“It’s brilliant Yorkshire Cancer Research is funding trials like FOxTROT 3, bringing more opportunities to take part in clinical trials to people living in the region” - Fiona’s experience

As a GP in Bradford, Fiona Fleming had often seen people with symptoms of bowel cancer at her surgery.

She’d also sent hundreds of text and email reminders to those who had missed out on their bowel screening, which finds cancer at the earliest possible stage.

But she never imagined that one day she’d be facing a bowel cancer diagnosis of her own.

Now, after taking part in the FOxTROT 3 bowel cancer clinical trial funded by Yorkshire Cancer Research, she is championing the charity’s crucial work, which has not only shaped her own experience but will also benefit future generations.

Fiona, who lives in Leeds, admits when she first started noticing blood in her poo, she initially delayed doing something about it.  

With one of her sons imminently expecting his A-level results and the other waiting for his GCSE grades to arrive, she had other life events and priorities to deal with.  

However, knowing the importance of getting her symptoms checked, she eventually took a faecal immunochemical test (FIT) and arranged to see a fellow GP to discuss her symptoms.  

A FIT test involves using a small stick to take a sample of poo. The sample is then tested for traces of blood, which can be a symptom of bowel cancer. As well as being used to detect early signs of cancer, the test can be given to people with bowel cancer symptoms to determine if they need an urgent referral to hospital for further investigation.

Fiona said: “As a GP, I thought cancer will never happen to me. And I thought about the number of people I see who have symptoms that fortunately turn out to be nothing serious.  

“But in the end, I knew I really did need a colonoscopy. I’d been to the loo and there had been blood in my poo, so I took the FIT test knowing I would receive a positive result.”

As she suspected, within a few days Fiona received a phone call from the hospital inviting her for a colonoscopy, which is a test that looks at the bowel more closely using a camera.  

If small growths called ‘polyps’ are found, they can sometimes be removed as part of the procedure. A sample of cells can also be taken from the bowel to find out if cancer is present.

Fiona explained: “You can see the view from the camera on a screen, and I noticed the doctor was looking at what seemed like a very big polyp. I remember wondering why she didn’t just immediately remove it. Instead, she took some cell samples.”

Just a few years earlier, Fiona’s elder sister had died from breast cancer at the age of 50. This experience made her anxious about her own diagnosis and hesitant to even tell her children the news.

She said: “For the first four or five days, while waiting for the official diagnosis, I couldn’t sleep. I’d already written myself off and mapped out the whole of my future.  

“Having gone through the death of a family member from cancer, it became really difficult to tell my kids. They had lost an aunt to cancer and therefore cancer meant to them that people die.”

Despite her initial fear and worry, Fiona was put at ease when, just two weeks later, she saw Dr James Platt, Speciality Registrar in Medical Oncology at Leeds Teaching Hospitals NHS Trust and Clinical Research Fellow at the University of Leeds who supports people undergoing cancer treatment.

Image caption: Dr James Platt

Dr Platt reassured Fiona that her cancer was treatable and outlined the options available to her, including the opportunity to take part in a bowel cancer clinical trial called FOxTROT 3.  

FOxTROT 3 is a follow-up to the earlier FOxTROT 1 bowel cancer trial, which found that giving six weeks of chemotherapy before an operation led to fewer serious complications after surgery and reduced the risk of cancer coming back.

Led by Professor Jenny Seligmann, Consultant Medical Oncologist at the University of Leeds and Professor Dion Morton, Professor of Surgery at the University of Birmingham, FOxTROT 3 is investigating whether extra chemotherapy using three drugs instead of two can further improve benefits in people who can tolerate more intensive treatment.

As part of the trial, Fiona received three different types of chemotherapy drugs before and after surgery: fluorouracil (5FU), oxaliplatin and irinotecan.  

There were some difficult times during her chemotherapy, and, as a single mum, she was grateful for the support of family and the local “mum brigade” during her treatment.

Fiona said: “I sometimes feel like it didn’t happen; like I’m talking about someone else. Overall, everything went swimmingly well. I wasn’t in a lot of pain following my surgery and went home after just four nights in hospital.”

“There were times during the last lot of chemo when my mouth was very sore and I got nose bleeds. I also struggled with the cold and I lost quite a lot of hair. But the main long-term effect has been on my fitness.”  

“I’m quite an active person, but I put on weight after the surgery. Returning to fitness has been a slow process and I’m still not as active as I was, but I have got back to doing parkrun which I really enjoy.”

The initial chemotherapy shrunk Fiona’s tumour significantly, which meant removing her tumour was a simpler process. But beyond her own benefits, Fiona hopes that her participation in the trial will help future generations.  

As a medical professional, Fiona found her professional background provided many benefits during her cancer diagnosis, from understanding medical jargon to having colleagues and friends by her side throughout her treatment. She’d also seen many of her patients successfully recover from cancer and had no fear of hospitals.  

The experience has also made her more passionate about encouraging her patients to complete their bowel screening kits when invited, and she now feels a sense of “kinship” with those going through cancer.  

Just days after her first chemotherapy treatment, Fiona received her first bowel screening kit in the post. It arrived at a moment when the NHS in England was expanding bowel cancer screening to younger people aged 50 to 60 - something Scotland had offered routinely for years. Before then, screening had only been available to people aged 60-74.

“My other sister lives in Scotland and she’d already had two or three bowel screening kits by the time I got mine,” Fiona explained. “The doctors told me I’d probably had a polyp in my bowel for a long, long time, and it had likely been a normal one that had become cancerous. So having my screening earlier probably would have made a difference.

“It’s not my personality to think about what might have been. It didn’t happen, and there’s nothing I can do about it now. But I’m pleased the programme has been extended and other people will now benefit. My experience has made me a bit more aware of the need to find new ways to get people to do their screening.”

Taking part in a clinical trial also brought home the importance of research and the vital role it plays in improving treatment for cancer.

“I think research is paramount,” Fiona said. “I was able to have laparoscopic, or keyhole surgery, which means you can recover faster and have a smaller scar. When I was a junior doctor, I did general surgery and back then they didn’t do many of those.

“I was also treated with a chemotherapy drug called 5FU, which was developed through research and has now been around for many decades. Prior to that there was very little treatment for bowel cancer. Without research, we wouldn’t be able to treat it in the same way we do now.

Fiona now has regular scans to check the cancer hasn’t returned, which is something she admits she is sometimes anxious about. But she says she is very optimistic about the future and wants to “make the best of things now.”  

She added: “I feel having cancer is a wake-up call. I do have moments where I think ‘why me?’. But then I’ll see a lovely rainbow in the sky, or some beautiful flowers, and mostly I just feel lucky that I’ve survived.”

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