Category: Department of Surgery and Cancer

From Aleppo to Imperial: One surgeon’s journey

Dr Hadi Alagha

Dr Hadi Alagha from the Department of Surgery and Cancer shares his inspiring journey of becoming an orthopaedic surgeon. Learn about his remarkable path from Aleppo to Imperial College London and the hurdles he encountered along the way.

My path has been anything but ordinary, shaped by a deep desire to make a difference.

My story starts in Syria, a home that I have not returned to since I left in 2012. At that time, I had successfully completed three years of undergraduate medicine at the University of Aleppo. Like many others, due to the war I had to leave behind my family, friends and memories. This experience ignited a fire in me to pursue my dream of becoming an academic orthopaedic surgeon.

After some searching, I found my way to the University of Debrecen in Hungary, where I joined as a third-year medical student. It was here that I discovered my passion for scientific research, leading me to complete a Master’s in Sports and Exercise Medicine at the University of Nottingham with distinction in 2016. By the time I graduated from medical school in 2018 summa cum laude, I ranked second among my peers, a proud moment that set the stage for my future.

Transforming hip replacement outcomes with machine learning

I chose to pursue my PhD at Imperial under the supervision of Professor Justin Cobb because of his pioneering work in introducing innovative technologies to the field of arthroplasty – surgery to restore the function of a joint. I hold Professor Cobb in high esteem as both a valued confidant and mentor, whose insights and support have greatly enriched my academic journey. I joined the PhD programme in Clinical Medicine Research at the MSK Lab in October 2018, and my journey was a thrilling ride. My doctoral thesis, titled “Predictive factors and outcomes in primary hip arthroplasty,” focused on developing and validating machine learning (ML) models to predict patient outcomes after hip replacement surgery.

Clinical practice and implant selection for hip disease requiring replacement often exhibit significant variability, making it difficult to predict outcomes. Differences among patients, surgeons, and units can obscure the effectiveness of certain approaches. Machine learning provides a powerful complement to traditional statistical methods, such as multivariate regression models, by handling large numbers of predictor variables and their complex interactions. This allows for more accurate forecasting of clinical outcomes.

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Breastfeeding and Breast Cancer: Exploring the potential link

PhD Sophia D'AlessandroOctober is Breast Cancer Awareness Month. This is a crucial time to raise awareness about screening, treatment, and prevention of breast cancer. PhD student, Sophia D’Alessandro from the Department of Surgery and Cancer examines her research looking at the link between breastfeeding and the reduced risk of breast cancer in our latest blog.

Breast cancer is one of the most prevalent cancers in the world, alongside prostate, lung and colorectal cancer. It is estimated that there are more than 150 new cases diagnosed every day. But why does breast cancer occur? We know cancer is a multifactorial disease caused by a variety of different factors, which can include mutations in key cancer-causing genes, and lifestyle-related risk factors such as age, being overweight, smoking, family history of breast cancer and hormone therapies. However, there are also factors that can reduce a person’s risk of breast cancer risk, such as breastfeeding. 

Current research suggests that the risk of developing breast cancer decreases by 4% for every 12 months of breastfeeding. But it’s not yet clear why. The primary function of the human breast is to produce nutrient rich milk for babies. Therefore, the complex structure of the breast is designed for this function. It is comprised of fatty adipose tissue, surrounding lobules and ducts. The lobules produce milk, and the ducts transport it to the nipple, where it can be expelled and fed to a baby. In addition to this, the ducts of the breast are lined by a layer of specialised cells known as epithelial cells. It has been shown previously that breast milk may contain some of these breast epithelial cells, which are then digested in the babies’ stomach and cause them no harm. However, around 85% of breast cancer cases arise from the epithelium, so it is thought that the loss of mutated breast epithelial cells through breastfeeding may play a role in reducing breast cancer risk.  

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Staying active as we age: Reflections and tips on National Fitness Day

Professor Alison McGregor

To mark National Fitness Day, former NHS physiotherapist and elite sports researcher, Professor Alison McGregor from the Department of Surgery and Cancer, reflects on her lifelong passion for physical activity. She explores the benefits of staying active as we age, offering practical advice on breaking sedentary habits and maintaining fitness throughout life.

My career began as a physiotherapist in the NHS, but I dreamed about working in sport. At that time, I played a range of racquet sports and hockey. Oddly enough my engagement with elite sport came through my research career rather than my academic career. For nearly 18 years, I worked with elite rowers and the GB rowing team. In 2012, I had the honour of running with the Olympic torch in London, representing Imperial.  

My passion for sport and activity persists, and although I no longer compete, I run most days, cycle to work and occasionally go on long hikes and expeditions to stunning parts of the world including Kilimanjaro in Tanzania, Machu Picchu in Peru, the Manaslu Circuit in Nepal and Hadrian’s Wall which is closer to home. But why do I remain so active as I get older? 

We all know that physical activity is good for our health and wellbeing. National Fitness Day is a great time to think about our lifestyle choices, particularly our balance of physical activity and sedentary activities.  Sitting for more than 6-8 hours – which many of us do during the average working day – is not good for us. So, how do we change this?  

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Better, quicker and more effective treatment for patients with sepsis

Sepsis kills five people every hour and accounts for about 50,000 deaths per year in the UK alone. To mark World Sepsis Day, Professor Anthony Gordon, Chief Investigator of the SepTiC study and Head of the Division of Anaesthetics, Pain Medicine and Intensive Care (APMIC), who is also a consultant in intensive care medicine and NIHR Senior Investigator, sheds light on how the study aims to find more effective treatment for sepsis patients.

Sepsis is one of the most serious conditions medical teams deal with. It’s life threatening and always considered a medical emergency. We don’t fully understand why it effects some people at different times but we do know it is caused by the immune system having an extreme response to an infection, most commonly due to an infection caused by bacteria. This causes organs to stop working properly and the body to damage itself because of that immune response, sometimes leading to multiple organ failure.

Patients with sepsis can deteriorate rapidly and this can sometimes be difficult to spot because the symptoms, such as fever, pain and breathlessness, are common to many other diseases. Anything we can do to improve care for these patients is vital to improving outcomes.

For patients receiving critical care in the intensive care unit, this can be even more challenging because they aren’t always able to tell us how they are feeling. But these patients are also at the highest risk because they are already so unwell.

This is why research to refine and improve treatments for sepsis is so vital – so we can respond as quickly as possible, in the most effective way, to help more patients make a full recovery, without lasting side effects.

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Embracing sleep for cognitive health: Insights from our recent study

Dr Raha West presenting her findings in South Korea

Are you a morning ‘lark’ or a night ‘owl and how is this linked to brain performance? To mark Sleeptember, Dr Raha West from the Department of Surgery and Cancer explores her recent research on over 26,000 people which found those who are naturally more active in the evening scored better on intelligence, reasoning and memory tests.

As we slip towards Sleeptember, a month dedicated to raising awareness about the importance of sleep, it’s the perfect time to reflect on the findings of our recent study published in the BMJ Public Health. Our analysis delves into how sleep duration, chronotype (whether you’re a morning person or an evening person), and various health and lifestyle factors influence cognitive performance in older adults. 

The Motivation Behind Our Study 

The importance of sleep in maintaining overall health, particularly brain health, has always intrigued me. The idea that our daily sleep patterns, including how long and when we sleep, could significantly impact our cognitive abilities led me to explore this further. Previous research has shown that poor sleep quality and duration are linked to various health issues. Still, the specific influence of chronotypes on cognition, especially in older adults, remains under-explored. 

Methodology and Participant Selection 

Our study utilised data from the UK Biobank, which includes a comprehensive set of health information from over half a million participants aged 40 and above. We focused on 26,820 individuals who completed detailed sleep and cognitive assessments. Participants were divided into two cohorts based on the cognitive tests they completed, ensuring a robust data analysis. 

Key Findings: Sleep Duration and Cognitive Performance 

We discovered that sleeping 7-9 hours per night is optimal for cognitive health. Both shorter and longer sleep durations were associated with poorer cognitive performance. This finding emphasise the importance of maintaining adequate sleep duration to support brain function.   

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Completing the jigsaw: can milk banks contribute to transformed perinatal health in the UK?

Dr Natalie Shenker MBE

This week marks World Breastfeeding Week, a global campaign dedicated to informing, engaging, and galvanising action on breastfeeding and related issues. Dr Natalie Shenker MBE from the Department of Surgery and Cancer reflects on the progress made in related maternal health research in 2024, and explores how milk banks can help in the much-needed transformation of perinatal healthcare in the UK.

2024 has already been a remarkable year for human milk and lactation science. As interest grows globally in the sector, our understanding of the complex and ancient evolutionary physiological strategies involved, and their impact on infant and maternal health, deepens. The maternal health impacts of lactation and how to best support families are the key focuses of my research, and like much of the work across women’s health, has been largely ignored by mainstream science.  

In partnership with The George Institute, the new Women’s Health Network at Imperial College London is seeking to correct these crucial gaps. Excitingly, our study into the mechanisms through which breastfeeding can reduce the risk of certain types of cancer has received further funding from Breast Cancer Now. Yet, there is still so much to discover. Just last month an entirely new hormonal response that explains how breastfeeding protects against osteoporosis was described by scientists at UC Davis. They found bone metabolism increases during lactation to keep up with the large amount of calcium required to produce milk, at the same time as levels of the protective hormone oestrogen fall. Scientists were therefore previously stumped as to how breastfeeding prevents rather than causes maternal osteoporosis. The work, published in Nature, found that during breastfeeding, certain neurons in the brain called KISS1 neurons release a protein called CCN3. This protein helps increase bone repair, boosts the activity of skeletal stem cell activity and even speeds up how quickly fractures repair.

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Enhancing quality of life for head and neck cancer patients

 

Grainne Brady

Did you know that each year, amost 13,000 people in the UK will be given the news that they have head and neck cancer? Unfortunately, these numbers continue to rise. To mark World Head and Neck Cancer Day, we hear from Grainne Brady, PhD Student at Imperial’s Department of Surgery and Cancer, NIHR Clinical Doctoral Research Fellow and Speech Language Therapist at the Royal Marsden NHS Foundation Trust London. She shares her expertise on the link between head and neck cancer and changes to swallowing, communication and the potential impact on quality of life. 

Treatments for HNC include surgery, radiation and chemotherapy(1). Traditional risk factors for HNC include a history of tobacco and alcohol use (2). More recently, human papilloma virus (HPV) has been recognised as a risk factor for the development of oropharyngeal cancer which is a subtype of cancer affecting the back of the throat, tonsils, back of the tongue and soft palate (2). The discovery that a virus can cause this condition has led to the development of a UK-wide HPV vaccination programme available for both boys and girls aged 12-13 years (3). 

There have been huge advances in the treatment of HNC over the past two to – three decades. These include advanced radiation techniques like intensity-modulated radiation therapy and minimally invasive surgeries such as transoral robotic surgery, which are now standard of care techniques (4).   

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Bladder problems: Can we be less shy about having a pee?

Prof Marcus Drake

Bladder problems affect millions of people around the world, yet they remain shrouded in silence and embarrassment. Professor Marcus Drake, Chair in Neurological Urology, explores why society continues to be shy about this topic, and highlights why more medical research is needed to improve bladder care.

People do not generally spend a lot of time thinking about their bladder. After all, each pee only takes about 20 seconds. Since we might go for a pee just six times a day, that means only a couple of minutes are given over to the bladder daily.

As well as not thinking about it much, we also seem to be reluctant to talk about it. This may be a reflection on society, since peeing is a vital function yet talking about it seems to be discouraged. Perhaps this does not matter so much for most people. But it does matter for anyone with a bladder problem. This reluctance means that people can leave it very late to get help. For many it makes the experience of getting help difficult too.

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Shining a Light on Ovarian Cancer

Christina Fotopoulou

To mark Ovarian Cancer Awareness Month, Professor Christina Fotopoulou, Chair in Gynaecological Cancer Surgery and Professor of Gynaecological Cancer in the Department of Surgery and Cancer, and consultant gynaecological oncologist at Imperial College Healthcare NHS Trust—reflects on Imperial’s recent breakthroughs in the field. Delving into Imperial’s pioneering efforts to enhance diagnosis, treatment, and understanding of this complex disease, Christina also sheds light on some of the unique challenges faced. 

The time has come once again for Ovarian Cancer Awareness Month in the UK. This is our annual opportunity to shine a spotlight on ovarian cancer and increase awareness of a disease that has been a significant challenge for women for centuries (see fig. 1).  

Imperial and Imperial College Healthcare NHS Trust have made significant strides towards improving the diagnosis and management of ovarian cancer for many years, and there is even long-term hope of a cure in the future. Through pioneering systemic and surgical therapeutic strategies and conducting ground-breaking research, the Imperial clinicians and researchers  have established themselves as global leaders in the field of gynaecological cancer.  

For example, James Flanagan recently received half a million pounds from Cancer Research UK (CRUK) for his Early Diagnosis programme and Anke Nijhuis was awarded a £1 million Career Development Fellowship from CRUK to establish her own independent research within the Department of Surgery and Cancer. Additionally, the Parasol foundation has generously awarded over £1 million to support research into drug resistance, tumour heterogeneity, and more personalised, predictive imaging.  

The fight continues for better care, improved quality of life and increased survival rates for patients. 

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Involving critically ill children in research: Is that even possible?

When a young patient’s life hangs in the balance, the last thing on the minds of stressed parents, families and patients would be to get involved in research. Or is it? Despite the turmoil, some brave families and children have volunteered to support clinicians in their research by taking part. Dr Padmanabhan Ramnarayan, Clinical Reader in Paediatric Critical Care in the Department of Surgery and Cancer and Honorary Consultant in Paediatric Intensive Care at Imperial College Healthcare NHS Trust and West London Children’s Healthcare, explains why.  

I have been a children’s intensive care doctor for over 20 years, and for most of that time, I have been leading research that has involved critically ill children. My patients are young, their parents and families are super-stressed, and most of the treatments are given in an emergency – all of which seem like perfectly valid reasons to not involve sick children in research. Despite this, my experience is that parents and families are overwhelmingly in support of research. Why? 

The evidence gap 

Since children’s intensive care is a young speciality, much of our practice is ‘borrowed’ from adult intensive care or newborn intensive care. This is not ideal because our patients range from birth to 18 years of age, with diseases as diverse as asthma, respiratory infections, accidents and trauma, sepsis and brain injury. Without high-quality research to guide care, the treatments provided to sick children may not be the best or the most effective. Doctors and nurses, and parents and families, understand this. By agreeing to include their children in research studies, parents want to improve the care provided to future patients. 

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