No doubt many will still be reeling from the diagnosis revealed by the Princess of Wales on Friday, but as an oncologist with a reputation spanning almost fifty years, I am pleased to say that what she told us – together with the extraordinary progress in field of cancer care in the last decade in particular has given me good reasons for optimism.
When I started my career in medicine, cancer was a dirty word and everyone received the same treatment, largely in the form of one-size-fits-all chemotherapy.
Today we tailor treatment to the patient, a form of personalized medicine supported by enormous advances in molecular and genomic analysis. By examining cancer cells under a microscope in a pathology lab, doctors can now determine much about whether the cancer has spread and the exact risks of it returning.
This may partly explain the five-week delay between the Princess’s surgery, which took place in mid-January, and her starting chemotherapy at the end of February.
Chances are that Kate will feel like her hair is thinning over the months, says Karol Sikora
It may take a few weeks for lab data to be collected, while doctors don’t want to begin any form of treatment until the wounds from Kate’s surgery have healed.
Fortunately, the fact that Kate has stated that she is now receiving preventive chemotherapy indicates that analysis shows that her cancer has not spread beyond the abdominal area. If she did, she would receive a more aggressive form of chemotherapy.
Instead, she undergoes so-called ‘adjuvant’ chemotherapy – from the Latin adjuvare, meaning ‘to help’ or ‘support’ future health.
This usually happens when doctors think there is more than a 5 percent chance of the cancer returning; a lower chance is considered low risk and further treatment is not considered necessary.
This applies to all forms of cancer, while the risk ratio differs from country to country: in the US this is two percent and not five.
Of course, patients are given a choice: some, especially the elderly, may weigh the debilitating effects of chemotherapy against their likely life expectancy in general and decide not to participate.
At just 42 years old and with three young children, that option is clearly not reasonable for Kate.
Radiotherapy does not apply either, because it simply cannot be used for cancers in the abdominal area: the intestines are extremely sensitive to radiation and would disintegrate at the required radiation level.
Hence a course of chemotherapy, which for all cancers is typically administered over a period of four to six months at two to three week intervals, giving normal critical tissues such as bone marrow and skin cells time to recover.
Kate has an extensive and extremely supportive family network
The fact that Kate revealed in late February that she had started chemotherapy suggests that she has undergone one cycle and is preparing for, or is currently undergoing, another.
Anyone who has experienced it knows it is no fun. While the days of extensive vomiting due to chemotherapy are thankfully long gone thanks to targeted medications, there are some troublesome side effects that are unfortunately normal.
Chief among these is the immense fatigue, which tends to worsen as treatment progresses, while many patients report uncomfortable tingling in the legs due to damage to the nervous system.
As for hair loss, it varies. Breast cancer patients cannot avoid this due to the type of medications used, but those treated for other cancers seem to do better, although there is a good chance that Kate will feel like her hair is thinning as the months go by .
Kate with Prince Louis during Queen Elizabeth II’s Platinum Jubilee celebrations
All of this is a tall order for anyone, especially someone in the public eye, but offset by Kate’s youth and fitness levels, along with the fact that, in addition to her husband William, she has an extensive and extremely supportive family network, including her mother. parents and siblings.
Although she must be careful not to become overly ambitious – gentle exercise is helpful, but stress certainly is not – I have been struck by her positivity and calm nature, which I have no doubt will help her recovery immensely.
Years on the medical front line have taught me that people with an optimistic attitude seem to handle the setbacks of chemotherapy treatment better than others, and Kate clearly falls into that category. I am confident she will prevail.
Professor Karol Sikora is a consultant oncologist in London. He is a former director of the WHO Cancer Programme.