Cancer patients are being kept awake during operations to protect them from coronavirus, the Evening Standard can reveal.
Concern is mounting that people are delaying seeking medical advice for potential symptoms of cancer - and that the number who die prematurely as a result could exceed those who die with Covid-19.
It came as the number of coronavirus patients in London hospitals continued to fall – with the North West overtaking the capital for the first time.
There were 2,033 Covid-positive patients in London hospitals on Saturday – down almost 60 per cent on the peak of 4,813 on April 8 – and 2,191 in the North West, Downing Street said yesterday.
The number of hospital deaths in London rose by 58 yesterday to 5,156.
As part of Bladder Cancer Awareness month, London surgeons today issued an appeal for people to get checked for bladder cancer – saying it was one of several cancers where the danger of allowing it to go untreated often outweighed the risk of contracting coronavirus in hospital.
Bladder, oesophageal and stomach cancers are so potentially aggressive that, if left unchecked, they could rapidly become untreatable. Average survival for advanced bladder cancer is two years.
Awake surgery involves patients being given a spinal anaesthetic – similar to painkilling epidurals given to women during childbirth – to numb them from the chest or waist down.
Patients can also choose to be sedated – meaning they sleep through the operation. This avoids the need for intubation – making the operation less risky, in terms of coronavirus, for the patient and the surgical team.
However, more serious operations continue to be performed under general anaesthetic.
Ben Challacombe, chairman of the British Urology oncology section and a consultant urological surgeon at Guy’s and St Thomas’ NHS trust, said: “At the moment, anything that possibly can be done under an anaesthetic block, sedation or a spinal anaesthetic is being done that way. We have evolved to doing that because of the risks of Covid.”
Guy’s Hospital, in London Bridge, is using the “awake” procedure for over 70 per cent of operations to remove a tumour from the bladder. These are the more straightforward procedures that are done using an endoscope, or surgical “telescope”.
Patients are ordered to self-isolate at home for a fortnight before surgery and are admitted 24 hours before the operation to allow them to be tested for Covid-19.
Ramesh Thurairaja, the trust’s head of bladder cancer, said: “We are taking all precautions, even when they are negative - because of the uncertainty of this virus.
“If they are having a bladder tumour removed through a telescope, we are avoiding general anaesthetic and giving them a spinal anaesthetic, so that reduces the risk. They don’t have to be awake – they can be sedated if they want to.”
Surgeons are concerned that only about a fifth of patients with suspected symptoms of bladder cancer – visible blood in urine, known as haematuria – are coming to hospital for checks. Guy’s would normally check 20-25 patients a week – but only five a week have been turning up.
Mr Challacombe said: “Only 20 per cent of them are coming in. Covid hasn’t cured them, of course – it’s just made them more scared to come.
“We are now quite concerned we are going to have a big bulge in patients that are out there with bad disease who should come through but they’re not coming.
“We need to get the message across: if you have blood in the urine, you should come.”
About 10 per cent of people with blood in their urine will be diagnosed with bladder cancer. More than two-thirds of bladder cancer patients have the problem detected in this way.
Guy’s and St Thomas’ has been operating via the private facilities at London Bridge HCA Hospital during the coronavirus pandemic.
About 10-15 bladder cancer operations in the last month but surgeons emphasise that there is capacity to treat all urgent cases.
Plans are being drawn up to increase capacity for cancer surgery across the NHS but it will take “many months” before the backlog is eradicated.
The standard tests for blood in the urine are an ultrasound scan and a 90-second “telescope test” – inserting a tiny camera into the bladder via the waterway, which is done under local anaesthetic.
Experts are particularly concerned about painless haematuria – as painful haematuria is normally caused by a urinary tract infection rather than cancer.
The disease is three times more common in men, and in people over 50, but Guy’s has treated patients in their 30s and 40s.
Bladder cancer is the ninth most common cancer in the UK – the fourth most common in men - with a total of about 13,000 cases and 5,000 deaths per year.
Mr Challacombe said: “If your bladder cancer progresses, you are in big trouble. If you get metastatic bladder cancer where it has spread to your lymph nodes or your bones or your lungs, you are unlikely to live two years.
“At the moment, these patients have got the most to gain from being diagnosed. If these cancers get out of the bladder, they become incurable very quickly.”
Mr Thurairaja said that while fewer women were diagnosed, they tended to have more advanced disease as their symptoms are sometimes written off as due to urinary infections
He said: “That is the reason why women tend to do worse, because the assumption is always that it is an infection and they will be fine. But they present late, and it’s too late to be managed.
“It’s one cancer where [incidence] has not really significantly improved over the years – probably because people are living longer.
“Despite Covid, there are still risks associated with bladder cancer – that you will get worse and you may die of your cancer.”