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Monday, February 15, 1999 Published at 12:25 GMT


Health

Huge variation in cancer survival rates

TME is smooth whereas other excisions have more ragged edges

Survival rates for rectal cancer can vary as much as 700%, depending on which surgeon operates, according to a BBC report.


Trust Me, I'm a Doctor on rectal cancer
Patients who are operated on using a special technique for clearing out the tumour area are five times less likely to suffer a recurrence of cancer, surgeon Professor Bill Heald told the BBC2's Trust Me, I'm a Doctor programme.

He estimates up to 2,000 lives a year could be saved if it was used more widely.

The technique - known as total mesorectal excision (TME) - was pioneered in the UK and has been adopted across the world.

But, despite recommendations in a 1997 NHS report and from the Royal College of Surgeons, not all British surgeons use it.

Cancer claw

Professor Heald from Basingstoke began using the technique several years ago.

He said: "If you break off the claw of cancer it will return and you will die as we cannot cure local recurrence of cancer generally."


[ image: Professor Quirk:
Professor Quirk: "90% of people who suffer recurrent local cancer will die"
He says TME reduces the chance that cancer will recur from 35% to 5%.

Pathologist professor Phil Quirk has promoted the use of TME around the world with Professor Heald. He says 90% of people who suffer local recurrence will die.

With TME, not only is the cancer tumour removed but all the surrounding fat.

Professor Quirk says rectal cancer grows out through the wall of the rectum, making it important to remove all the affected area.

Professor Heald describes it as being like a crab in jelly.

"The jelly has to be lifted out of the jelly mould without breaking off the claw of the crab."

He said most doctors doubted his findings when he first published them.

But in 1989 two Swedish doctors came to Basingstoke to see if they could use TME to improve their poor rectal cancer survival rates.

Their recurrence rates have since dropped from 30% to 5%.

Norway, which has also adopted the technique, has seen survival rates rise from 70% to 94% for the cancer.

Similar rates have been noted in Stockholm and Amsterdam.

Best chance

Professor Quirk said: "If I had rectal cancer I would want to have TME by surgeons with a low recurrence rate whose specimens were of optimum quality. You can ask no more for patients than you would for yourself."


[ image: Professor Heald: pioneered TME]
Professor Heald: pioneered TME
Bridget, a patient from London, had TME on her rectal cancer.

She says she only asked for the technique at Basingstoke because her father worked in the NHS and researched the survival rates.

She said: "I was very fortunate that my father worked in the NHS and could research the best surgeon. When it is your life and you have only one chance at it you want to make the best of that chance."

Symptoms of rectal cancer include changes in bowel habits and rectal bleeding. Colorectal cancer - cancer of the colon and rectum - affects 27,000 people in the UK every year.



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