The pursuit of excellence
The Gynaecology unit at The Royal Marsden takes a multidisciplinary approach to treating patients with ovarian, cervical, womb, vaginal and vulval cancers. With an expert team including surgeons, medical and clinical oncologists, pathologists, radiologists and nurses, The Royal Marsden is a centre of excellence in gynaecological cancers. The primary treatment for many of these cancers is surgery. The Royal Marsden has pioneered robotic procedures – to date, our surgeons have carried out more than 700 robotically assisted operations – and the treatment of recurring cancers. “Robotic surgery offers patients less blood loss, pain and scarring, and shorter hospital stays, compared with open surgery,” explains Ms Marielle Nobbenhuis, Consultant Gynaecological Oncology Surgeon.
Mr Thomas Ind, Head of the Gynaecology Unit and Consultant Gynaecological Oncology Surgeon, adds: “We’re at the heart of international discussions about how to train surgeons in robotic gynaecology surgery. We’ve seen the success of our Robotic Surgery Fellowship, funded by The Royal Marsden Cancer Charity, and more recently had a nurse join our unique Robotic Nursing Fellowship programme”.
A key focus of surgical procedures performed at The Royal Marsden is on cancers that have recurred. This is a unique area of expertise, often involving long and complex operations crossing multiple organ sites. Consultant Gynaecological Oncology Surgeon Mr Des Barton has established a team with specialists in other tumour types to carry out these procedures, which can sometimes be the last surgical solution for patients and, at present, the only hope for a possible cure. Mr John Butler, Consultant Gynaecological Oncology Surgeon, says: “Over the past decade, we’ve been increasing our repertoire of surgical procedures with the overall aim of removing all of the disease and improving patient outcomes and surgical precision.
“PINPOINT is an exciting new device that offers high definition and advanced fluorescence imaging in real time during open and laparoscopic surgery. It will allow surgeons to identify and remove just the lymph nodes that are potentially affected by cancer, increasing the accuracy of the procedure and reducing complications such as lymphoedema. It will also allow surgeons to look at blood flow for optimising bowel surgery.”
Historically, some gynaecological cancers have had a poor prognosis, but that is beginning to change. “We are seeing substantial progress in research,” says Dr Susana Banerjee, a Consultant Medical Oncologist whose research is generously supported by the Lady Garden Foundation. “Several new targeted drugs have been licensed in recent years, giving more treatment options that will improve survival rates.”
The Royal Marsden recently participated in an international trial that demonstrated that the drug olaparib, a PARP inhibitor also known as Lynparza, could cut the risk of disease progression or death by 70 per cent in patients with newly diagnosed, advanced BRCA-mutated ovarian cancer. Dr Banerjee, co-author of this work, says that the “landmark” results represent a shift in how we should treat ovarian cancer.
The unit is also focusing on understanding why some patients might be resistant to PARP inhibitors and exploring other treatment options. Royal Marsden patients will be the first in the world to trial the effectiveness of ATR inhibitors, a new treatment type that targets weaknesses in cancer cells, in a trial led by Dr Banerjee.
The Gynaecology Unit works closely with the Cancer Genetics Unit to offer genetic testing to at-risk patients – specifically those with the BRCA1 and BRCA2 gene mutations, which can increase a woman’s lifetime risk of ovarian cancer to 60 per cent.
The Mainstreaming Cancer Genetics (MCG) programme, which began in the Gynaecology and Breast units, aims to provide faster and more efficient testing for these genes. Led by Dr Angela George, Clinical Lead for the Cancer Genetics Unit, the programme has benefited more than 2,000 patients. An additional advantage of MCG is that relatives with the BRCA mutation have the option of having ovaries removed now or after they have had children.
“We predict this could prevent 283 cases of ovarian cancer and 77 deaths each year in the UK,” says Dr George. “It has revolutionised testing for women.”
The Royal Marsden and its academic partner, The Institute of Cancer Research, have led the development of more precise radiotherapy techniques that offer kinder treatments for all patients with gynaecological cancers, whether treated here or further afield.
State-of-the-art technology means that our patients can benefit from innovations such as volumetric modulated arc therapy, stereotactic body radiotherapy and image-guided adaptive brachytherapy, led by world-leading Consultant Clinical Oncologists such as Dr Susan Lalondrelle and Dr Alexandra Taylor.
Dr Lalondrelle, Lead for Radiotherapy, says: “The MR Linac – which combines MR imaging and radiotherapy – is useful for treating cancers that are hard to see with standard technology and hard to treat due to organ motion. We are the first department in the UK to use the MR Linac to visualise pelvic cancers and adapt daily treatments, and I am leading an international research consortium studying which gynaecological cancers we can treat most effectively.”
Combining ultrasound and cone-beam computed tomography (CBCT) – an imaging technique used just before treatment – while treating tumours in the cervix has been the focus of recently published research conducted by Dr Lalondrelle and colleagues Dr Emma Harris and Dr Helen McNair. They found that this method made it easier to identify the target and normal tissue at the start of each radiotherapy session, and could potentially be used to deliver more accurate radiotherapy with less damage to healthy tissue.
Alongside research and surgicalinnovations, The Royal Marsden strives to provide the very best nursing care. “We wouldn’t be able to deliver an excellent standard of care for our patients without the work of our nursing teams,” says Mr Ind.
The Gynaecology Unit includes a variety of dedicated nursing roles, including staff nurses, research nurses, clinical nurse specialists (CNSs) and advanced nurse practitioners (ANPs). CNSs offer emotional support, information and advice from diagnosis, throughout the course of treatment and during follow-up.
In gynaecology, this might include providing practical advice about the menopause, intimacy, body image; sexuality and fertility after patients have finished treatment. Jane Ash is one of the new ANPs on the unit, having been a CNS for 10 years. Her role means that patients have continuity of care and are seen more quickly. With her enhanced skills, she may be taking on more of the tasks that a specialist registrar might perform. She says: “I see patients from their very first stay in hospital through to their follow-up clinic – which means they really benefit from continuity of care. “It’s been hugely valuable to have experience as a CNS in this role. I have an understanding of the psychological needs of patients and know what support services they may benefit from.”