Cancer care and treatment

We are able to offer internal radiotherapy, known as brachytherapy. This is where solid radioactive material is placed inside the body to destroy cancer cells. It is placed within or near to the cancer, and as the radiation does not travel very far the advantage of this treatment is that it gives a high dose of radiotherapy directly to the tumour, but a low dose to normal tissues.

In women, brachytherapy can be used to treat cancers of the cervix, womb or vagina. It can be used on its own or combined with other treatments such as external radiotherapy.

In men, brachytherapy is a common procedure used to treat prostate cancer and is recognised as an alternative to traditional, external beam radiotherapy. It involves implanting ‘seeds’ or ‘pellets’ of radioactive material directly into the prostate gland under a general or spinal anaesthetic. These ‘seeds’ are about the size of a grain of rice.

Brachytherapy is also used to treat other forms of cancer such as thyroid cancer.

At Barts Health we have a dedicated brachytherapy theatre and recovery rooms on our wards. Our rooms are all spacious single ensuite rooms with their own fridge and temperature control, to ensure that patients receiving this type of treatment are as comfortable as possible during their stay with us.

Brachytherapy is provided at St Bartholomew's Hospital.

Chimeric antigen receptor T-cell therapy, or CAR-T therapy, uses the body’s own immune system to combat the disease.

As part of the treatment, a type of white blood cell called T-cells are collected from the patient and programmed in a lab to detect and kill cancerous cells.

Once the cells have multiplied, they are infused back into the bloodstream through a drip, where they get to work over a number of months.

CAR-T therapy is offered to patients with lymphoma or acute lymphoblastic leukaemia for whom all other treatment options have been exhausted and would otherwise be offered palliative chemotherapy.

Patients stay in hospital for around four weeks.

In around 50% of cases, treatment leads to a cure.

CAR-T therapy is currently available at St Bartholomew's Hospital to patients that meet a strict criteria.

Chemotherapy is the use of drugs to treat the whole body and to kill cancer cells wherever they might spread. Most typically, these are given as an intravenous infusion via a drip, an injection under the skin (subcutaneous), or some chemotherapy drugs can be given in tablet form.

Chemotherapy drugs can be given on their own, but are frequently given in combination. Treatment is usually given every few weeks for a variable duration, but typically lasting several months. The drugs given and their frequency will depend on the type of cancer.

All side effects will be carefully explained and ways to avoid/treat them will be discussed by the teams involved in your care. The majority of side effects are temporary and will resolve on completion of treatment. Your clinical nurse specialist and doctors will explain specific side effects of the drugs you are receiving.

The majority of patients requiring chemotherapy at our hospitals will receive their treatment as an outpatient. These facilities are provided in the following locations:

• St Bartholomew's Hospital, ward 7A – This ward has been located for the best views of the city of London, and patient treatment areas are light, spacious with comfortable chairs.

• Newham Hospital – chemotherapy day unit on the first floor of the hospital corridor leading to East Ham and West Ham wards.

• Whipps Cross Hospital – Woodlands day Unit on Margaret Close, near the James Lane entrance.

Some patients may require overnight stays in hospital, but this will be discussed with you prior to treatment.

We have the latest in CyberKnife technology, which uses non-invasive (no actual knives are involved), high dose radiotherapy to treat particular types of cancer in all parts of the body.

The CyberKnife machine consists of a robotic arm and a compact linear accelerator that can be moved all around the body of a patient to deliver high dose radiation where required. It is so accurate that it avoids surrounding health tissue and can reduce the need for conventional surgery. It also requires fewer treatments than conventional radiotherapy.

The technology allows doctors to track and detect the exact position of a tumour during treatment. So, if a patient moves, or the tumour shifts slightly while a patient breathes, the machine will automatically correct and adjust its position relative to the movement.

Treatment times are generally longer than with conventional radiotherapy, but it requires fewer visits to the department and the comfort of patients during treatment is always accommodated.

CRS and HIPEC is a treatment combination used to treat cancers that have spread into the abdominal cavity, affecting the surface which is called ‘peritoneum’.

Traditionally, the cancer which affects the peritoneum has been considered a condition not curable surgically and not very responsive to intravenous (IV) chemotherapy. However, there is evidence that if the size and spread of the cancer is limited, then a special surgical procedure called “cytoreductive surgery” that removes all the visible disease can be helpful.

This treatment can involve major surgery to remove organs in the abdomen and the peritoneum. Once the tumour has been removed, a heated chemotherapy is delivered directly to the abdominal cavity while you are under the anesthetic to kill off any remaining unseen cancerous cells that could otherwise grow. The cancer cells are exposed to a high dosage of chemotherapy drug and the general undesired effects are minimised. The treatment that we can offer will vary depending on the extent that the cancer has spread.

HIPEC is provided at The Royal London Hospital.

Immunotherapy is a type of cancer treatment that helps your immune system fight cancer. The immune system helps your body fight infections and other disease.

Different types of immunotherapy work in different ways. Some immunotherapy treatments help the immune system stop or slow the growth of cancer cells. Others help the immune system destroy cancer cells or stop the cancer from spreading to other parts of the body.

Immunotherapy treatments can be used alone or combined with other cancer treatments. Immunotherapy drugs have been approved to treat many types of cancer. It is normally given intravenously through a drip into a vein.

We are involved in trials for other, new targeted therapy drugs.

Targeted therapy is a cancer treatment that uses drugs to target specific genes and proteins that are involved in the growth and survival of cancer cells. Targeted therapy can affect the tissue environment that helps a cancer grow and survive or it can target cells related to cancer growth, like blood vessel cells.

Immunotherapy and targeted therapy is provided at St Bartholomew's Hospital, Newham Hospital and Whipps Cross Hospital.

Our comprehensive radiotherapy service offers state-of-the-art treatments for patients with cancer and some benign conditions.

Radiotherapy uses high-energy x-rays (radiation) to destroy cancer cells. It may be given on its own, or alongside other treatments such as surgery, chemotherapy or brachytherapy. Each course of radiotherapy is carefully planned based on the patient and the type of cancer they have. The doctor will prescribe the amount of radiation needed for the treatment. It can be delivered in one treatment, or it may be delivered in daily smaller doses.

At Barts Health we have five modern linear accelerators (linacs), a CyberKnife unit that can deliver high dose radiation and an Orthovoltage unit that delivers effective treatments for skin cancer.

We provide:

• Volumetric Modulated Arc Therapy (VMAT) – the radiation is delivered whilst the Linac rotates around you. This allows the radiation to be shaped to the tumour whilst reducing the dose to the organs nearby.

• Image Guided Radiotherapy (IGRT) – the use of scans and x-rays to ensure you are in the correct position for your radiotherapy before it is delivered.  The radiographers compare the pre-treatment image with the planning image to ensure that the treatment will be delivered correctly.

• Stereotactic Radiosurgery – a non-invasive treatment that uses a high dose of radiation to a small part of the brain.

• Stereotactic Ablative Radiotherapy (SABR) – the use of multiple small radiation beams from many different angles to deliver high dose radiotherapy to the tumour.

• Deep Inspiration Breath-Hold (DIBH) for left sided breast cancer – the use of deep breathing and breath hold during treatment to reduce the amount of radiation received by the heart.

• Total Body Irradiation (TBI) - radiotherapy is delivered to a patient’s whole body.

The majority of patients requiring radiotherapy will receive treatment in our radiotherapy department situated in the basement of St Bartholomew’s Hospital.

The aim of surgical treatment is to remove the cancer along with some surrounding normal tissue to ensure it has been completely removed. In addition, surgery often will search for any signs of spread by taking biopsies of other tissues such as lymph nodes.

While often surgery will be the first treatment option, this does depend on the type of cancer and the site. The range of surgical options is enormous but, if you require surgery, you will be operated on by surgeons who are experts in surgery for their particular cancer. Our multidisciplinary team ensures that you are offered the best combination of surgery and when necessary, chemotherapy and radiotherapy.

Surgery is provided at St Bartholomew's Hospital, The Royal London Hospital, Newham Hospital and Whipps Cross Hospital.

Some side effects can be managed at home. If a side effect is concerning you or is not improving after following the guidance below, please call the 24 hour chemotherapy hotline on 07917093738.

Always mention any side effects to your doctor at your next appointment. It can be helpful to write them down in a diary so you remember them.

Bruising/bleeding

Ring the hospital immediately if you have any unexplained bruising or bleeding such as nosebleeds, blood spots or rashes on the skin, blood in your stools or when passing urine or bleeding gums.

Chest pain

This is a rare side effect but should be taken seriously. Ring the hospital immediately. If severe, ring 999.

Constipation

This can be treated using medicines that can be bought from your chemist, e.g. senna.

• Keep well hydrated by drinking plenty of water
• Try to eat more fibre (cereals, raw vegetables and fruits)
• Gentle exercise such as short walks can help to improve constipation

Contact the hospital if it is severe or continues for more than 48 hours.

Diarrhoea

This can be treated using medicines that can be bought from your chemist e.g. loperamide (Imodium).

• Keep well hydrated by drinking plenty of water

Contact the hospital if it is severe, i.e. between 2-6 extra episodes in the last 24 hours or if you have any blood in you poo or if diarrhoea continues for more than 24 hours.

Fatigue/tiredness

• Taking regular gentle exercise such as talking a short walk can help
• Avoid doing tasks or activities that you do not feel up to
• Ask your friends and family for help with everyday tasks

If you feel excessively tired, you can’t get out of bed or it is affecting your daily activity then ring the hospital.

High temperature

Ring the hospital immediately if you have a temperature over 37.5°C or if you have general flu like symptoms without a high temperature. Paracetamol and ibuprofen can hide a temperature and should only be taken if you are feeling otherwise well and your temperature is between 36°C -37.5°C.

Nausea (feeling sick) and/or vomiting (being sick)

• Keep well hydrated by taking small sips of water
• If you have already been given some anti-sickness medication, take these as stated on the label
• Try eating small amounts of food
• Ginger tea and ginger biscuits can help to reduce nausea

If you vomit more than once in 24 hours contact the hospital.

Skin reactions

• Use moisturising creams on a regular basis (if you are having radiotherapy treatment please discuss what type of cream to use with the radiotherapy team)
• Wearing cotton gloves and socks after applying moisturiser can help keep the skin moist on your hands and feet
• Anti-histamines can be used if the skin feels itchy

Please call the 24 hour chemotherapy hotline on 07917093738 if you experience:

• A new or worsening rash with or without itching or pain
• Painful hands or feet with or without redness swelling/numbness or tingling
• Peeling or blistering of the skin
• A painful, red or purplish rash that spreads and blisters.