together. I feel that if I’m going to die young, I’m not going to sit around and wait for it to happen. I have a life to live, and would like lots of nice times with my family and friends. I want my daughter to have happy memories of the time we have together. “My partner and I are open and honest in front of our daughter and have carefully kept her informed. She’s ten years old now, and is a sturdy little girl. Nothing goes on behind closed doors –she comes with me to hospital and we tell her everything – using language she understands ‐steadily, piece by piece. Any questions are answered openly and honestly. And because I’ve not needed chemotherapy or radiotherapy, visually I’ve not changed. For me, this has been a particularly good thing as my daughter hasn’t had to deal with me looking any different. As soon as I came back from hospital each time, she had her mummy back.

 

“I’d made it clear to those around me that I didn’t want pity and sadness around me. I’m really lucky that the majority of my family and friends support me in enjoying life to the full. I go out, work, and treasure the time with my partner and daughter. A year after the first surgery, I can honestly say I’m feeling great. I’d forgotten what it was like to feel energetic, and I’m making the most of the moment. I’m happy.” In the last year Ruth has travelled abroad – something she’d like to do more of over the next few years. She’s passionate about life and adds: “I feel like I’m opening a new chapter of my life. I’m grateful that I know the situation I’m in, so can plan the time I have left. It’s made me look carefully at life and get a balance between pleasure and stress verses earning money. “I have complete faith and trust in Neil Pearce and his team. I’ve never doubted them – they are so good at what they do. Everyone including the anaesthetist and the nurses are not only experts, but also very caring. Even the non‐clinical people in Mr Pearce’s team are knowledgeable and positive, including his secretary who I looked forward to seeing each time I was in hospital.”

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