Michelle Stepney

Michelle Stepney

Michelle Stepney

W_MM_PS_Michelle - Michelle, stepney, cancer,...

The choice Michelle Stepney faced was stark. Michelle, already mother to a four-year-old boy, was 19 weeks pregnant with twins when she was diagnosed with cervical cancer.

As she sat clutching her husband Scott's hand, Michelle listened to the doctor's grim ultimatum: she had to choose between her life and that of her unborn babies. 'The gynaecologist told me I could have lifesaving surgery the following day,' recalls Michelle.

'This would involve a radical hysterectomy - removing my womb and cervix - and would virtually guarantee my long-term survival without the need for any follow-up chemotherapy or radiotherapy, but it would mean ending the life of my unborn babies.'

The other option was to wait for the twins to be born before she had treatment, but this was highly risky for Michelle. Without immediate treatment, the tumour could grow rapidly and spread beyond a point where it was operable. 'His advice, based on current medical practice, was for me to immediately have the surgery,' says Michelle, an accountant, now 35. 'I was hysterical with grief. I had my son Jack, who I adored, but these babies were already part of me; I had seen their faces on the scan. I was their mother, I was meant to protect them. How could I agree to their deaths just to save me? It felt like agreeing to murder.'

'I understood how Michelle was feeling, but to me the choice was fairly clear cut - I wanted my wife alive,' says Scott, now 37. 'But I wasn't the one carrying the babies and I was frightened about how Michelle would cope emotionally if she did lose the twins.'

At their home in Cheam, Surrey, the next few days were spent in a blur as the couple did their best to come to a decision. 'It was torture,' says Michelle. 'I'd put Jack to bed with a cuddle and a bedtime story and realise how much he needed me. I'd then tell Scott I had decided to go through with the hysterectomy for Jack's sake.

'But then I would have a night of the twins kicking inside me and wake up unable to go through with it. It was like the most dreadful roller coaster and I couldn't get off.' A few days later, with the decision still not made, Michelle contacted her cancer nurse at The Royal Marsden Hospital in Surrey. 'I told her I couldn't say goodbye to the twins and begged her to find another way to try and get the three of us through this nightmare alive.'

INSTRUMENTAL MRI

Concerned about Michelle's fragile state, her oncologist called a meeting of about 30 specialists including obstetricians, gynaecologists, pathologists, surgeons, psychologists and, crucially for Michelle, radiologist Professor Nandita de Souza.

Professor de Souza, who works for the Institute of Cancer Research at the hospital, had scanned Michelle in the days following her diagnosis. The images of the tumour she took to the meeting were to prove instrumental in saving the twins' lives.

This is because the magnetic resonance imaging (MRI) scanner at The Royal Marsden is not only one of the most powerful in the country, but it has a unique probe which can be placed near internal cancers, ensuring close-up and clear images. The magnetic resonance imaging (MRI) scanner at The Royal Marsden is one of the most powerful in the country (file picture)

'The use of the trans-vaginal probe together with the scanner had given us an extremely clear picture of the size of Michelle's tumour, where it was situated and also what type it was,' explains Professor de Souza, who pioneered its development.

'The probe showed the tumour hadn't spread and was sited on the outside of the cervix rather than inside it or the womb. It also gave enough information for the team to decide that the tumour probably wouldn't spread rapidly and would respond to chemotherapy.'

Now confident they could side-step the conventional approach, the team pooled their expertise to create a programme of treatment to contain Michelle's tumour long enough for the babies to grow to a size when it was safe to deliver them by Caesarean.

JUGGLING ACT

'It was decided that low-grade chemotherapy until the twins were born would offer the possibility of containing the spread,' says Professor de Souza. After the birth, Michelle would then have more chemotherapy, the hysterectomy and radiotherapy.

It was a juggling act of huge complexity. Too much chemotherapy and the babies could suffer from side-effects such as deafness; not enough and the tumour would grow anyway. The worst case scenario was that the twins would be damaged and Michelle's cancer would spread.

But simply being able to offer this approach was unbelievably radical. 'Even just a few years ago, for women who found themselves in Michelle's position, the only option was a hysterectomy and the termination of the unborn baby,' says Professor de Souza.

Just three years after Michelle's diagnosis, there have been further advances in scanning technology. This month, the Institute of Cancer Research and The Royal Marsden have launched a new generation of scanner that is twice as powerful and provides images as clear as an anatomy textbook.

'LIFESAVING, REVOLUTIONARY TECHNOLOGY'

'Modern high-powered scanners such as these are revolutionising hospital medicine,' explains Dr Tony Nicholson, Dean of The Royal College of Radiologists.

'Not only do they allow clear visual access to dense areas of the body such as the abdomen and the lungs - which were hard to read with previous machines - but they also provide "functional" diagnosis.

'We can see a tumour's cellular make-up, which gives us information on the type of cancer it is and, crucially, how it will respond to different types of treatment. Before such machines, we were second guessing the cancer, and treatment was not as effective.'

These new scanners may also mean that rather than carry out surgery to remove a tumour, doctors will adopt a watch-and-wait policy instead. For Michelle, the new technology was literally a lifesaver, and when the oncologist explained the new plan, she didn't hesitate.

'Even when they explained that the twins might be deaf as a reaction to the chemotherapy, I didn't care. We'd been offered a lifeline and I was going to grab it with both hands.'

The twins survived, and the cancer had shrunk. Michelle began her weekly chemotherapy sessions the next week. After just the second one, she suffered hair loss and sickness.

'Of course it was a price I was more than willing to pay,' says Michelle, who this year won the Cancer Research UK Woman of Courage Award. 'But I was concerned about the effect on the twins. The day after chemotherapy they'd be very quiet and still. But the weekly ultrasound showed they were developing fine.'

Michelle's cancer wasn't scanned until 31 weeks into her pregnancy because it's not clear how MRI affects unborn babies. In fact, this final scan showed the tumour had shrunk by about ten per cent. Michelle would probably not need chemotherapy following the birth.

'Not only had the twins survived, but the cancer had shrunk. It was a miracle,' says Michelle. Then, at 33 weeks, Michelle went into spontaneous labour. 'I went into our local hospital, St Helier's, as planned, and was given steroid injections to help the babies' lungs develop.'

Alice was born first, weighing 3lb 11oz, followed by Harriet at 3lb 5oz. Too small to be held by their mother, they were whisked to the special care unit, where they spent the next six weeks. 'The nurses brought me some Polaroids, but the next morning I went to meet them,' says Michelle. 'I wasn't allowed to touch or feed them, but it didn't matter - we'd all made it.'

SAFE DELIVERY

With the babies safely delivered, it was Michelle's turn for treatment. 'For the first time I got really scared,' says Michelle. 'Until then I'd concentrated on the babies, I didn't really acknowledge I had cancer. Now I had to face up to it.'

In January 2007, Michelle underwent a radical hysterectomy; her ovaries were saved - sparing her an early menopause. The operation appears to have been a complete success and there is no sign of the cancer recurring. Michelle has six monthly internal checks and a yearly MRI scan.

The twins are now healthy, boisterous two-year-olds. 'Sometimes I wonder whether it was all a dream, whether I really did have cancer. But I will never forget how close we came to losing them,' says Michelle.

'Thanks to the miracle of modern scanning, and the dedication of the medical team, all three of us are here and healthy today.'

 This story first appeared in the Daily Mail