Depending on the type of treatment you need you will likely be treated at RNOH, UCLH or both. Oncology treatment takes place at UCLH (chemotherapy and radiotherapy) and most surgery takes place at RNOH. At both UCLH and RNOH, we look after sarcoma patients of all ages.
At UCLH we have a paediatric oncology ward (ward T11) for children up to 12 years, an eighteen-bed Teenage Cancer Trust Unit (ward T12) for 13-19 year olds, and two oncology wards (T14 and T16) for adult patients.
Out-patient chemotherapy is given at UCLH in paediatric, adolescent, and adult Day Care Units at the UCLH Macmillan Cancer Centre. The Macmillan Cancer Centre provides clinic, chemotherapy, and imaging services for cancer patients. Patients and carers can also use the roof garden and are very welcome to use the Macmillan Support and Information Service at any stage of their cancer journey.
Private and overseas patients are treated on the private patient unit HCA Healthcare UK at UCLH (ward T15), which includes a dedicated Young Person's Unit.
At RNOH there are both paediatric and adult surgical wards.
Surgery is carried out within the London Sarcoma Service for sarcomas in all sites of the body. A core surgical team based at RNOH provides orthopaedic surgery for limb and trunk tumours, and a number of site-specific extended multidisciplinary teams provide surgery for abdominal sarcomas, thoracic sarcomas, gynaecological sarcomas, head and neck sarcomas, peripheral nerve sarcomas and spinal sarcomas.
Radiotherapy treats cancer by using high-energy rays, which destroy the cancer cells while doing as little harm as possible to normal cells. Radiotherapy may be used as part of treatment for both soft tissue sarcomas and bone sarcomas. It involves being treated for a few minutes every day, except weekends, usually for several weeks. The number of treatments will depend on the type, size and position of the cancer within your body, but the whole course of treatment for early cancer will usually last about 6 weeks. Radiotherapy is given in the Radiotherapy Department at University College Hospital, which is located in the basement of the hospital.
Patients receive high quality radiotherapy treatment at UCLH for sarcomas at all body sites, for children, teenagers and adults. The radiotherapy department has the most up-to-date equipment and consequently is at the forefront of current radiotherapy techniques. UCLH has been designated as one of two planned UK sites for proton radiotherapy facilities, due to open in 2020 and which will be especially important for sarcoma patients who need radiotherapy.
There are four designated sarcoma clinical oncologists: Dr Beatrice Seddon, Dr Franel Le Grange and Dr Mabs Ahmed who treat patients aged 20 years and over, and Dr Jenny Gains who treats patients aged under 20 years.
Your doctor will discuss the aims and side effects of radiotherapy with you in clinic. Before treatment can be started it must be planned. If your tumour is in a limb you will need to have an immobilisation cast made to keep the limb still, so that you will be treated in exactly the same position every day. This is made in the mould room. You will then have a CT scan wearing the cast, which is used to plan the radiotherapy. This process takes 2 - 3 weeks, which is why radiotherapy does not start immediately. During radiotherapy you will be seen every week by one of radiotherapy nurses, and at regular intervals by a doctor, to monitor for side effects.
One month after completion of radiotherapy patients are seen in clinic at UCH to ensure resolution of acute reactions and to set up a follow-up schedule.
Chemotherapy involves being given anti-cancer drugs through a drip. Many of our patients will need chemotherapy as part of their treatment. Chemotherapy is given at University College Hospital. At UCLH, there is extensive experience in the delivery of high intensity chemotherapy for sarcomas, and in providing the required supportive care including full ITU and interventional radiology services.
You will be treated either as an out-patient in Day Care in the UCLH Macmillan Cancer Centre , or as an inpatient on the oncology wards on T11 (children), T12 (teenagers), T14 and T16 (adults). If you are having in-patient chemotherapy, your treatment will be arranged by a team of chemotherapy nurses who will contact you before your first hospital admission, and who will coordinate your care all through treatment.
In a unique innovation at UCLH, some in-patient infusional chemotherapy has been transferred from the ward to the Ambulatory Care Unit, by delivering the intravenous fluid part of the regimens in large fluid bags carried by the patient in a back-pack. This allows patients to be able to leave the hospital during treatments which would otherwise mean staying on the ward with a drip for several days. Patients receive chemotherapy in the day on the Ambulatory Care Unit, and stay at night in a local hotel.
Many of our patients live some distance away from UCLH. It is not always practical to travel up to UCLH for all aspects of treatment, so for each patient we make arrangements with a named consultant at their local hospital to share care for treatment including antibiotics for infections, blood transfusions, and sometimes for chemotherapy and radiotherapy. We have patient-held Shared Care folders which contain details of a patient's diagnosis and treatment, contact details for UCLH, and contact details at the Shared Care Hospital. With these folders, we aim to improve the communication between UCLH and the Shared Care Hospital.
A range of innovative ablative (locally destructive) therapies are available at UCLH and RNOH, which can be used in conjunction with other treatments such as chemotherapy and radiotherapy. These include radiofrequency ablation of liver, lung and soft tissue metastases, and vertebroplasty to strengthen bones in the spine weakened by cancer. These therapies allow destruction of a tumour using energy delivered to the tumour though fibre-optic probes placed into the tumour. The procedure is carried out under sedation or a short general anaesthetic. It allows patients to have tumours treated without having large operations.
A major part of the service provided to sarcoma patients is supportive care, symptom control, and palliative care.
At UCLH the sarcoma team are very well-supported by an excellent consultant palliative care team who work with a team of clinical nurse specialists, providing advice and support for palliative and end of life care.
At RNOH patients are referred to local specialist palliative care services when it is appropriate to do so for complex symptom control, psychological support and end of life care. The sarcoma team at RNOH work closely and in partnership with local teams supporting patients. The RNOH team have undergone specialist training in end of life care and are developing resources further. They hope to have fixed sessions each week with a specialist palliative care physician in the near future. An end of life care policy has recently been developed to ensure patients and their families receive the best care during the last months and days of their life.
When you have finished treatment it will be important for you to be monitored to check for any signs that the cancer has returned or become active again. You will be seen in clinic regularly, by your surgical team, oncology team, or both. Follow up will normally involve an examination by your doctor, together with an x-ray or scans, depending on where your cancer was. Even if your cancer is completely gone, we will still need to check you for several years.
We recognise that end of treatment can be a stressful time for some people.
The UCLH Macmillan centre run a health and wellbeing event for people who have recently completed or are coming to the end of their treatment, which includes
- A range of workshops, run by healthcare professionals, on fatigue, sleep, physical activity, diet and relaxation.
- A chance to speak to others and share experiences
Help and advice is also available on the general Macmillan website.