Ian Paddick, a Consultant Physicist at specialist in radiation oncology, Amethyst Radiotherapy, discusses some of the challenges, practicalities, design considerations, and logistics, of installing a Gamma Knife radiosurgery machine into medical facilities, with a particular focus on the Queen Square Radiosurgery Centre within the University College Hospital in central London.
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October is breast cancer awareness month. Throughout the month, there are a range of fund-raising activities and events taking place to support the research and treatment of breast cancer. It also encourages people to be aware of the signs and symptoms of the disease, which is the most common cancer in the UK, representing 15% of all cancers.
The majority of breast cancer patients are women, although it can affect men as well. According to Breast Cancer.co.uk, the rate of breast cancer in women has doubled over the past 50 years and a woman in the UK born after 1960 has around a 1 in 7 risk of developing breast cancer.
86% of breast cancers in women are diagnosed at stage 1 or stage 2, which means that the cancer hasn’t spread throughout the body. Stage 4 breast cancer is known as metastatic breast cancer. Metastasis is the process of cancer cells breaking away from the original tumour and travelling to other areas of the body.
The brain is one of the most common areas to which breast cancer spreads, occurring in around 15% to 24% of women with metastatic breast cancer (also known as secondary breast cancer). Breast cancer may also spread to the lungs, liver, and bones, either through the bloodstream or the lymphatic system.
The general symptoms that breast cancer has spread include constant tiredness, nausea, and unexplained weight loss and loss of appetite.
Specific signs that breast cancer has spread to the brain include headache; feeling sick or being sick, weakness or numbness down one side of the body; seizures; difficulty with speech; problems with vision; confusion; memory problems; and changes in behaviour, mood, and personality.
When breast cancer spreads to the brain, it can be treated but not cured. Treatments may involve slowing down the growth of the cancer and also relieving symptoms, and may be given alone or in combination.
When breast cancer spreads to the brain, the cells are still breast cancer cells rather than brain cancer cells. This means that the treatment for breast cancer with brain metastases may vary from the treatments for other types of brain cancer.
The type of treatment will depend on a range of factors, including how many tumours are present and what size they are; the location in the brain; and if the cancer has spread to any other areas of the body.
The most common treatments include steroid drugs to reduce pressure and swelling on the brain and relieve symptoms; and radiotherapy or stereotactic radiosurgery or radiotherapy.
Stereotactic radiosurgery is also known as Gamma Knife surgery, and it is not a conventional type of surgery involving incisions or insertions into the brain. It uses highly targeted doses of radiation from an external machine to destroy the cancer cells, whilst avoiding the healthy tissue.
Brain tumour patients and their families in the UK have called for a new drug to be made available on the NHS to treat low-grade gliomas. The Guardian reports that the drug, known as Vorasidenib, has been proved to be effective in clinical trials but is not yet used within the NHS.
Vorasidenib works by inhibiting the enzymes IDH1 (isocitrate dehydrogenase) and IDH2 and is able to cross the blood-brain barrier, according to the The Brain Tumour Charity. A phase 3 clinical trial involving 331 patients showed that the drug significantly slowed the progression of residual or recurrent grade 2 gliomas.
Patients who took the drug required less frequent treatments and had few side effects. It has been approved by the Food and Drug Administration (FDA) in the US and is available to be fast tracked by those patients in most need. However, it has not yet been approved for use in the UK.
The Guardian reports on the case of Shay Emerton, a 26 year old biochemistry graduate. He was diagnosed with a slow-growing grade 2 glioma in 2021. He had surgery which successfully removed 98% of the tumour, but the remaining tumour requires regular six month monitoring because there is a risk that it might regrow.
Emerton said: “It’s so frustrating that there is something out there which could potentially help me to live a longer life and I can’t access it. They stopped the clinical trial because it was so successful.” His mum Dawn added: “People say you can wait until the drug is approved, but these patients do not have time. The tumour can progress at any stage.”
There has been widespread criticism from campaigners and researchers regarding the poor progress and funding levels for brain tumour research.
According to the National Cancer Research Institute, since records began in 2002, £10bn of funding into cancer research in the UK has been provided, but just £126m (1.3%) has been allocated to brain tumour research.
A Department of Health spokesperson said: “Brain cancer is a devastating disease, which is why we’ve allocated £40m for research in this area, on top of £1bn a year for wider health research.”
They added: “We’ve invested in every suitable research application made and the funding will continue to be available for further studies to develop new treatments and therapies for brain tumours.”
Brain tumours are currently the biggest killer of adults under 40 in the UK, with over 12,000 people being diagnosed with a primary brain tumour each year. There are over 130 different types of brain tumour that can cause a variety of symptoms.
These may vary from person to person, but common signs include headaches, changes in vision, seizures, nausea, dizziness, tiredness, and loss of taste and smell. Most of the time, these symptoms will have other causes, but anyone experiencing persistent or recurrent episodes of two or more symptoms is advised to consult a doctor.
For information about treatments for glioblastoma and Gamma Knife surgery, please contact Mr George Samandouras of Amethyst Radiotherapy.
The Brain Tumour Charity has launched an awareness campaign to boost the speed of brain tumour diagnosis in adults. The Better Safe Than Tumour campaign was launched in July 2022, and the message has already reached millions of people. A specially designed symptom checker on the charity’s website has been used over 38,000 times.
If you or a loved one have been experiencing two or more of the following symptoms, you are strongly advised to get in touch with your doctor: Persistent or recurrent headaches; fatigue; seizures or fits; nausea and vomiting; loss or disturbance of vision; speech difficulties, memory problems, or loss of taste or smell.
Other common symptoms of a brain tumour include cognitive changes, and weakness, numbness or tingling of the extremities. It’s important to remember that while brain tumours are rare, they can progress quickly, so the earlier they are diagnosed and treated, the better the prognosis.
The Better Safe Than Tumour campaign has been launched on the shoulders of the Brain Tumour Charity’s successful HeadSmart campaign, which focused on improving the speed of brain tumour diagnosis in children and young people. This has led to the average diagnosis time in the UK falling from 13 weeks to 6.5 weeks.
This is clearly a great result, and now the Brain Tumour Charity are aiming even higher with their new campaign, with a target to reduce diagnosis times to four weeks. This will bring the UK on a par with other countries who perform well in brain tumour treatment.
Currently, 78% of people are diagnosed within three months of seeing a healthcare professional, but 42% had to visit a GP three or more times in order to get a correct diagnosis. Furthemore, 74% resorted to going to A&E with their symptoms, and 46% of patients were informed they had a brain tumour by an A&E doctor rather than a specialist.
If you would like some information about Gamma Knife surgery, please contact Mr Neil Kitchen of Amethyst Radiotherapy.
A brain tumour diagnosis can be a shocking and upsetting experience, both for the affected person and their family and friends. On top of the difficult news, there may be practical matters to think about such as financial support, employment, and childcare, at a time when you feel the least like dealing with them.
To help people cope with these trying circumstances, the Brainstrust charity has launched a special support toolkit called the Brain Box. It contains resources that are designed to help you feel more in control of your situation, that you can turn to when you wake up feeling overwhelmed at 3am in the morning.
The boxes are free for anyone who has been diagnosed with a brain tumour or who is caring for a brain tumour patient, and they can be ordered directly from the Brainstrust website. There is the opportunity to provide details such as the age of the patient and the tumour type and grade, so that you can be sent the most relevant information.
For parents of children who have been diagnosed with a brain tumour, there is a Little Brainstrust Brainbox. Many of the resources are available online and can be downloaded.
What is contained in the Brain Box?
The Brain Box contains a number of different guides, and you are able to request which ones you would like to be included in your order. There is a general guide that explains the care you can expect to receive from your medical team, and a guide specifically designed for patients who are facing radiotherapy.
There are further guides covering issues such as how to cope with fatigue; how to have a difficult conversation; how to cope with behaviour and personality change; and a guide to understanding and managing the end-of-life care pathway.
If you would like further information about brain tumour treatment, please contact Mr Andrew McAvoy of Amethyst Radiotherapy.
Medical research organisations and charities have welcomed the news that the UK is to rejoin the EU’s flagship collaborative research programme Horizon. This will allow UK-based researchers to apply for grants and take part in projects under the programme, including those in under-represented areas such as brain cancer.
Britain has been excluded from the £85bn research programme since the official exit from the EU in January 2020. Previously, the UK was one of the most active participants in the programme. Although scientists have still been officially eligible to apply for funding, the process has been hugely hampered by red tape around data and cost sharing.
Now a deal has been made to allow the UK to rejoin Horizon, after a three-year delay as the Northern Ireland Brexit agreement remained mired in discussions and disagreements. The new deal is thought to be worth £2bn a year, with rebates if grants to UK scientists do not match this amount.
Thomas Brayford, Policy and Public Affairs Manager at Brain Tumour Research, commented: “The association with Horizon is a huge win for brain tumour researchers across the country and allows them to build on years of collaborative research with their European partners.”
He added: “Importantly, it also ensures that the UK remains at the forefront of science and innovation.” Other non-EU countries, including Norway, New Zealand and Israel are also a part of the programme, and there is the possibility of Canada, Japan and South Korea joining in the future.
Horizon is the largest medical and scientific collaborative research scheme in the world, and it allows individual nations to develop research projects at a far faster pace than they otherwise would have been able to. This is why medical research groups in particular have expressed their delight in the news that the UK is to become a full member once again.
Beth Thompson, Chief Strategy Officer of the Wellcome Trust, said: “Collaboration schemes make it a lot easier for scientists to work together across borders.”
She added: “This means really big collaborations such as the Human Brain Project, involving 500 researchers in 19 countries to help us understand how the brain works and how to address neurological problems, can take place with ease.”
“It can also mean researchers can come together to investigate things like rare diseases, at a scale that wouldn’t be possible within one country.”
“Collaboration is great for the vitality of science in the UK and elsewhere, and it’s great for new discoveries and innovation and the economy. But it’s also great for health and helping to solve the urgent health challenges the world faces.”
The news is particularly welcome for campaigners who have been calling on the UK government to improve the funding and clinical trial process into brain cancer treatment. Espite £40m over five years being allocated for this purpose in 2018, so far only £10.7m of these funds have been allocated to brain tumour research studies.
If you would like to find out more about brain cancer treatment and Gamma Knife surgery in the UK, please contact Mr Neil Kitchen of Amethyst Radiotherapy.
Brain tumours are growths of cells in the brain, which can either start in the brain (primary brain tumours) or spread to the brain from other parts of the body (secondary or metastatic brain tumours). There are over 130 types of brain tumour, some of which are benign (non cancerous) and some are malignant (cancerous).
When a brain tumour is diagnosed, it will be given a grade of 1 to 4, as per World Health Organisation (WHO) guidelines. Grade 1 and 2 brain tumours are slow growing and unlikely to spread to other parts of the brain, although they can still cause damage if they are left untreated.
Grade 3 and 4 brain tumours are fast growing and cancerous, and more likely to spread to other parts of the brain. The treatment for a brain tumour will depend on its grade, and also the size and location in the brain and the general health of the patient. A specialist may recommend surgery, radiotherapy, chemotherapy, or a combination of these treatments.
Some people with brain tumours are interested in exploring complementary therapies that can be used alongside conventional therapies or surgery. One such therapy that is currently undergoing research is ketogenic diet therapy (KDT). This involves eating low amounts of carbohydrates, moderate protein and high levels of fat.
According to the charity Brain Tumour Research, KDT triggers multiple biochemical pathway changes that may have a protective effect on neurological functions. However, more evidence is needed before it can be recommended as an effective management therapy for brain tumour patients.
The KDT has been used to effectively help manage other medical conditions, including epilepsy, before anticonvulsant medicines were invented. It is thought that it may be beneficial for some brain tumour patients, because cancer cells process energy differently to healthy cells.
Cancerous cells use very high levels of glucose which is derived from carbohydrates, but they cannot make effective use of fats or ketones. Therefore, by restricting the amount of carbohydrates in the diet, blood glucose levels will always remain at normal levels and this may inhibit the growth and spread of cancerous cells.
However, research is still in the early stages. The Brain Tumour Research charity reports that a clinical trial protocol for KDT is being put in place in the UK, and extra funding is currently being sought to take the process forwards.
People who have been treated for a brain tumour may experience some lasting after effects, including problems with movement, speech, and an increased risk of seizure and stroke. The NHS recommends following general healthy lifestyle advice, including stopping smoking, taking regular exercise, and eating a healthy balanced diet.
If you would like to find out more about brain tumour treatment, please contact Mr Andrew McAvoy of Amethyst Radiotherapy.
Brain metastasis refers to the spread of cancer to the brain from another part of the body, and sadly it is one of the most frequent causes of cancer-related deaths. One of the most common types of cancer that can metastasise to the brain is melanoma, which is a form of skin cancer. Here is some more information about risk factors, symptoms, and treatments.
The main cause of melanoma is skin exposure to ultraviolet (UV) light. This can be from the sun, or from an artificial light source such as a sun bed. People with pale skin, lots of moles, or a history of melanoma in the family are most at risk. However, anyone can be affected, so it is important to take steps to protect yourself from UV light.
In many cases, skin cancer is preventable by avoiding the use of sunbeds and taking extra care outdoors, particularly between March and October when the sun is at its strongest. Whenever possible, stay in the shade between the hours of 11am and 3pm during these months.
When you are outdoors, apply a high factor sunscreen (at least 30 SPF) to all areas of exposed skin. Cover up with a wide brimmed hat, UV protection sunglasses, and close weave cotton clothing for extra protection. Remember that UV is still present even on a cloudy day, so you should still take precautions when outside whatever the weather.
Children’s skin is particularly delicate and sensitive to the sun, so take extra care to keep them protected. If you are by the sea or a pool, remember to reapply sunscreen after they have been in the water. More information on sun safety can be found on the NHS website.
Check your skin regularly for any changes or warning signs, particularly in areas that are often exposed to the sun. Common symptoms of skin cancer include a sore that doesn’t heal within four weeks. It may look red and rough with raised edges, or white or pink with a shiny surface. It may feel sore to touch, and itch or bleed
Moles that have changed in appearance, or you have noticed for the first time may be a sign of melanoma. Normal moles are round or oval shaped with smooth edges. If you notice a mole that has mixed colours, blurred edges, is growing or swollen and itchy or crusty, then it’s advisable to contact your doctor who may refer you to a specialist.
Skin cancer is usually treatable, especially if it has been caught in the early stages. The main form of treatment is surgery to remove the melanoma and any other cancerous cells that have spread in the body. Sometimes an area of healthy skin around the melanoma is removed to minimise the risk of the melanoma returning.
Radiotherapy may also be used, especially if a large area is affected or the cancer is in an area that is difficult to operate on.
If you are looking for radiotherapy hospitals in the UK, please visit our website today.
A cavernoma is a cluster of abnormal blood vessels, and in most cases, it has a similar appearance to a raspberry. They can be found in the brain or more rarely the spinal cord and can be very small or measure several centimetres. Here is some further information about the condition and its treatments.
According to the NHS, cavernomas are sometimes also known as cavernous angiomas, cavernous haemangiomas, or cerebral cavernous malformation (CCM).They are sometimes confused with a brain tumour, but this is not accurate, as it is a group of blood vessels. They are non-cancerous and do not spread to other areas of the body.
However, cavernomas can grow in size which may lead it to press on other parts of the brain and this can cause complications. There is also a risk of bleeding, which may be mild or severe depending on the individual. Once one bleed (or haemorrhage) has occurred, this increases the likelihood of another one. Multiple or single cavernomas may be present.
Symptoms may vary from person to person, and they can depend on the size and location of the cavernoma. Sometimes they do not cause any symptoms at all. The most common symptoms include haemorrhage, seizures, dizziness, slurred speech, vision disturbances, fatigue, headaches, and problems with memory and concentration.
There is thought to be a genetic link in around half of all cavernoma cases, but according to the NHS, the condition can also occur randomly. Genetic testing is available to determine whether the condition has been passed on through a parent to a child.
There may be an increased risk of cavernoma if a person has previously had radiotherapy or some other form of radiation exposure.
Cavernoma Alliance UK, a charity that supports patients and their families and campaigns to raise awareness of the relatively unknown condition, reports that there is conflicting evidence as to the frequency of cavernomas. One study found that 1 in every 625 people in the UK has an asymptomatic cavernoma, which equates to about 108,000 people.
Another study found that prevalence was much higher, with undiagnosed cases occurring in 1 person in every 217.
Cavernomas that are not causing severe symptoms are often diagnosed during investigations for other conditions. The most reliable diagnostic tool is considered to be an MRI scan, although CT scans or angiography can be used.
Treatment will depend on the individual, and on the size, location, and amount of cavernomas present. The cavernoma may be monitored or surgery may be offered. This may be in the form of neurosurgery or stereotactic radiosurgery, also known as Gamma Knife surgery.
Cavernomas can be treated by Mr Patrick Grover at Queen Square Radiosurgery Centre, Amethyst Radiotherapy UK.
Multiple sclerosis (MS) is a neurological condition that affects the nerves and causes disruption to the way that messages are carried to the brain. This can result in a range of symptoms that may be invisible, mild, moderate, or severe. There is currently no cure for MS, but it can be treated and managed.
The treatment may depend on the type of MS that is diagnosed, and the individual symptoms that are present. The NHS reports that there have been considerable advances in treatments over the past 20 years, and research into new therapies is continually ongoing.
There are two main types of MS: relapsing remitting MS (RRMS) and primary progressive MS. The former type is the most common, making up between 80% and 90% of all MS diagnosis. Symptoms may flare up and then relapse or even disappear at intervals. In some cases, periods of remittance can last for several years.
According to the NHS, about two thirds of people with relapsing remitting MS will go on to develop secondary progressive MS, which involves a gradual worsening of symptoms rather than peaks and troughs of severity.
Primary progressive MS (PPMS) is diagnosed in 10-15% of people with the condition. In this case, symptoms develop gradually and become worse over time, with no marked relapses. In some cases, early relapses may occur in PPMS, and this is referred to as active primary progressive MS.
Symptoms for all types of the condition can be similar, but they can also vary in severity and some people will not experience all of the symptoms. The most common include fatigue, problems with walking, balance and muscle coordination, blurred vision, and muscle stiffness and spasms.
Identifying the right treatment for MS requires expert medical advice, because it depends on the type of disease, the symptoms present, and how far the condition has progressed. While there is no cure, in some cases the progression of the disease can be slowed down, and the severity of the symptoms can be eased.
According to the MS Society, everyone who has been diagnosed with the condition should be offered a review of their treatment with a specialist at least once a year.
RRMS can be treated with disease modifying therapies (DMTs). There are already various products that have been approved for use in the UK, and an MS specialist will be able to advise about which ones are the most suitable for individual patients.
DMTs are not usually used to treat people with secondary or primary progressive MS, although there are some exceptions. The MS society reports that a new drug called ocrelizumab (Ocrevus) can be used to treat PPMS if caught in the early stages, and the person meets certain eligibility criteria.
Alongside treatments, symptoms can be managed by rehabilitation therapies including physiotherapy and cognitive behavioural therapy.
Mr Jonathan Hyam of Amethyst Radiotherapy is a specialist in treating multiple sclerosis and nerves damage.
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