Pancreatic cancer - chemotherapy and Whipple’s surgery
When Yvonne Sheppard started feeling bloated and like she had constant indigestion, and regularly woke up with night sweats she was convinced she was going through ‘the change’. However when she started going off her food and losing weight at a rate of 1lb a day she thought she ought to see her GP anyway. Her GP told her however that it might not be the menopause and gave her drugs to clear the indigestion. However, after taking the drugs for a couple of days she wasn’t feeling any better and her daughter Kerry read the drug information leaflet. “I don’t think you should be taking these” said Kerry “you’ve got a lot of the symptoms they say you should see you doctor about.”
I had the mental strength to deal with the disease but physically it was down to the consultants and the staff at Spire
Yvonne went back to her GP who referred her to the Royal Hampshire County Hospital in Winchester for investigations into suspected gallstones. After an endoscopy the doctor thought he saw something suspicious and she was sent for a scan. It was Yvonne’s worst nightmare when the doctor asked her to gather her husband and three grown up daughters around her and they were all devastated when they were told she had a tumour on her pancreas. The doctor had already arranged for Yvonne to see Mr Neil Pearce, Consultant General Surgeon at Spire Southampton Hospital, who is one of the country’s leading surgeons sub-specialising in hepato-biliary and pancreatic surgery. Mr Pearce rescanned Yvonne to see exactly where the tumour was and how big it was and then sent her home to be with her family for a few days, before bringing her into hospital with the intention of performing a complex Whipple’s operation.
The Whipple’s procedure is one of the most delicate, technically demanding operations a surgeon can perform. During the procedure, which is usually four to six hours long, surgeons work amid critical arteries and veins in the body to remove the head of the pancreas, a portion of the bile duct, the gallbladder and the duodenum. Occasionally a portion of the stomach may also be removed. After removal of these structures the remaining pancreas, bile duct and the stomach is sutured back onto the intestine to direct the gastrointestinal secretions back into the gut. The challenge is to remove all cancer cells, while not harming healthy tissue.
In September 2007, Yvonne went into Spire Southampton Hospital for the surgery, but before Yvonne had come round from the anaesthetic Mr Pearce phoned her family and asked them to come in and see him because he had bad news. He told the family that the cancer was nasty and aggressive. The tumour had a 360 degree wrap around a key, central artery, three biopsies all confirmed that this was a very advanced cancer, called a T4N2 tumour, of which very few are operable. “I had to tell Yvonne and her family that in this case the tumour was too difficult to remove, so I had performed a double bypass operation to relieve the jaundice and the blockage to her duodenum.” said Mr Pearce. “I then warned them that without treatment their mother may only have three to four months to live and may not even make Christmas. The best case scenario would be that she would get well enough to have Chemotherapy which might make her more comfortable and buy her some more time. However,” says Mr Pearce “even this was unlikely”.
Yvonne was told about the tumour and her first question was “OK, what’s plan B then?” But her body was breaking down and she was jaundiced and weak. Her daughters were distraught – they had never even seen their mother with a cold before. Kerry told Mr Pearce that she was convinced her mum would do whatever it took to get better. Mr Pearce was not optimistic but said he hoped she was right.
It was nearing Christmas and Yvonne gathered her daughters around her and told them never to think that she hadn’t achieved all she wanted to in life. “If I was going to die I didn’t want them to think I hadn’t fulfilled my dreams,” she says. “I told them I had done everything I ever wanted to in life and that I had travelled all I wanted and was incredibly proud of all they had achieved. I really needed them to know that.”
A week later Yvonne saw Mr Timothy Iveson, Consultant Oncologist at Spire Southampton Hospital with a special interest in gastro-intestinal malignancies. He told her in no uncertain terms that the Chemotherapy he would give her was not a cure but that it would hopefully make her more comfortable. However because of her speed of recovery from this surgery and her positive attitude he was prepared to try combination chemotherapy to try and shrink the tumour.
The tumour was measured before Chemotherapy and was 4.5cms long. Yvonne had three sessions of Chemotherapy which took her through December – making Christmas 2007 a pretty bleak affair for the Sheppard family.
After 12 weeks the tumour was measured again and they had their first piece of good news in many months. The tumour had shrunk more than 50% to 2cm. “It was brilliant,” says Yvonne. “The doctors said they hadn’t seen a response like that ever before and we were over the moon. I was particularly pleased when Neil Pearce intimated that, given my body’s reaction, he hadn’t ruled out the possibility of performing the Whipple’s surgery.”
Yvonne was booked in for another course of Chemotherapy, but determined to get the most out of life the Sheppard’s booked a cruise to coincide with the end of the treatment. A second scan was carried out after 24 weeks, just days before their cruising holiday was due to start and everyone was astounded to discover that the tumour had shrunk so small it was almost immeasurable. “We almost didn’t need a plane to fly to the start of our cruise,” says Yvonne. “We felt like we could have flown there ourselves!” Two days after the cruise had finished Yvonne was back at Spire Southampton Hospital having the Whipple’s surgery at long last.
The surgery, which lasted 8 hours, was an astounding success. Mr Pearce wrote a letter to Mr Iveson which Yvonne now holds dear; it mentions the stunning pathology results following the operation, and best of all states ‘no evidence of viable disease left’. The cancer had completely disappeared.
“Yvonne did phenomenally well.” says Mr Pearce. “She had an unprecedented level of response to the treatment she had and now looks incredible. She has completely bounced back from the surgery and Chemotherapy showing that she had a really positive psychological attitude and approach to it all. It is the combination of recent advances in chemotherapy treatment, modern surgical techniques and her extra-ordinary will power that have given her this second chance at life. All of the team here at Spire are delighted with her current progress”
Yvonne adds: “I had the mental strength to deal with the disease but physically it was down to the consultants and the staff at Spire. They reassured me so much and were intuitive to my feelings. Mr Pearce and Dr Iveson were so approachable and professional. Thanks to them and their team I am here now.”
This Christmas will be a much happier affair for the Sheppard’s, with all the family, including two grandchildren, gathered together. In January Yvonne and her husband are going to Los Angeles to join a ship which will cruise the Hawaiian Islands. “I am so excited” says Yvonne “and I’m determined to live life to the full.”