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Treatment

maconyoutubeIn this section we bring together basic information about the main types of cancer treatment and how they are provided in North Wales.

If you are being treated for cancer, your healthcare team will be there to provide you with written and verbal information and support at key points along your care pathway. Both diagnosis and treatment can be a worrying and confusing time but staff should always be willing to answer your questions and listen to any concerns.

Detailed information about treatment for specific types of cancer can be found at a number of reliable websites including Macmillan Cancer Support, Cancer Research UK and NHS Direct Wales. Our local Macmillan Cancer Information and Support Centres stock a wide range of free information booklets about specific treatments and cancer types.

Treatment usually begins soon after cancer is diagnosed. In North Wales there is an expectation that each new patient will be discussed by a multidisciplinary team (MDT) which includes a range of specialist health professionals. The professionals who make up your multidisciplinary team will depend on your type of cancer. The MDT will meet regularly to agree the best treatment options for each patient in their care.

A member of your MDT will then discuss the different treatment options with you, taking into account your own wishes. It can be helpful to have a family member or friend with you when your treatment is being discussed. Our section on ‘tips for asking questions’ may be helpful.

The main types of treatment for cancer are surgery, radiotherapy and chemotherapy. Treatment might mean receiving one of these, but increasingly it means receiving a combination of the different types of treatment available. Radiotherapy and chemotherapy are commonly referred to as oncology treatment.

Some types of cancer grow very slowly and may cause no problems for many years. In this situation you may not need to have any treatment for some time. Your doctor will monitor you (active surveillance or watchful waiting) so that if the cancer does start to cause problems you can be given treatment at that time.

Please follow the links below to find out about cancer treatments in North Wales:

 

Surgery

Surgery is one of the most common treatments for cancer. It may be recommended for a number of reasons:

  • Confirming a diagnosis (biopsy)
  • Removing a tumour
  • Staging ( judging the size and extent of the cancer)
  • Reconstructing a part of the body
  • Relief of symptoms

A single operation may achieve more than one of the outcomes listed above.
In North Wales, surgery will usually be performed at one of the three District General Hospital in the region. Best practice guidance sometimes recommends that surgery is done by teams who have specialist experience and for this reason surgical treatment of some cancers may be based at a single hospital. For instance, specialist surgery for oesophageal and gastric cancers is based at the Wrexham Maelor Hospital, whilst specialist surgery for gynaecological cancers is based at Ysbyty Gwynedd in Bangor.

Details for the main Hospitals in North Wales can be found by following the links below:

Ysbyty Gwynedd, Bangor
Ysbyty Glan Clwyd, Bodelwyddan
Ysbyty Maelor, Wrexham

Some cancer surgery can be highly specialised and patients from North Wales requiring such treatment may need to travel to hospitals in North West England. These hospitals serve a much bigger population and are therefore better able to provide this specialist care. Details of these centres can be found by following the links below:

Thoracic (chest surgery): Liverpool Heart & Chest Hospital, Broadgreen
Plastic surgery : St Helens and Knowsley NHS Trust, Whiston
Liver surgery : Royal Liverpool & Broadgreen University Hospitals NHS Trust
Pancreatic surgery: Aintree Hospital NHS Trust
Neuro surgery : Walton Centre for Neurology and Neurosurgery NHS Trust
Bone surgery : Robert Jones and Agnes Hunt NHS Trust, Oswestry

Radiotherapy

Radiotherapy, sometimes known as radiation treatment, relies on the use of carefully targeted high energy X- rays. About 4 out of 10 people with cancer will have radiotherapy which may be used for a number of reasons:

  • Destroy a tumour
  • Control symptoms
  • Shrink a tumour prior to surgery
  • Destroy small amounts of tumour that may be left after surgery

For patients attending the North Wales Cancer Treatment Centre for radiotherapy there is a locally produced information DVD which offers a step by step guide to radiotherapy – from referral to end of treatment. The DVD is designed to improve the experience of people who may be coming to the Unit for the first time.

Click on the image to view the DVD
(opens in a new window)

There are also open evenings at the Glan Clwyd Radiotherapy Unit on the first Wednesday of every month, 5.00 – 6.00pm. Newly referred patients and their families are welcome to visit the Radiotherapy Unit at the North Wales Cancer Treatment Centre for an informal tour and a chance to learn more about radiotherapy treatment from health professionals and patient representatives.

The open evenings are supported by Tenovus Cancer Care. For more information call free on 0808 808 1010 or ask a member of your healthcare team.

Radiotherapy can be given in two ways – externally and internally.

External radiotherapy is the conventional type of radiation treatment for cancer and is so called because the radiation is delivered from an external source. In North Wales there is a single Radiotherapy Centre which houses four radiotherapy machines (called linear accelerators) and this is based at the :radiotherapy

North Wales Cancer Treatment Centre
Ysbyty Glan Clwyd, Bodelwyddan, LL18 5UJ
01745 445130 (main reception)

The treatment itself is similar to having an ordinary x-ray picture taken but takes a few minutes to deliver rather than seconds. It is usually given as an outpatient treatment in a number of small doses over a period of days or weeks. The course of radiotherapy is specifically designed for you by specially trained doctors, radiographers and physicists. The aim will be to destroy as much of the cancer as possible without damaging healthy cells. Treatment is becoming progressively more effective as techniques and equipment become more advanced.

The Royal College of Radiologists has produced a useful step by step virtual tour of the places, procedures and staff that you may expect to meet if you are going for radiotherapy.

Patients living more than 30 miles from the Centre, and who are fit and able to care for themselves, may have the option of staying in the Gwawr Hostel based at the Cancer Treatment Centre during the period of their treatment. Hostel rooms are limited in number and so cannot be guaranteed.

Please use the links below to download Information booklets produced by North Wales Cancer Services and which may be useful if you are expecting to have radiotherapy treatment.

Radiotherapy and You
Gwawr Hostel accommodation

Some specialised radiotherapy, such as ‘stereotactic’ or paediatric radiotherapy, is not available in North Wales and in these cases patients may need to attend centres in Manchester or on Wirral, Merseyside. Details of these centres can be found by following the links below:

Clatterbridge Centre for Oncology NHS Trust
Christie Hospital NHS Trust, Manchester

Internal Radiotherapy is so called because the ionising radiation source is located inside the body. The most common type of ‘internal’ radiotherapy is brachytherapy and in North Wales may be chosen as a treatment option for some prostate and gynaecology cancers. Radioactive metal wires, seeds, or tubes are placed inside or close to a tumour and are left inside the body for a period of time, ranging from a few minutes to a few days.

Patients in North Wales for whom brachytherapy has been chosen as the preferred treatment will attend centres in Manchester or on Wirral, Merseyside. Details of these centres can be found by following the links below:

Clatterbridge Cancer Centre NHS Foundation Trust
The Christie Hospital NHS Foundation Trust, Manchester

Chemotherapy

Chemotherapy (‘chemo’) is treatment with anti-cancer drugs that are used to destroy or control cancer cells. A single drug may be given or several different drugs may be given together. The aim of the treatment will depend on the type of cancer you have and how advanced it is.

Chemotherapy can be given:

  • by injection or a ‘drip’ directly into a vein (intravenous chemotherapy)
  • by mouth as tablets or capsules (oral chemotherapy)
  • by injection into the fluid around the spine and brain (intrathecal chemotherapy)
  • directly into a body cavity, for example the bladder
  • by injection into muscle or under the skin
  • directly to the skin as a cream for some skin cancers

Chemotherapy is usually given in a dedicated outpatient unit over several different sessions. Each of the three main hospitals in North Wales has a cancer treatment unit. Details for each unit can found by following the links below:

Alaw Cancer Treatment Unit
Gwynedd Hospital
Bangor
Gwynedd
LL57 2PW
01248 384008 (main reception)
Click here to view an Information booklet for the Alaw Unit

North Wales Cancer Treatment Centre Glan Clwyd Hospital
Rhyl, Denbighshire
LL18 5UJ
01745 445566 (main reception)
01745 445234 (Heulwen Day Unit)
Click here to view an Information booklet for NWCT Centre

Shooting Star Unit
Wrexham Maelor Hospital
Wrexham, LL13 7TD
01978 727629 (main reception)
01978 727631 (outpatient enquiries)
01978 727602 (treatment unit)
Click here to view an Information booklet for the Shooting Star Unit

Occasionally chemotherapy will need to be given in an inpatient setting and in these cases treatments are usually given on Enfys Ward at the North Wales Cancer Treatment Centre or the Alaw Ward, Ysbyty Gwynedd Bangor. Details for patients and families can be found by following the links below:

Enfys Ward, North Wales Cancer Treatment Centre, Rhyl
Alaw Ward, Ysbyty Gwynedd, Bangor

A few highly specialist chemotherapy treatments may be given at centres in North West England. The centres serve a larger population and are better able to provide these services. Details of these centres can be found by following the links below:

Clatterbridge Cancer Centre NHS Foundation Trust
The Christie Hospital NHS Foundation Trust, Manchester
Royal Liverpool & Broadgreen University Hospitals NHS Trust

Hormone Therapy

Hormones are natural substances made by glands in our bodies. They are carried in the bloodstream and act as messengers between one part of our body and another. Hormones can have a wide range of effects including the growth and activity of certain types of cells and organs.

Some hormones can influence the growth of certain types of cancer. Hormone therapy for cancer is the use of medicines which are able to block the effects of hormones. Not all cancers respond to hormone therapy. Doctors use hormone therapy for people with cancers that are hormone sensitive or hormone dependent. Cancers that can be hormone sensitive include breast cancer, prostate cancer, ovarian cancer, womb cancer (also called uterine or endometrial cancer) and kidney cancer.

Hormone therapy may be the main treatment or may be given in combination with other treatments such as surgery or chemotherapy. Depending on the type of hormone therapy, it may be given in an outpatient hospital setting or may be prescribed by your GP.

Stem Cell and Bone Marrow Transplants

In some cancers, such as certain types of leukaemia, multiple myeloma, and some lymphomas, a stem cell or bone marrow transplant can be an important part of treatment.

Bone marrow is the soft, sponge-like material found inside bones. It contains immature cells known as blood-forming stem cells. These stem cells divide to form more blood-forming stem cells, or they mature into one of three types of blood cells: white blood cells, which fight infection; red blood cells, which carry oxygen; and platelets, which help the blood to clot.

Bone marrow and stem cell transplants are procedures that restore stem cells that have been destroyed by high doses of chemotherapy or radiotherapy or damaged by the cancer itself. The stem cells are ‘harvested’ from either the bone marrow or from the blood stream.

There are three types of transplants:

In autologous transplants, patients receive their own stem cells.
In syngeneic transplants, patients receive stem cells from their identical twin.
In allogeneic transplants, patients receive stem cells from their brother, sister, or parent. A person who is not related to the patient (an unrelated donor) may also be used but there must be a good ‘match’ in the tissue type of donor and patient.

A stem cell transplant from another person can also help treat certain types of cancer in a different way other than just replacing stem cells. The donated cells can often find and kill cancer cells better than the immune cells of the person who had the cancer ever could. This is called the “graft-versus-cancer” or “graft-versus-leukemia” effect. It means that certain kinds of transplants actually help fight the cancer cells, rather than simply replacing the blood cells.

Stem cells will be harvested days or weeks before the patient has their high dose chemotherapy or radiotherapy. When the time is right the patient will be given the stem cells by infusion which will seem rather like a blood transfusion.

Blood and stem cell transplants are very specialised treatments. At the moment all North Wales’ patients are referred to the Christie Hospital, Manchester, for these treatments.

The Christie Hospital NHS Foundation Trust, Manchester

There is an expectation that stem cell transplants will soon be carried out at specialist centres in North Wales.

Cancer Trials

Cancer research trials are carried out to try to find new and better ways of preventing, diagnosing, screening, treating and controlling the symptoms of cancer.

New cancer drugs or treatments are first tested in the laboratory (pre-clinical trials) before they are given to people in trials. If it seems they may help to treat a particular cancer, they are tested in phase 1 trials. If these are successful, the drug is used in phase 2 and then phase 3 trials. Phase 4 trials are carried out after a drug has been licensed – they collect information about side effects, safety and the long term risks and benefits of a drug. Usually, a new treatment has to go through a few phase 3 clinical trials before doctors are confident enough to accept it as the new standard treatment.

People who run trials involving patients (trial researchers) have to offer a treatment they believe is at least as good as, or possibly better than, the best available treatment. The trials have to be conducted following strict rules and guidelines to ensure patient safety.

What are the benefits?

  • You may have a new treatment that is only available in a clinical trial.
  • You may have more check-ups, tests and scans than usual, which you may find reassuring.
  • You will be helping to improve cancer treatments for future patients.

What are the drawbacks?

  • You may have to make more trips to hospital.
  • The extra tests and check-ups could increase your worry about cancer.
  • You may have to do some paperwork.
  • You may have unexpected side effects from the new treatment.

You may be asked to take part in a trial, or if you are interested in taking part in a trial you could ask for more information from your healthcare team.

If you have agreed to take part in a clinical trial or research project, you will be in contact by a research nurse. Their role is to help coordinate your care while you are on the trial. This includes organising investigations and taking blood samples. The research nurse will provide you with information about the trial and answer any questions you may have. They are there to support both you and your family.

Download and view the Cancer Research UK leaflet ‘Understanding Clinical Trials for Cancer’

In Wales, cancer research activity is coordinated by the Wales Cancer Research Network (WCRN) (incorporated into the National Institute for Social Care & Health Research Clinical Research Centre (NISCHR CRC).

The WCRN provides research staff through regional networks in North, South East and South West Wales. These are skilled research professionals that include Clinical Trial Unit Managers, Trial Managers, Trial Practitioners, Research Officers, Research Radiographers, Research Nurses, Clinical Trial Assistants and Administrators.

For more detailed information you may like to look at the following websites:

The Wales Cancer Research Network website will give you information about trials currently being run in Wales
Cancer Research UK provides general information about cancer trials and lists all cancer trials and studies currently recruiting across the UK

Macmillan Cancer Support provides general information about trials, including why and how they are carried out.

In addition to taking part in a clinical trial or research project as part of your treatment or care, there are opportunities for people to get involved in all aspects of the research process. The research teams believe that ‘user’ involvement will lead to research that is more relevant to people’s needs and concerns, is more reliable, and is more likely to be used to improve health and social care services. By involvement in research we mean working with researchers to plan, manage, carry out and present research. This active involvement is facilitated through the Involving People initiative.

Patient Information Booklets

Cancer services in North Wales produce a wide range of information booklets which are designed to support patients, family and friends at key points along the care pathway. In addition, every cancer patient should receive an information folder which includes some ‘core’ information and can be used to store additional information booklets that you may acquire as you progress along your care pathway.

Information booklets complement the information that will be given to you by members of your healthcare team and any decisions about your treatment and care should only be made in consultation with your health professionals.

To view the library of cancer information booklets produced in North Wales, please follow the link below:

North Wales’ patient information booklets

Accessing Cancer Treatments

In North Wales the Betsi Cadwaladr University Health Board will pay for most cancer drugs and treatments. However, the Health Board needs to make sure that the treatments it funds have a clear benefit so that they are able to help as many people as possible.

Occasionally your doctor may want to give you treatment that isn’t automatically funded through the NHS. This can be any type of treatment but will most often be a particular surgical procedure or cancer drug.

In these cases your doctor will have to make a special request which is called an ‘Individual Patient Request for Funding’ (IPFR). The IPFR will be presented to the Health Board and a decision will be made on the basis of evidence that the treatment being requested will be effective in your specific case.

In England the government sets aside money that can be used to pay for some cancer drugs and treatments that aren’t routinely funded through the NHS – this is called the ‘Cancer Drugs Fund’. Wales doesn’t currently have a cancer drugs fund although this has been the topic of considerable political debate within the Welsh Government.

Tips for Asking Questions

It can be difficult to talk about serious illnesses, such as cancer. Your feelings and fears may make it hard to ask the right questions and to remember the answers. You may feel that your doctors and nurses are too busy to answer your questions.

Remember you have a right to receive as much (or as little) information as you want. The doctors and nurses are happy to spend time giving you honest answers to your questions.

The link below will take you to a few tips that may help you make the most of your time in the clinic:

Tips for asking questions

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