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Ruth Willrich was given a new lease of life after having 75% of her liver removed as part of her cancer treatment at Spire Southampton Hospital in 2010. Despite being told, aged 45, that she may only have five years left to live, Ruth 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, believed 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 over twenty 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 at the time was the lead‐surgeon at Southampton’s neuroendocrine tumour team ‐ one of the five leading laparoscopic liver centres in the world. Mr Pearce was leading the way with innovative multi‐disciplinary approach to ensure each patient’s treatment was tailored to his or her specific needs, and he mirrored this practice for his private patients at Spire Southampton Hospital. Ruth said at the time: “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, since medically retired but now leading PLANETS Cancer Charity as their Chairman, explained 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, particularly around that time, 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 led 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. The team tackle all aspects of the disease using a combination of treatments timed for the maximum benefit for each individual patient. The aim is to add to 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 in 2010 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 2011 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 said at the time: “In the majority of cases, we cannot eradicate every minute trace of cancer. Ruth will have 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 will continue 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.

Neil has recently said ‘in addition to her treatments I am confident that Ruth’s incredibly positive mental attitude added substantially to her long‐term prognosis‐ partly by enabling her to cope with all the procedures she has had over that first 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 was still limited, Ruth remained upbeat: “Nobody could help being anything but positive with Neil and his team. We actually had a lot of fun and jokes along the way, and it was refreshing to have been treated by such advanced, professional people who were also so down‐to‐earth and human.

Incredibly, more than 10 years on, Ruth has had no further treatment aside from her monthly injections. She celebrated her 50th birthday with a trip of a lifetime to Hawaii, a treat from her sister and brother-in-law and 8 years on, is now thinking of how she might celebrate her 60th! After initially setting herself the target of seeing her daughter Georgi turn 18, she is now looking forward to Georgi, now 22 years old, starting a career with BA and making more memories with her in some far flung places!  Ruth remains upbeat and positive and despite enjoying a very full social life, manages to also find the energy to work in commercial garden maintenance in all weathers, which keeps her fit in the process.  She is also a Trustee of PLANETS Cancer Charity and over the years since it’s inception has arranged various events, supporting Neil Pearce with his vision and helping many other patients in the process.

 

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