On the last Wednesday in February, the British Parliament in London hosted a special event. Around 20 MPs from across the UK discussed with health professionals, patients and officials from the National Health Service (NHS) how to promote meaningful changes in the treatment of a rare type of cancer, cholangiocarcinoma.

British journalist accredited to report on the royal family, Katie Nichol, was at the heart of the event. Not in her journalistic capacity, however, but in that of a cancer survivor and member of Britain’s only cholangiocarcinoma charity AMMF.

With her was the doctor who operated on her, “a diamond doctor who saved my life” as Nichol says when she talks about the disease and the battle she fought. The…diamond has a Greek signature. She is the distinguished Greek liver, biliary and pancreatic surgeon at the UK’s Royal Free Hospital, Dr. Dora Pissanou, who has been working at the hospital since 2011, becoming the first woman in the UK to be appointed as an attending liver transplant surgeon at the hospital and the Reference Center for Liver Tumours and Transplants.

Difficult meeting

“Rethink liver cancer” was the theme of the event and everyone who attended, from the British public’s favourite journalist to the organisation’s illustrious board and health professionals, with the Greek surgeon prominent, gave their own heartfelt testimony about the disease and informed the efforts that will lead to early – and life-saving – diagnosis and treatment.

Nichol’s first meeting with the Greek surgeon took place two years ago, in February 2023. Ms Pissanou had been in Britain for 17 years already – she started as an unpaid visitor at the Liver Unit in Birmingham in 2006 and then trained at hospitals in Newcastle and London.

The 46-year-old, then a journalist responsible for reporting on the British royal family for media outlets such as the BBC, Good Morning Britain and Sky News, and a mother of two, was facing a health scare. As part of the screening there were findings that also led to an MRI scan of the upper and lower abdomen. This scan was obtained by the health professional at the facility where it was carried out at the oncology board at the Royal Free Hospital where Ms Pissanou attends.

The diagnosis was clear: cholangiocarcinoma, a rare and aggressive type of bile vessel cancer. And the doctor had to inform the patient of the -urgent- treatment. “There was a tumor about 8 cm in the liver. I explained to the patient that I had to remove a large part of her liver, but also a significant number of lymph nodes. It was a difficult surgery from a technical point of view,” recalls the conversation Mrs. Pissanou had while speaking to”THEMA”. Indeed, the operation lasted about 11 hours. The entire section of the left lobe was removed with extension to the right, as well as part of the right, left and middle hepatic veins, and extensive lymph node cleansing throughout the upper abdomen to shrink the chances of metastasis.

Two and a half months later, in May 2023, the journalist had returned to work – covering the crowning of Charles and Camilla Sand as King and Queen of the United Kingdom, while undergoing chemotherapy. But she was determined that she would communicate in every possible way the value of early diagnosis of cancer, even the rarest cancer such as the one she faced, and her activism through the cholangiocarcinoma charity AMMF, which she learned about from the Greek doctor.

An uncommon cancer

“This organization was founded by a patient’s husband who had ended up in 2002. At that time, even the name of the cancer was not known to the ordinary people of Britain. But now we are seeing more and more people being diagnosed with cholangiocarcinoma. Clearly there has been an increase in recent years, and of course all scientists have been focusing on this. There is a lot of interest and research in understanding why this is happening,” says Pissanou.

As she explains, it is a cancer that grows in the bile vessels (intrahepatic and extrahepatic). This is why it is slow to give symptoms, resulting in many cases going undiagnosed in the early stages. The 46-year-old journalist, for example, was very lucky because she was diagnosed early through screening. Nicol has mentioned in her speeches about this that she felt overwhelmed, but the blood tests she had done showed nothing. She was lucky though because she was operated on soon after another surgery in that part of the hospital was cancelled.

“Indeed there is not a specific marker in the complete blood count that raises suspicion. In advanced stages cancer markers and liver enzymes are increased. Cholangiocarcinoma has specific features that can be diagnosed by CT scan. If screening could be done in the population, as is done for breast cancer, for example, the equivalent mammogram in this cancer would be MRI,”
he says.

The rarity and aggressiveness of the disease is suggested by the hard numbers: 60%-70% of patients are diagnosed with metastatic or unresectable disease (with a median survival of 12 to 15 months). 30%-40% may undergo surgical treatment, such as Nicol. Recurrence of the disease is common in the majority of cases. Factors that may be implicated in the increased incidence include chronic liver disease, increased prevalence of diabetes, obesity and alcohol use, and environmental factors.

The dysfunctions of the health care system

The Royal Free Hospital, where Ms Pissanou has worked for the past 14 years, is home to the North London Reference Centre for Liver Tumours and Transplants, covering around 6 million people. She performs around 80 hepatectomies a year and more than 200 minor surgeries such as bile removal, hernia removal etc. The issue of waiting time for surgeries could not be left out of our online conversation with the Greek surgeon.

“The waiting list is huge in all hospitals in the health system. For operations such as so-called minor ones, patients go back and forth with symptoms to the doctor until the moment of surgery arrives. It takes at least a year for a bile extraction,” says Pissanou, attributing the situation to the pressure built up by the coronavirus pandemic and the pathologies that the UK health system – like other European ones – carries. “Doctors, like all health professionals, are making a huge effort to deliver our services as they should to the public. The health system is still effective thanks to our work. I don’t know how long it will be sustainable. This is a question that is on the minds of health professionals in public health systems. The need for funding is strong,” the surgeon clarifies.

This is most highlighted when it comes to critically ill patients such as oncology patients. As is the case in Greece, doctors are exhausting treatment options by utilizing clinical trials and protocols to include patients. Actions and initiatives such as the one in which Dr. Pissanou participated in the British Parliament enhance the work of the health care system and highlight the problems, but also the solutions that exist.

“People trust the health system in Britain. And that gives strength to those of us who work in it. Personally, I am very proud to be part of the liver team at the Royal Free Hospital, where we are constantly striving to improve outcomes for patients,” she says. The case of the named patient who came to the Royal Free Hospital bears testimony to this. The doctor, for her part, clarifies that as a health professional she does not focus only on the health problem and its treatment. “I focus on the patient and what he needs. I inform about the operation, the treatment, everything related to the disease and its management. I spend time explaining what the surgery involves and how it may affect life afterwards,” she says. “Each patient is unique not only in their anatomy, but also in their personality. Let’s not forget that we are all equal before God and death, famous or not,” she adds.

She loves Greece, but keeps a professional distance from the rest of the world. “I was lucky enough to do a residency at the First Surgical Clinic at the Laiko Hospital. At that time, Professor Felekouras, a doctor who inspired me and other young doctors to take up liver, biliary and pancreatic surgery, had come from the USA. I applied for an unpaid visiting post in Birmingham. I wanted to experience this exciting field of surgery. And I still remember how I felt when I saw my first liver transplant on October 2, 2006,” she recalls.

Back

She enjoys working with Greek doctors and watching them excel at home or abroad. “I am proud of those who return to the country. At least 15 doctors have passed through my department who now have positions in universities and the NHS,” she says, and clarifies that she is not yet interested in getting a return ticket. “I fought hard for what I achieved in Britain,” she notes. Her own goal now is to continually lengthen the list of patients who are winning their lives back. As the 49-year-old journalist raises her voice loudly, shares her experience and trains to run a half marathon to support the Cholangiocarcinoma Foundation.