‘We have to be careful about saying that a cancer diagnosis came out of the blue’: oncologist after Princess Kate’s diagnosis

Is it common for cancer to be discovered during another procedure?

“We don’t know what happened to Kate Middleton. It was a planned operation, maybe they already suspected. To say that it came out of the blue, as is the current story: we have to be careful with that. There must have been a specific complaint for which other investigations were first carried out and ultimately an operation was planned. We don’t know what kind of cancer it is, but based on her age, ovarian cancer or colon cancer is the most likely.

“There are various ways to detect cancer. A biopsy is often taken beforehand and then surgery is performed if the diagnosis has already been established. But for example, a woman can undergo a procedure to treat endometriosis and accidentally discover cancer. Or a cyst or growth has been seen on the ovary, which only becomes clear after surgical removal that it is a tumor. It could also be colon cancer. This is often accompanied by preceding complaints of constipation. You may suspect cancer, but the diagnosis is only made once the tissue has been removed and examined under a microscope by a pathologist.”

Which type of cancer is the most difficult to detect?

“Ovarian cancer is insidious and difficult to detect early. This cancer has few or no symptoms and is located deep in the abdomen. You only experience symptoms when the cancer has already spread in the pelvis. In scientific research, we are increasingly trying to detect cancer at an early stage in the blood via a so-called liquid biopsy, a blood sample. It will just take a few years before we can put that into practice.”

Kate Middleton has received preventive chemotherapy. What is that?

“A surgeon removes what he or she sees with the naked eye, often also the first node stations around the tumor and a few biopsies of the healthy-looking tissue. But a surgeon cannot look microscopically. If there is already gland involvement or if it is an aggressive tumor, there is a real chance that there are still cells. You can tackle these micro-metastases that have spread in the body with preventive chemotherapy to minimize the chance that the tumor will return. With preventive chemo you never really know whether it has achieved anything.”

Do we screen enough in your opinion?

“We screen people in an age category in which the chance of finding cancer is greatest: breast cancer between the ages of fifty and seventy, colon cancer from the age of fifty. And that’s good, because if there is only a small chance of detecting cancer, it is difficult to mobilize the entire population. Of course, this does not mean that these cancers cannot occur under the age of fifty.

“A case like Kate’s helps raise awareness that cancer also affects younger people. Fortunately, this is still a smaller percentage, but it is increasing slightly. Everyone has a stomach ache or some constipation sometimes. There is no need to immediately worry about such symptoms. But if your complaints persist, it is good to go to the doctor – even at a young age.

“My advice is to participate in all screening tests that are offered. It was recently in the news that the percentage of people who participate in stool tests and breast cancer screening is woefully low. We must therefore especially optimize the existing population surveys so that more people participate. General practitioners play an important role in this.”