Pioneering yet personal
Professor Martin Gore, Medical Director at The Royal Marsden and Consultant Medical Oncologist in gynaecology
The Royal Marsden is a centre of excellence for gynaecological cancers, offering a specialist research-led service for the staging and treatment of ovarian, cervical, endometrial, vaginal and vulval cancers.
“Our Gynaecology Unit is made up of a multidisciplinary team of experts who treat patients using the latest techniques and technologies in surgery, systemic therapy, chemotherapy, radiotherapy and brachytherapy,” says Professor Martin Gore, Medical Director at The Royal Marsden and Consultant Medical Oncologist in gynaecology.
“We also work closely with The Royal Marsden’s excellent Cancer Genetics Unit to offer genetic testing to patients who are at risk of an inherited gynaecological cancer.”
We have moved away from the traditional 'one size fits all' approach and now use treatments that are much more appropriate to the patients individual cancer
hospital in the UK to use DaVinci Xi surgical robot
The primary method of treatment for many gynaecological cancers is surgery. Cervical cancer can be treated with a hysterectomy or, in young women who want to preserve fertility options, a trachelectomy – a less radical option involving the removal of the cervix. The treatment for uterine cancer is the removal of the uterus, Fallopian tubes and ovaries.
In early 2015, The Royal Marsden became the first hospital in England to purchase the latest da Vinci Xi surgical robot – a device that allows surgeons to make microscopic incisions with greater accuracy and control than ever before.
This enables the Gynaecology Unit to offer patients the most up-to-date surgical techniques, and The Royal Marsden was the first hospital in the UK to use the new robot to perform a hysterectomy, trachelectomy and lymphadenectomy (dissection of the lymph nodes).
“We have the latest surgical equipment and our surgeons are among the most experienced in the UK,” says Mr Thomas Ind, Head of the Gynaecology Unit and Consultant Gynaecological Surgeon. “The Royal Marsden has always pioneered new techniques, including the very first robotic hysterectomy in the UK in 2007. The new da Vinci Xi robot ensures we will remain at the forefront of cancer treatment and continue to pioneer new methods.”
Radiotherapy is used for the primary treatment of gynaecological cancers, particularly for some cervical and vaginal tumours. It may also be recommended following surgery to reduce the risk of recurrence. Gynaecological cancer patients are individually assessed before being given a personalised treatment plan.
“Our Gynaecology Unit offers the full patient pathway, from diagnosis to follow-up,” says Dr Susan Lalondrelle, Consultant Clinical Oncologist. “We have moved away from the traditional ‘one size fits all’ approach and now use treatments that are much more appropriate to the patient’s individual cancer, which means they have better outcomes and fewer side effects.”
A new linear accelerator machine, the Brunel, has been installed at The Royal Marsden in Chelsea to offer patients state-of-the-art radiotherapy. Arc therapy and intensity-modulated radiotherapy (IMRT) allow external beam radiation to be shaped more closely around the target, reducing the dose to surrounding organs such as the bowel, bladder and pelvis.
Combined with the latest image-guidance systems, this delivers the most accurate treatments for pelvic cancers. For brachytherapy, where radioactive material is placed directly into the affected area, image-guided techniques can increase the dose of radiation where it is really needed.
An MRI scan identifies the tumour and ensures treatment is delivered based on each patient’s tumour size and anatomy, while avoiding the surrounding normal tissue and organs. Image-guided brachytherapy is used to treat patients with vaginal, vulval and cervical cancers.
CyberKnife delivers external-beam radiotherapy and is extremely precise, thanks to its robotic arm and sensors that track the position of both patient and target. The accuracy of the treatment means larger doses can be delivered each time, so patients will need fewer sessions. It is particularly useful for patients with tumour reoccurrence in areas that have previously receive radiotherapy, and for cervical cancer patients unsuitable for brachytherapy.
The Royal Marsden and The Institute of Cancer Research is now among the first institutions to own the MR Linac system, one of the world’s most advanced radiotherapy machines which combines an MRI scanner and a linear accelerator. It has the potential to monitor more closely the effects of radiotherapy during treatment, allowing further adaptation and individualisation of treatment plans.
“We offer image-guided IMRT as standard care,” says Dr Alexandra Taylor, Consultant Clinical Oncologist. “With these new technologies, including CyberKnife, we can now treat disease that we couldn’t with conventional methods and can offer more curative options.”
centres across UK taking part in our recurrent ovarian cancer study
Dr Susana Banerjee, Consultant Medical Oncologist and Research Lead for the Gynaecology Unit, launched a national study in August 2015 that recruited 140 women with recurrent ovarian cancer. About 20 other centres across the UK are taking part in the study, which involves a new targeted drug in combination with the chemotherapy agent paclitaxel.
“The Gynaecology Unit has a dynamic clinical trials portfolio that involves chemotherapy, radiotherapy, surgery and targeted therapies,” says Dr Banerjee. “Our research aims to deliver individualised, precision therapy. We are driving treatment to help improve survival, quality of life and patient experience.”
Support after treatment
Gynaecology clinical nurse specialists (CNSs) at The Royal Marsden are trained cancer nurses. They offer emotional support, information and advice from diagnosis, throughout the course of treatment and during follow-up.
“It is our aim that each patient is given their own key worker as a source of support,” says Jane Ash, Gynaecology CNS. “Some may have more contact than others with the CNS, and that will depend on how their treatment affects them and what support network they have. We can’t change the fear associated with a diagnosis, but we try to ease the impact this has on people’s lives.”
As well as discussing the different treatment options and side effects with each woman, a gynaecology CNS can provide practical advice about menopause, intimacy, body image, sexuality and fertility, helping the patient to resume a normal life.
Anuska Randolph, Macmillan Support Worker, focuses on the patient’s survivorship needs after treatment. She says: “The cancer experience can have a profound psychological effect, and the end of treatment is a key transitional period to a ‘new normal’. We aim to provide a holistic approach to care through multidisciplinary management that is person-centred and addresses the diverse needs of our patients.”