A retired bank worker whose medical tests repeatedly failed to find a cause for his symptoms was given a 'shock' diagnosis after returning from a holiday. Mark England, from Sale, said he had been back and forth to the GP after noticing he was peeing a lot more than usual. He underwent a series of inconclusive tests before noticing a major red flag symptom during a trip to Fuerteventura.
Blood clot on holiday
The 68-year-old, who loves hiking and playing the guitar, went to the toilet and passed a blood clot while away at the end of November last year. When he got home, he had a CT scan and a rigid cystoscopy under general anaesthetic. Doctors found a four-centimetre-long tumour and he was diagnosed with bladder cancer.
Reflecting on his diagnosis, Mark said: "I knew something was wrong, but I didn't expect to be told I had cancer. It was such a shock, especially as I wasn't feeling particularly ill and had just been on holiday."
Incurable cancer
Mark, who now lives in Sandbach, Cheshire, had a PET scan in April that revealed the cancer had spread into the muscle surrounding the bladder, as well as to nearby lymph nodes, meaning the disease is incurable. As a result, he was unable to have radiotherapy or further surgery. He was then referred to The Christie, a specialist cancer centre in Manchester, where he started on a treatment called EV-P in late May, which combines a targeted therapy (enfortumab verdotin) with an immunotherapy (pembrolizumab).
"My journey so far hasn't been an easy one. I had two stays in hospital in April and May to remove clots from my bladder, but I've started treatment now, which is a relief," said Mark, who has been with partner Debbie for over 30 years. "I have had no real side effects, so I have been able to go out walking with Debbie, which is something we both love to do. Being able to have a decent quality of life is so important, and this treatment seems to be giving me that."
MANIFEST study
Mark, who worked for a bank for over 40 years before retiring, is the first patient to join the MANIFEST study, one of the largest immunotherapy studies in the country. Led by The Christie, researchers want to recruit 3,000 people from across the country who are about to have immunotherapy for the first time for breast, bladder, kidney, or skin cancer. The aim is to understand why immunotherapy works for some people and not for others.
Patients in the study will be followed over four years, with researchers collecting detailed biological samples, clinical information and immune system data at key stages of their treatment. This data will form a national resource for scientists, clinicians and industry partners to accelerate discovery and improve patient care across the NHS and worldwide.
"When I was asked to take part, I said yes straight away. We can only get new treatments for this awful disease if people like me take part in research. It was a no-brainer," says Mark. "It won't help me, but it might help someone like me in the future, so it's worth it."
Dr Marija Miletić, Senior Translational Research Fellow at The Christie NHS Foundation Trust, is Mark's clinical contact for the study. She said: "Immunotherapy is one of the most important recent developments in cancer treatment. Thanks to advances in science and technology, we now have treatments that help the patient's own immune system to recognise and fight the cancer. That's incredible. However, people respond to immunotherapy in different ways, and we are still learning why. That's why the MANIFEST study is so important. By working with people like Mark, we can work out how the immune system responds to immunotherapy, as well as learning more about other important areas, such as side effects. We hope this will be one of the keys to unlocking the next generation of more precise, better tolerated and more effective immunotherapies."
