When Dawn Green was diagnosed with cancer four years ago, doctors delivered the crushing news there was nothing more they could do, and gave her just three months to live.
As she made funeral plans and explained to her two daughters, Megan and Kirsten — then ten and 11 — that she was going to die, the 30-year-old had a desperate look on the internet to see if there was anything that could help her.
‘I wasn’t given a name for the cancer when I was diagnosed in January 2008,’ recalls Dawn, who lives with her partner Jay in Kettering, Northants. ‘I wanted to find out more about it, what caused it, why I’d got it — all the usual questions.’
The online search threw Dawn a lifeline. She discovered she had a cancer called pseudomyxoma peritonei (PMP), which usually starts in the appendix and often spreads into the abdominal cavity, into the space between the organs and the abdominal wall.
Although the cancer develops slowly, the common symptoms — a bloated stomach, loss of appetite, pelvic or stomach pain and weight loss — means it is commonly misdiagnosed, and often not detected until it has spread.
Patients like Dawn, who is now 34, are usually then told nothing more can be done for them because surgery is impossible without damaging vital organs.
Indeed, Dawn had been experiencing chronic stomach pains for 15 months before she was diagnosed. Doctors thought she had a gall bladder problem — the cancer is also commonly misdiagnosed as irritable bowel syndrome or ovarian cancer. But Dawn’s internet search showed that contrary to what she had been told, there was a treatment — and it was available at two NHS hospitals, The Christie in Manchester and Basingstoke and North Hampshire Hospital.
The gruelling 12-hour operation involves removing all cancerous tissue in the body — in Dawn’s case her entire appendix, gall bladder, spleen, womb, ovaries, fallopian tubes, cervix and belly button, as well as parts of her liver, bowel, diaphragm and intestines and rectum.
This is then followed by a ‘chemo bath’, where the abdominal cavity is filled with warm chemotherapy liquid — normally for 90 minutes, while the patient is still under anaesthetic. It is known among patients as MOAS — the Mother Of All Surgeries.
Dawn is one of an increasing number of cancer patients previously considered too sick to treat, who are being given this controversial combination of surgery and chemotherapy.
The procedure has been recently modified to treat a range of more common forms of cancer that can spread to the abdomen, in the same way as Dawn’s did, such as appendix, bladder, bowel and ovarian.
Indeed, some of the country’s leading cancer experts say up to 20 per cent of bowel cancer patients — more than 5,000 a year — and many ovarian cancer patients whose cancer has spread extensively to their stomach, could benefit from chemo baths, officially called Hyperthermic Intraperitoneal Chemotherapy.
This is because bathing the inside of the stomach with heated chemotherapy increases the chances of the cancer cells being killed, says Sarah O’Dwyer, a consultant cancer surgeon at The Christie hospital.
‘Heat at 42c is able to kill cancer cells without affecting normal cells in the body,’ she explains.
‘If the drug was given into the general circulation at that temperature, the body would heat up and the heart would stop.
‘But because the tissue lining the abdominal organs acts as a barrier to absorption of the drug, it can reach a high concentration in the tummy where the tumours are without reaching the blood stream and causing damage to other tissues.’
The treatment was approved by the government’s health watchdog, the National Institute for Health and Clinical Excellence, in February 2010, and the two NHS units that offer it do around 180 procedures a year.
Despite the severity of the treatment, no patients have died during a chemo bath, although 1 per cent of patients die afterwards from complications such as infections and organ failure.
After being referred to Basingstoke and North Hampshire Hospital, Dawn had her treatment in June 2008. Although it usually takes 90 minutes, she had it over three days because of the severity of her condition.
‘It’s pretty horrific and before you have it you think, “How can anyone survive this?”’ says Dawn.
‘I said goodbye to my daughters, and wondered if I would ever see them again. I didn’t let them see me cry, but as soon as I got in the car to set off for the hospital, I broke down — I was so frightened.
‘When I woke up after the operation I felt like I’d been hit by a truck. I had heated chemotherapy inside me and for the next 23 hours, I was rotated in bed by the nursing staff to make sure the chemotherapy got to all parts of the abdomen. Then it was drained and a fresh batch put in for another 23 hours. The heat was not a nice feeling but I was drugged up, and the doctors were monitoring me all the time, so I felt I was in good hands.’
She had to have a temporary colostomy bag afterwards but it was reversed after three months.
Now, 4½ years after being told she had three months to live, Dawn has a decent quality of life.But she admits: ‘It’s not an easy treatment and I still struggle with tiredness and bowel issues, and eating can be quite difficult.
‘I have recently found out that the cancer has returned, and am now considering my treatment options, but the chemo bath has given me the chance to see my girls, who are now 14 and 15, grow up and to spend time with them.’
Dr O’Dwyer believes thousands more patients could benefit from the chemo bath treatment. However, many doctors don’t even know about it, so they are not being referred, she says.
‘More than 35,000 people are diagnosed with bowel cancer in the UK each year, and in about 20 per cent of cases, the cancer spreads within the tummy.’
‘A lot of these patients are currently only offered palliative care. Yet this chemo bath treatment could be beneficial to some, giving them a chance of a cure and extra years of life.
‘Our study of 30 bowel cancer patients — where the disease had spread to the stomach — shows that with chemo bath, 63 per cent were alive after three years.
‘Among those treated palliatively, all died within 12 months. It is a massive difference.’
However, critics say the 12-hour procedure carries such significant risks of infection and is so invasive it is just too dangerous.
Studies from small units in Europe show around 10 per cent of patients have serious complications — although results from the two UK centres are better.
Dr O’Dwyer says: ‘We now know who is likely to benefit, and we have improved the surgical techniques, making this a much safer procedure than five or ten years ago.’
Critics also question whether pumping the chemotherapy directly into the abdominal cavity is the best option. Dr Andy Gaya, a clinical oncologist at Guy’s and St Thomas’ hospitals in London, says: ‘Chemotherapy only gets down a few cell widths into the tissue, so it is unclear whether it really makes a difference.
‘Furthermore, pumping the chemotherapy directly into the abdominal cavity can be very painful and cause scarring.’
Most experts agree that more research needs to be done into the technique, but, in the meantime, a greater number of doctors and patients should be made aware of its existence.
Dawn, who has set up a support group called Pseudomyxoma Survivor, says: ‘I really believe if I hadn’t found that information on the internet, I wouldn’t be here today.
‘I was given a death sentence — and consider myself so lucky to have received that treatment.’