'They took out 95% of my tumour'

By Jane Elliott
Health reporter, BBC News

Alison is cautiously optimistic

Alison Moss considers herself a very lucky lady.

Last year doctors discovered she had a grade-three brain tumour. But today, after surgery to remove 95% of the tumour, she is much recovered and her symptoms easing.

It was a chance accident that led to the tumour being spotted after a blow to the head during a sailing accident.

"I was sailing a little dinghy and I got hit by the boom and had concussion symptoms for a couple of days and then had a fit," she said.

Slow-growing tumour

"I was taken to hospital in Athens and was there for about 10 days because they could not understand what was causing the severe pressure on the brain."

Doctors suspected a tumour as a scan showed a shadow in the brain and this was confirmed when Alison got back to the UK.

My oncologist is very hopeful that they have got rid of all of it Alison Moss

"They think the bang on the head activated it and caused it to become more aggressive," said Alison.

"Otherwise it might have been another 10 to 15 years before it caused me any problems."

Surgeons at Imperial College Healthcare NHS Trust were able to remove 95% of her tumour by surgery and with chemotherapy and radiotherapy they are hopeful they have got the remainder of the cancer.

"They said it is life-limiting, but my oncologist is very hopeful that they have got rid of all of it which is excellent," she said.

Real-time scans

Neurologist Mr Dipankar Nandi, who treated Alison, said using an ultrasound scanning technique during the operation had allowed them to produce a real-time map of the brain and enabled them to remove most of her tumour.

In the past, relying just on Magnetic Resonance Imaging (MRI) scans taken before surgery, they could only safely remove between 50-60%.

Mr Nandi feels the scans offer surgeons better access

"You had the scan in front of you when carrying out the operation and found the opening based on them, but when you open up the brain it shifts and after you take the tumour out the scans that you have before the surgery are really no longer valid," he said.

"MRI intra-operatively is hugely expensive and very cumbersome and you can probably use just once or twice."

But he said that by carrying out intra-operative ultrasound scans as many times as needed they got a much clearer picture of the area being worked on.

"Once we open up we have the MRI of the patient taken before surgery, we use that to guide the opening, and once we have opened the skull before we open the lining of we take the first scan and we merge it," he said.

"We then start taking the tumour out and can keep repeating the scans. It takes a minute and you have a real-time feedback and you can see where the structures are.

"It allows us to take out a far larger part of the tumour than we would have previously dared."

He said that in Alison's case, because of where her tumour was positioned, there were worries she could have been paralysed down one side and might lose her speech if too much of the tumour was taken.

Study techniques

Imperial College has launched a three-year study to assess whether using intra-operative ultrasound scans results in more accurate brain cancer biopsies, and whether using the scans enables them to pinpoint the area of the tumour, better assess its severity and therefore decide on appropriate levels of chemotherapy and radiotherapy.

Matthew Worral, from the Royal College of Surgeons, said better imaging was needed before the technique could be used widely.

"The use of ultrasound to get images of brain tumours is a potentially useful technique but still has some significant limitations," he said.

"The appearance of healthy brain tissue and tumour is very difficult to interpret on ultrasound, amounting to subtly different shades of grey.

"Both further training for neurosurgeons and higher quality imaging technology will be required if this is to fulfil potential. We await the results of the current three year study with interest."

But Alison, from Hertfordshire, has no doubts that the technique has helped her.

Nearly a year after surgery she is still fatigued and forgetful, but says her symptoms are easing.

"I don't think they can ever say you are completely cured, but they are hopeful and I feel really genuinely lucky. It was growing so it would not have been long before I started getting symptoms."