With an increasing number of training days, we believe it is important to recognise those who have successfully participated in the SNB training. Below are the hospitals in which participant’s of SNB training work.
Queen Victoria Hospital, East Grinstead
Oxford University Hospital, Oxford
City Hospitals, Sunderland
Central Manchester University Hospitals, Manchester
SNB is a procedure that is very operator sensitive. It is evident that new operators have a higher error rate when they start which decreases as they gain experience. As we introduce SNB across the UK, we are attempting to do so such a way as to keep the error rate low across all hospitals adopting the procedure through our extensive training programme.
The training consists of three components: initial lectures, procedure implementation and continual feedback.
In the preliminary lectures we cover first the nuclear medicine & physics aspects to SNB, followed by the surgery & pathology components. This is complimented with videos of how to undertake SNB, outlining the specific features, positives and pitfalls. In the afternoon there is a practical session where the attendees exhibit the earlier teachings of the day. Each hospital is encouraged to send a team of people forming the nucleus in the provision of the service, who are all sent home with a copy of the lectures and the videos. This proceedure has been analysed by the Royal College of Surgeons and has their approval.
These units (the nucleus mentioned previously) are then encouraged to begin SNB within their hospitals but initially combining it with a neck dissection to prevent error, until 10 cases have been performed successfully. They are then able to continue the procedure without the safety net of a neck dissection. During this period the team is offered mentorship as they proceed through the cases.
The final component has two aspects. In order to ensure that the units are maintaining the highest standard possible, they are asked to complete a form through an electronic database about each patient treated with SNB. We can then monitor their performance and report back to them. HNCF is also contributing to the quality of the procedure and safety of the patients by giving each centre that completes the training a special fluorescent camera for a period of a year. The advantage of this is that we create the tracer molecule injected around the tumour both radioactive and fluorescent. This reduces the chance of error through missing a sentinel node by having two targets on it; one radioactive the second a fluorescent particle. This is a brand new approach to helping maintain quality and optimum success, which we believe to be groundbreaking.
The pictures above and below show the position of the sentinel node after the radiation has been injected around the tumour. It has then spread through the lymph system, highlighting the cancerous area. The left photo is prior to injection and radiation mapping, and the coloured pictures on the right show after the injection.
HNCF Director and surgeon Professor Mark McGurk is conducting a unique study at Guy’s Hospital in London that has not been carried out anywhere else in the world for the treatment of oral cancer. The study consists of an exclusively engineered molecule with a fluorescent tag, which is then injected in the patient’s arm so that the molecule can travel through the patient’s blood stream and then attach itself on the receptors that are expressed by the cancer cells.
The molecule has previously been used by a Dutch medical team on bowel cancer patients, with promising results. Guy’s hospital is extending the molecule’s use by carrying out 20 cases in oral cancer, to see if the results are applicable in this field of oncology also.
Mr Smith (photographed), a mouth cancer sufferer, is the second in a series of patients taking part in this trial. Essentially, the molecule is drawn to the tumour and fluoresces it, which, in turn, will allow surgeons to locate it more efficiently, thus minimising the amount of healthy tissue that is damaged in order to extract the malignant growth.
We are still unsure as to whether this molecule will fulfil its objective, but it’s the first in an array of new chemicals that can be used to minimise the surgical impact associated with conventional oral cancer surgery.
HNCF’s first goal is to introduce Sentinel Node Biopsy (SNB) to the UK for treating mouth cancer. In early mouth cancer, 30% of patients have undetectable microscopic spread of cancer to their neck by the time of diagnosis. SNB is a very accurate way of establishing when otherwise invisible microscopic clumps of cancer cells start to leave the main cancer and migrate. This is a watershed moment in the spread of the disease that completely changes treatment methods.
Currently, without SNB, all patients with mouth cancer undergo a complex 3-hour neck dissection operation, in order to protect the 30% of patients in whom the disease has spread. This means that 70% of patients have a major and unnecessary operation.
A large scale study has shown that SNB can identify the 30% of the patients whose cancer has spread, enabling them to be given the appropriate accelerated treatment that helps cure the disease. At the same time, it saves the other 70% of patients from having to undergo an unnecessary major surgery.
HNCF has already pioneered the use of SNB, but this test is only available in one centre in the UK. HNCF’s first goal is to introduce SNB to all the cancer centres in the UK, which will be made possible by the successful completion of a UK Prospective Randomised Trial performed to NHS standards.
Currently, HNCF trustees are training 15 centres in the SNB technique, in preparation for this trial. The trial will cost £2m to run: the HNCF hopes to contribute £500,000 of this, and applications are being made to national research funds for the remainder of the cost.
The introduction of SNB will revolutionise the management of mouth cancer in the UK and will set the pace for Europe and America.