Diagnosis
Radiology
Our Radiology team provide a modern imaging environment to support the diagnosis and treatment of patients with diseases of the pancreas and hepatobiliary system. Up-to-date equipment in the key modalities of ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and angiography, allied to the expertise of the imaging personnel provide clinical colleagues with the information required to offer patients the most appropriate forms of treatment for their condition.
The Hammersmith liver and pancreas cancer team has always been at the forefront of innovation. It was the first hospital in the UK to develop a hospital-wide patient archiving and communications system (PACS), which in the high-pressure environment of the modern NHS is vital for the rapid and accurate manipulation of patient images within the framework of the hepatobiliary/pancreatic MDT meetings. Allied to the PACS is a voice-recognition reporting system, which provides the potential for the rapid production and distribution of radiological reports.
Hammersmith is to be one of the first hospitals in the UK to be supplied with a PET-CT scanner that combines the anatomical information of CT with the functional qualities of positron emission tomography (PET). The department provides support to gastroenterology services for endoscopic activities including endoscopic ultrasound.
Gastroenterology and Staging
The Gastroenterology unit plays an important role in the diagnosis of HPB cancer. This is due to the nature of the clinical presentation of patients with malignancy.
The initial pathway to diagnosis, and then to accurate staging involves planning investigations such as ultrasound, CT scanning, MR scanning (axial & magnetic resonance cholangiopancreatography [MRCP], and endoscopic retrograde cholangiopancreatography [ERCP]) in a timely, efficient and appropriate manner.
Dr Westaby leads a team of five pancreaticobiliary endoscopists and Dr Vlavianos provides endoscopic ultrasound services.
Endoscopy
The role of endoscopy in the field of HPB diagnostics has changed considerably over the last decade. The previous use of ERCP to delineate pancreatobiliary disease has largely been replaced by the developments in cross-sectional imaging and also the increasing availability and expertise in endoscopic ultrasound (EUS). There remain occasional instances in which ERCP is still required to further delineate pancreatic and biliary lesions identified on imaging and also to facilitate both cytological and histological samples to be taken.
The increasing importance of EUS as a diagnostic tool in the field of HPB has been matched by the development of a new service at The HHNT Pancreatic Centre. The expansion of endoscopic services involved the appointment of the experienced operator Dr P Vlavianos. Within a period of nine months the EUS service has rapidly developed and is now estimated to include 300 examinations per annum.
In the diagnostic armamentarium against pancreatic cancer, ultrasound (EUS) has been shown to be extremely accurate in detecting pancreatic masses, which other imaging modalities sometimes fail to show. It is very sensitive in the local staging of the disease – especially when there is need to assess the size of the tumour and its relationship with the adjacent structures and even more importantly enables cytological confirmation through fine needle aspiration (FNA) at one setting.
Pancreatic tumour adherent to the portal vein. A previously inserted metal stent in the bile duct is visible at the upper part of the picture (bright white). Tumour measures 3 cm. across.
There are some exciting research projects going on to improve the early diagnosis of pancreatic cancers. One project is using EUS to obtain tissue or pancreatic juice for molecular and genetic analyses. In the future this may allow us to intervene at a pre-cancerous stage.
In another project researchers are attempting to deliver therapeutic agents straight into the tumour via EUS guided fine needle puncture.
Histopathology
The Hammersmith histopathology department has a team of specialist pathologists in disorders of the liver, pancreas and gastrointestinal tract, headed by Professor Gordon Stamp. The diagnostic laboratories provide efficient and rapid turnaround of diagnostic specimens.
The cytopathology department is one of the largest in the UK. The molecular diagnostics laboratory has a high throughput of automated immunohistochemistry, with a range of over 280 diagnostic tests. This enables us to identify treatment targets and unusual tumours that require specialist treatment. In HPB work this can account for up to 30% of surgical referrals.
As a tertiary referral centre, HHNT offers second opinions on the histopathology and cytopathology of patients from the NHS and private sector, and we are happy to provide second opinions at the request of pathologists, surgeons or patients.
The department has an active research programme to develop new ways of diagnosing and treating pancreatic and bile duct cancers, including the unique, fluorescent lifetime imaging of pancreas cancer, and a laboratory programme with the department of surgery investigating the genes involved in the progression of pancreas cancer, which will help us to identify new treatments in the future.
A cancerous area in a surgical sample is highlighted by a new Imaging technique developed in Imperial College department of physics in collaboration with the pathology team.
In collaboration with scientists in Imperial College and Cancer Research UK, the team is constantly innovating and testing new techniques for identifying the extent of cancers, and finding ways of analysing the changes that occur in the DNA of tumours.