I'm an oncologist: Cancer can develop in anyone — even a healthy person doing all the right things

Dr Lynda McSorley, consultant medical oncologist and Lead for Cancer Genetics at St Vincent’s Healthcare Group in Dublin.

Dr Lynda McSorley, medical oncologist at St. vincent's Hospital , Dublin. Photograph Moya Nolan

I grew up in Cork, the second eldest of four siblings. In the ‘80s and ‘90s, we were healthy by default. There wasn’t the same amount of processed food, and we lived in the country, so we were outdoors a lot. I didn’t enjoy field sports, but I loved swimming.

After my Leaving Cert, I went to UCC to do an arts degree. When I was thinking about career options afterwards, ‘I’d really love to be a doctor’ kept coming into my mind. At the time, there was no graduate-entry option, so after the arts degree, I repeated my Leaving Cert and got the points to go to the Royal College of Surgeons in Dublin to study medicine.

I’d lived at home in Cork until then, so that was a huge change. But it’s worked out well, and I ended up marrying a Dubliner.

After my specialist training in Ireland in medical oncology, I went to Australia during the pandemic and worked at Monash Health in Melbourne, a huge hospital and research centre. I had an interest in cancer genetics, and at Monash I got to see how it can work in practice, with things like mainstreaming genetic testing, which is now part of my role in Vincent’s with the National Cancer Control Programme (NCCP).

I chose oncology because I thought it was a fascinating area. It changes so quickly. You treat the whole person, the whole body. There are great research opportunities, and it’s a chance to make a real difference in many cases.

Medical oncology is the delivery of systemic anti-cancer therapies: Chemotherapy, immunotherapy, and oral anti-cancer treatments. That’s distinct from radiation oncology and surgical oncology, [but] we all work together.

Being an oncologist has made me more aware of what is within my control and what’s outside my control.

There’s a lot that we can’t control about cancer risk, for example, our genetics, our inherited DNA, but there are things we can control [such as eating] a healthy diet, regular exercise, moderate alcohol, not smoking, and safe sun exposure.

I’ve never smoked. I’m very aware to eat healthily, and I make sure I get outside for a walk regularly. I’m sun safe. I probably wasn’t as good with sunscreen in my 20s, but now I’m very consistent. Skin cancer is so common in Ireland.

A healthy person who’s doing all [the right things] can still develop cancer. One in two people in Ireland, during their lifetime, will have a cancer diagnosis.

If something is not normal for you, don’t ignore it

Ovarian cancer is the most common of the gynaecological cancers I treat.

In Ireland, we probably have about 400 cases of ovarian cancer per year. Often, ovarian cancer is diagnosed at a later stage, because the symptoms can be nonspecific, such as abdominal bloating, feeling full, a bit of abdominal discomfort.

You know your own body, so if you’re having symptoms that are not normal for you, and they’re persisting, talk to your GP. They will be able to order an ultrasound or a blood test, or refer you to a gynaecologist separately.

The gynaecological cancer that’s on the rise

Uterine cancer or endometrial cancer is on the increase globally, and the reasons aren’t entirely clear. A person will probably have about a 3% lifetime risk of developing it, unless they have a genetic predisposition.

Lynch syndrome, [an inherited genetic condition] which is pretty common in Ireland, increases uterine cancer risk for a woman by up to 50%, depending on the variant. It’s an area where there’s a lot of clinical research, which is a real positive because, for many years, there hadn’t been as much by way of clinical trials or new treatment opportunities for women. We’re seeing a big change now and a lot of new drug options coming online.

Ask about clinical trials

What I’d say to any woman who’s diagnosed with cancer is, ask your oncologist, ‘Is there a clinical trial appropriate for me at this stage?’ There may or may not be, because trials open and close frequently enough.

But at the next stage of your cancer journey, ask again, because there might be an opportunity at that point.

If there’s not a trial at your centre, your oncologist will be able to find out if there is an opportunity somewhere else. Ireland is under the international and European averages for how many oncology patients have the opportunity to access clinical trials. We’re running at around 3%, and should really be over 6%.

It’s a big focus for our hospital, and it’s a great opportunity for patients to access the newest drugs in a very regulated and safe way.

A new drug, Mirvetuximab soravtansine, was recently licensed for use in the NHS [for hard-to-treat ovarian cancer], and has shown excellent results in clinical trials. Ireland has an Early Access Programme open for it.

The medical oncologist applies to the drug company for the drug for each individual patient. It’s in a class of drugs called antibody-drug conjugates [designed to] deliver chemo directly to the cancer cells.

Many ADCs are being developed for ovarian, endometrial and cervical cancers.

Avail of screening

For cervical cancer, everyone, once eligible and invited, should take up the national screening programme, and those in secondary school should get the HPV vaccine.

I’m seeing some younger cases; premenopausal women who present with irregular bleeding. Again, if something is not normal for you, it should prompt a visit to the GP for a referral to a gynaecologist.

I’d love to see people diagnosed earlier and, ultimately, see HPV-associated cervical cancer eradicated completely through the vaccine.

Why genetics is changing cancer care

A big part of my work is around genetic risk. About 12% of cancers have a known underlying DNA alteration which, over a lifetime, will increase cancer risk.

They’re the population I really want to identify in my clinic because they’re women and men who may develop cancer under the age of the national screening programmes.

They won’t be picked up through screening in the majority of cases.

I developed mainstream testing pathways in Vincent’s. It’s the first hospital in Ireland bringing genetic testing for high-risk patients to an earlier point of care across breast, ovarian, pancreatic, prostate and GI cancers.

Cancer treatment is better and has more options

Cancer treatment has improved across the board, from the surgical techniques, to the chemotherapy and other therapeutic options available.

I have far more treatments available that I can give to patients.

If a chemotherapy works for a while and then maybe loses its effectiveness in an advanced cancer, there’s often something else I can give, or there’s a clinical trial opportunity.

People are living longer with cancer. If it’s not curable, it can still be treated.

Top tip: Everyone who is eligible for the HPV vaccine should have it.

• In conversation with Gemma Fullam