Patient 1

"Because I was taking low doses of a cytotoxic drug, which was extremely effective in containing my serious psoriasis (chronic skin disease), I went for an annual routine liver scan. This had always been a trouble-free formality and at first, when the radiologist pointed out a spherical patch on the nearby kidney, I thought perhaps I had a cyst. As I was taking a drug used in chemotherapy, I thought I was safe from the possibility of cancer. I had no symptoms and I thought the flashing abnormalities showing in the liver scan must be due to mild sclerosis, which would mean I would have to stop taking the drug. This was my main anxiety.

I was referred for further tests, but it was not until seeing a liver specialist to discuss the results, that the truth dawned. A third of my liver was completely non-functional. There must be an obstruction blocking the drainage of the bile duct for the left lobe. It was likely that the kidney lump was a primary cancer and that there was a secondary tumour in the liver. The kidney biopsy confirmed cancer, but the whole kidney could be removed and there was a surgeon in Guildford who might be able to remove the failed section of the liver.

From the moment my husband and I met Nariman Karanjia he inspired trust and confidence. He explained that the last tests showed that half the liver had failed and that until operating, the full damage would not be clear. On this basis the children, all three returning from college, gathered, shocked but mutually supportive, to spend family time (and watch the World Cup) before my surgery.

The time following surgery is blurred, but I remember great kindness and good humour from the staff. It had taken 10 hours and two surgeons and 60% of the liver was removed. The tumour was in the bile duct itself, with no visible spread to the liver tissue and the whole bile duct had been removed and a new drain constructed from duodenum. Only a third of the liver was essential to function and there would be some regeneration.

The tumour was also a primary not secondary growth. This led to the conclusion that the cytotoxic drug had disrupted my immune system and caused abnormal growth patterns. This also had implications for recovery, which included jaundice and pneumonia and some further surgical intervention to repair a leak. A further, non-malignant growth on a parathyroid gland added complication to the process of recovery leading to three months in hospital, persistent sickness and difficulty re-educating eating habits. Throughout all this Nariman Karanjia's care and concern never wavered. He was optimistic about the prognosis, once I was off the cytotoxic drug.

After discussion and advice I opted to undergo chemotherapy as a precaution against the possibility that there might have been unseen spread into the liver surrounding the bile duct. This has been a mixed experience, with periods of dreary sickness and all the other unpleasant side effects, but also times of relative normality. I hibernated throughout winter, sleeping fourteen hours in every twenty-four.

I was aware of many other people coping without complaint and of solidarity with others who have had treatment. People have accepted of me with or without a wig, dependant more on the temperature than appearance. I was able to go out locally when I felt well but avoided planned outings after having to cancel a couple of major arrangements.

Now it is all over and I have been given the all clear subject to regular screening. The psoriasis is re-emerging and new treatments have been discussed, but this seems much less significant after surviving life-threatening illness and surgery. It is amazing to feel well and energetic and I'm enjoying the bonus of being slimmer.

Over the last year I have been awed by the astonishing love and kindness of family and friends. I have learned how much goodness there is and I feel privileged to have had such wonderful care from an exceptional surgeon.."

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Patient 2 - A Patient who is also a Doctor

I qualified in medicine in 1956 so my medical knowledge, when I retired in 2001, was largely derived from my experience during those years of practice.

In June 2003 I was diagnosed with bowel cancer. I was lucky - the entire tumour was surgically removed 'a cure', you might say. And indeed my annual follow-up CAT scans after that were all negative - until the one I had this year - four years after the original operation. The radiologist was very apologetic, "Richard, I think there may be something a bit suspicious in your liver".

At this point I want to quote from a well-known textbook of medicine published in 1995 - only twelve years ago. 'As a rule, the presence of liver secondaries indicates incurable disease'. In a limited number of cases where there is a single metastasis, surgical removal of the part of the liver containing the tumour may be possible.This is associated with an approximately 25% chance of a five year survival.'

This accurately reflected the state of my knowledge when I was given the news. I genuinely believed that I had just received a sentence of death.The shock was all the greater because after four clear years I really thought I had got away with it. So when I went to see my surgeon a few days later I was expecting a somewhat depressing discussion. I was therefore astonished when he simply said 'we shall have to remove it' and immediately referred me to Professor Karanjia at Guildford. Five days later I was operated on and the liver tumour was completely removed. No chemotherapy was required. I am now back to a normal state of health.

A number of lessons can be learned from this little tale

The first is that even after successful removal of a primary bowel cancer, liver secondaries can occur, sometimes, as in my case, after quite a long period. Annual post-operative checks are therefore essential.

The second is that thanks to the new surgical techniques now available for their removal, they are no longer a sentence of death. If an (admittedly elderly, but reasonably well-educated) physician like me was unaware of this good news, then it is likely that a large proportion of the population might also be similarly unaware.

The third is that with these new techniques five-year and even ten-year survival rates that would have been unimaginable ten to fifteen years ago can now be achieved. These rates will continue to improve where patients can be encouraged to present at earlier stages of the disease.

The final message is that safe and complete removal of these liver tumours depends not only on the skill of the surgeon, but also requires the use of a range of highly specialised, complex pieces of equipment which are now an essential part of the process. Unavoidably, these are expensive but their use, in conjunction with the advanced surgical methods now available, means that 'A sentence of Death' is now rapidly being transformed into 'A Message of Hope'.

It is this that makes the support of the Liver Cancer Surgery Appeal so vitally important and so well justified. The more funding that becomes available to finance these exciting advances, the sooner we shall all see bowel cancer changed from a killer into a successfully treatable disease

Professor Richard Rondel MB FRCP
September 2007