Dr Charlie Zhou shares his experience of the National Sarcoma Awareness Project we fund.

In the United Kingdom, there are currently no designated modules on the undergraduate medical curriculum on sarcomas, and fewer than 20 designated centres treating sarcoma patients. Even in the designated sarcoma centres, only a few students get the opportunity to see sarcoma patients and work with experienced sarcoma clinicians. This results in many medical students graduating with little or no knowledge of sarcomas and even after graduation, the opportunities, time and desire to learn more about sarcomas are scarce.

To address this problem, a team at the Royal Liverpool and Broadgreen University Hospitals Trust, led by Mr CR Chandrasekar, have been conducting a National Sarcoma Awareness Project since 2013, funded by the Bone Cancer Research Trust.

Charlie completed a week-long placement at the Royal Marsden Hospital, shadowing a sarcoma specialist. We caught up with him to hear about he made of the experience.

What inspired you to apply for the National Sarcoma Awareness Project?

I have had a keen interest in cancer since my studies as an undergraduate. It has always stood out to me how strange it is that cancer is fundamentally a disease arising from cellular immortality. From an academic standpoint, whilst cancer is often known as a single entity from the perception of the public (and often even within the medical profession), learning about it reveals layer upon layer of complexity and heterogeneity.

As a result, I have for a long time been contemplating a career in oncology. In the past, I have sought opportunities to gain exposure to basic research, epidemiology as well as clinical experience. The National Sarcoma Awareness Project seemed like a natural progression where I could appreciate the role of specialist centres in the treatment of a rare condition and observe the very cutting edge of medical research.

What was your understanding of sarcoma before you embarked on the project?

My understanding of sarcoma prior to the project was extremely rudimentary - I knew that it was a rare cancer that was often associated with a poor prognosis. In particular, I was lacking knowledge regarding red flag symptoms, the diagnostic pathway and appropriate investigations as well as suitable treatments.

Could you tell us about any of the patients you encountered?

The most significant lesson that I have learnt in my first 6 months as a doctor is that practising medicine is rarely about life and death. Instead, the primary role of a doctor (in my opinion) is promoting quality of life and ultimately quality of death.

On this front, one particular patient stood out. He was a young gentleman that had progressed through all the lines of therapy and whose disease was no longer responding to treatment. We had reached the limits of what current medical knowledge and technology was able to do. Whilst at the time of consultation, the patient was well in himself we needed to have a frank discussion about the patient's prognosis and what we could offer if and when the patient became symptomatic to allow comfort and dignity at the end of life.

Did anything surprise you about the way sarcoma is diagnosed or treated?

The most surprising thing was when I was told that sarcoma chemotherapy treatment had largely remained unchanged for 30 years (or even longer), despite cancer being one of the most active areas of medical research.

What do you think junior doctors should be most aware of with regard to sarcoma?

The safest doctors are those that recognise when to call for help. Sarcoma prognosis is inversely associated with size at presentation. Unfortunately, the vast majority of sarcomas are greater than 10cm at the time of diagnosis. I would say that junior doctors should be aware of the 4 red flag symptoms and if these are present a specialist opinion should be sought.

To learn more about the symptoms of bone cancer, visit our information page.

The Bone Cancer Research Trust has committed to funding the National Sarcoma Awareness Project for a further year.

If you are a final year medical student or F1/F2 doctor interested in taking part, please contact sarcoma.awareness@rlbuht.nhs.uk with your name, designation and email contact. You will receive free e-learning resources and a link to the online questions .

The top scoring participants will be given the opportunity to take part in funded short term clinical fellowships at a regional sarcoma centre to further their knowledge on sarcomas.