Breast surgeons at the Newcastle Hospitals have become the first in the UK to offer a pioneering new treatment to breast cancer patients.
In 2014 Newcastle Hospitals became the first, and is still the only trust in the UK to offer a procedure known as Radioactive Seed Localisation. The procedure uses a very low dose radioactive seed – about the size of a grain of rice – as a beacon to guide surgeons to the exact location of the tumour that is being removed.
Now, breast specialists at the Royal Victoria Infirmary (RVI) will use the radioactive seeds to assist with the localisation of cancerous lymph nodes.
Mr Henry Cain consultant oncoplastic breast surgeon at the RVI said: “Traditionally, patients with a pre-operative diagnosis of cancerous lymph nodes are recommended to have a full clearance of the majority of the lymph nodes in their armpit. It is now understood that for some patients this more radical surgery is unnecessary especially for those patients having pre-operative chemotherapy.”
Currently, the positive lymph node is marked with a clip prior to chemotherapy so that surgeons can make sure this node is removed during the patient’s operation. On the morning of surgery a guide wire is inserted into the cancerous lymph nodes to guide surgeons to the correct node. As it can be difficult to know the exact location of the tip of the guide wire, this approach can result in more tissue being removed from the armpit.
Now, as with breast tumours, a specialist radiologist, using ultrasound as a guide, inserts a seed directly into the cancerous lymph node. Surgeons then use the seed as a guide to its exact location, meaning only the cancerous lymph node is removed.
Mr Cain believes expanding the use of radioactive seeds to the removal of lymph nodes will have huge benefits to patients undergoing breast cancer surgery at the RVI.
He said: “Due to improvements in staging techniques we are seeing an increasing number of patients being diagnosed pre-operatively with axillary node disease, where cancer is detected in the lymph nodes in their armpit. Using this highly targeted approach means some patients will not have to have a full axillary clearance as only the cancerous lymph nodes would be removed.
“We have already completed over 800 operations to remove breast tumours using this procedure, with excellent results. Expanding the use of this exciting new procedure to the removal of cancerous lymph nodes will allow us to do less aggressive surgery, but still maintain a high level of success in our breast cancer patients.”
Patient story
Marian Stokle from Heaton in Newcastle is one of the first patients in the UK to have a targeted axillary dissection using a radioactive seed. The 58 year old mother of two, was diagnosed with breast cancer in January 2017, she explains: “I found a thickened area in my breast after the Christmas holidays last year. I’d had my routine mammogram eight months earlier which was clear, but I was worried so made an appointment to see my GP straight away to have it checked.”
Tests showed that Marian had stage 3 HER2-positive breast cancer and a 57mm tumour in her breast. Marian met with Mr Henry Cain soon after to discuss her treatment options and was told that because of the aggressive nature of her cancer she would need chemotherapy followed by a mastectomy and full axillary clearance, where all of the lymph nodes from the armpit are removed, and then radiotherapy.
Marion started her chemotherapy in February 2017 and had such a good response that she no longer needed a mastectomy and treatment using the radioactive seeds became an option. She said: “Mr Cain explained how the new procedure works and the benefits of using such a targeted approach. The procedure to have the seeds implanted only took an hour and a half and although it was a little uncomfortable it was relatively painless. I even managed to have a week in Majorca in between the insertion of the seeds, my last chemotherapy session and my surgery.
I came back to the RVI to have the operation a few weeks later and was home the same day.”
Marian is full of praise for the teams who looked after her, she said: “I am eternally grateful to Mr Cain and the team. I had such wonderful care from everyone in oncology and surgery and I’m so thankful to them all.”
Using the targeted approach meant that Marian was able to avoid having more tissue than required removed from her breast and armpit, which resulted in a much shorter recovery time than if she’d had a full node clearance.
Marian is now back to work as deputy head of Hadrian School in Newcastle and has just completed her final round of radiotherapy. Marian said: “My sister had breast cancer 16 years ago and the advancements in the treatment options available are remarkable. I feel so lucky that I live in Newcastle and have been able to have this pioneering treatment. I can’t thank everyone enough.”
She added: “I feel great, the radiotherapy is tiring but I‘m back to work and pilates, it’s nice to start getting back to normal. Losing my hair was quite upsetting but its growing back now and I feel like I’m getting my life back.”
