Most women diagnosed with breast cancer have surgery to remove it. A new technique that is being tested aims to make operations more accurate.
Samantha Matthews, 48, head of college admissions from Surrey, was one of the first to undergo the technique, she tells Adrian Monti.
Samantha Matthews, 48, head of college admissions from Surrey, was one of the first to undergo the technique
A few days after Christmas last year, I noticed an uncomfortable swelling in my left breast. Two years earlier, I had a similar problem with the same breast.
This was caused by harmless cysts that were painlessly removed in the hospital, so I wasn’t too concerned and assumed they were cysts again.
At the beginning of January I spoke with my GP, who referred me to the hospital. I went for my appointment a week later. After physical examination, a mammogram was taken, which found nothing abnormal, although an ultrasound picked up more cysts.
These were drained and a biopsy was taken. But a few days later, I felt a pea-sized lump, which was unsettling.
A week later, the biopsy results showed that I had an early, low-grade tumor, about 1.5 cm in size. I was strangely calm. My husband Brian, 56, hugged me and said it would be okay. It was hard to tell our daughter Maisie, 16,.
At the next appointment in late January, my consultant Edward St. John explained that a small magnetic seed — the size of a grain of rice — would be inserted into my left breast to act as a marker for locating the tumor during surgery. This was a new technique to make the tumor easier to find. The semen would be removed during the operation.
At the same appointment, the seed was inserted through a thin needle by a radiologist and guided into place using ultrasound. This took seconds. To make sure it was in the right place, a mammogram was taken.
On the day of the surgery, ten days later, dye was put in my chest to reveal the sentinel node in my armpit – where cancer cells are likely to spread first. During the procedure, three nodes were removed to see if the cancer had spread. It hadn’t.
Diagnosis: MRI scan with a tumor
Then I got a general anesthetic and the next thing I remember was coming by with a bandage on my chest. Brian picked me up and I was home four hours after surgery.
I had some pain where the nodes were removed, but no pain in my chest. Within three days I was working from the couch.
The surgery left a small dip near the nipple where the tumor was removed.
When I have fully completed my treatment I can have minor reconstruction surgery if I wish.
I will start on April 13 with a two-week radiotherapy to destroy cancer cells that have been overlooked.
Then I will start taking tamoxifen, an estrogen receptor blocker, for at least five years. The hormone estrogen can stimulate cancer cells to grow, so this reduces that supply, but also causes menopausal symptoms.
We always participate in the Marsden March, a charity walk from the Royal Marsden grounds in Chelsea to Sutton; this year will be special because of the great treatment I had there.
I had some pain where the nodes were removed, but no pain in my chest. Within three days I was working from the couch
Edward St John is an oncoplastic breast surgeon at Royal Marsden Hospital in London.
There are about 55,000 new breast cancer patients in the UK every year. Almost a third of these cases are arrested through screening.
When a patient is referred, we do a physical examination of the breast and armpit area before performing imaging with a mammogram and an ultrasound. Finally, a biopsy is taken.
If cancer is detected and needs to be removed, the exact position of the tumor must be accurately marked. Several decades ago, if a patient had a tumor, the entire breast was removed.
But now, studies have shown that a lumpectomy – where a tumor is removed with a small margin of healthy tissue – followed by radiotherapy gives the same survival rate and better quality of life than removing the entire breast in a mastectomy.
There are about 55,000 new breast cancer patients in the UK every year. Almost a third of these cases are arrested through screening
Determining exactly where the tumor is located in the breast is critical to maintaining healthier tissue. The traditional way to mark the tumor is through a thin, flexible wire with a barb at one end. This is guided to the tumor using an ultrasound or a mammogram.
It usually happens a few hours before surgery and takes less than ten minutes. However, it must be done on the day, which can delay surgery and increase patient anxiety. The surgeon would then use the guide wire as their marker and tunnel into the breast tissue to remove the wire along with the tumor.
This method is still widely used in hospitals across the country. In rare cases, however, the wire can accidentally come loose, which means that the tumor cannot be found and an extra wire may need to be placed.
Also, if for some unforeseen reason the operation was canceled after the wire was inserted, it cannot be easily removed as there is a barb on the end to fix it in place.
In the past five years, a new method of locating a tumor has been introduced, in which a tiny ‘seed’ is inserted through a thin needle to locate small tumors or tumors at an early stage. Some use radio frequency to mark the tumor, while others use radar technology.
The seed can be placed weeks before surgery, which can be useful if, for example, the patient needs chemotherapy before surgery.
In January, the Royal Marsden started research with a new kind of ‘seed’ called the Sirius Pintuition, which has been developed in the Netherlands in recent months. We were the first hospital in the UK to use it. The seed consists of a magnet with a titanium coating. Once it’s in the patient, I use a small handheld magnetic detector to locate it.
On a screen I can see how far the detector is in millimeters from the seed as I tunnel through the tissue to reach it. It also emits a beep sound, with the pitch changing as you get closer.
This is much more accurate than the threads, which give no indication of how far away you are from the tumor. The new seed can be inserted up to 180 days in advance, so there is no pressure to have it on the day of surgery.
Samantha had her semen inserted ten days earlier, so all I had to do on the day of her surgery was to make sure the detector was getting a good signal.
Then I make my incision with the seed as my guide and, as soon as I get close, I remove a block of tissue containing the tumor and the seed before closing the incision. You cannot be sure if you have taken enough tissue during a lumpectomy, but this will be confirmed by laboratory analysis afterward.
I conduct our study here with fellow oncoplastic surgeon Katherine Krupa. We hope it will tell us if using the seed for lumpectomies is safe and more accurate as compared to threads.
Depending on the findings, the seed could be used in other hospitals following a national evaluation study by iBRA-NET, a collaboration of UK breast surgeons looking at new devices. The seed can potentially be used for other types of cancer surgeries as well.
What are the risks?
A magnetic seed can affect anyone with a pacemaker, as they can be turned off with a magnet.
The Sirius magnetic seed costs around £ 160 each – cheaper than others, but more expensive than wires costing around £ 60.
Naren Basu, an oncoplastic breast surgeon at Spire Little Aston Hospital and Queen Elizabeth Hospital, Birmingham, says the tumor. It is hoped that the seeds will reduce the need for a second operation by being more accurate. ‘
How housework can improve your health. This week: build torso strength by carrying groceries
Who knew you could train your upper body and arms with shopping bags?
“ Try an exercise the jack carries, ” suggests Pilates personal trainer Hollie Grant (pilatespt.co.uk
It’s essentially about handling weights – here, full tote bags – in each hand and walking on, without allowing yourself to lean on either side.
‘Ideally, the bags should have the same weight. You can further challenge yourself by only carrying the weight in one hand. Make sure to switch the heavy bags between hands for the same amount of time for each hand.
“This is great for strengthening the obliques – the abs that line the side of your torso – and all of the core muscles,” says Hollie.
Try to do this the entire walk from the supermarket home.
Who knew you could train your upper body and arms with shopping bags?