My research programme investigates clinical challenges in patients with gynaecological cancer combining clinical trials/studies and translational research.

Test accuracy/accurate detection in Ovarian Cancer 

Ovarian cancer is the fifth most common cancer in women and is the leading cause of death from gynaecological cancer, with approximately 5,900 newly diagnosed cases each year in England. Most women present with late stage disease as symptoms are nonspecific; five year relative survival is around 40%. Not only is survival relatively poor, but living with late stage ovarian cancer is associated with poor quality of life as a consequence of: disease symptoms, surgical morbidity and the toxicity of chemotherapy.

I am the Chief Investigator of the NIHR funded ROCkeTS project which is an international collaboration between myself, Prof Sean Kehoe, Prof Jon Deeks, UoB, Prof Usha Menon, UCL, Prof Richard Neal, Bangor University, Imperial and the IOTA group Profs Dirk Timmerman, Tom Bourne and Ben VanCalster, KU Leuven University, Belgium to derive and validate novel risk scores to detect ovarian cancer. This project will be delivered in 4 Phases – Phase 1 Systematic reviews, Phase 2 – re-analysis of large established datasets/biobanks UKCTOCS, UKOPS, IOTA, Phase 3 – Prospective study in 2400 women, Phase 4 – generation of pathways. Phase 3 is a unique opportunity to build an extremely novel sample collection and will offer significant opportunities for translational research with collaborator Dr Jean-Baptiste Cazier in next generation sequencing technologies. ROCkeTS establishes Birmingham as the UK/EU hub for ovarian cancer diagnostics research and was awarded against intense competition from Manchester.

This research theme builds on my previous work in the evaluation of diagnostic tests in gynaecological cancer with Prof Khalid Khan at Queen Mary’s, London.

Metabolism research in Ovarian cancer

Obesity contributes to the development of several cancers. Working with Dr Paul Foster, Prof Weibke Arlt at CEDAM and Prof Jeremy Tomlinson at Oxford, I am investigating the impact of metabolic syndrome and dysregulation of hormone signalling pathways in Ovarian Cancer. I am investigating the use of Metformin, a well-tolerated anti-diabetic drug in serous ovarian cancer aiming to establish clinical trials with survival and translational endpoints to identify biomarkers of response with collaborators Prof Hani Gabra, Imperial and Prof Chris Poole, Warwick. Translational research with Dr Jo Morris, exploring DNA repair and Metformin has yielded interesting preliminary results which we aim to build on.  

Poor prognostic groups of endometrial cancer

Poor prognostic histotypes of uterine cancer contribute to 10% of the incidence of endometrial cancer but up to 50% of mortality from endometrial cancer. Working with Dr Fedor Berdevetski/ Dr Odintsova’s group, we are investigating the role of these novel proteins in metastasis in ovarian and uterine serous cancer.   

Surgery in Ovarian cancer

Extensive surgery has been shown to significantly improve survival in ovarian cancer in a paradigm shift from conventional approaches. I am Chief Investigator of SOCQER-2 - a prospective multicentre cohort study evaluating the short term and long term outcomes, including quality of life following extensive surgery in ovarian cancer. NICE has commissioned this study following on from the SOCQER-1 pilot study which has elicited international interest for its findings on Quality of life. This project will have substantial impact on ovarian cancer surgery in the UK as it will directly influence NICE guidance in 2017 on this subject.

Teaching design, delivery and enahncement

Undergraduate teaching – Year 4 Lead for Oncology for MBChB (2012 – date) s

Prior to my appointment, Oncology received poor student feedback with formal complaints made from students. I have  implemented curriculum change – revision of learning outcomes, revamped and designed assessments including both multiple choice questions and Objective structured clinical examination questions, improved e- learning resources. I have worked with trust leads in Oncology through a ‘Oncology reference group’ to promote ownership and delivery of high quality oncology teaching in trusts. These and other system wide changes have resulted in improved student satisfaction – student satisfaction for oncology is now good. I am introducing an innovation - ‘Survivors teaching students’ delivered by a charity in Ovarian Cancer on 21^st October this year. This is a UK first event, if student feedback for this event is good, I plan to develop this concept further across oncology to promote patient voices in teaching.  

Teaching leadership

Postgraduate teaching – Clinical Lead for fulltime programme MSc in Clinical Oncology, 2011 - 2013

I devised and helped deliver this innovative course which is the first in the United Kingdon to combine clinical observership in an NHS hospital with taught modules and a dissertation thesis. This course aimed at international students, has been extremely well received (student interview at http://www.birmingham.ac.uk/students/courses/postgraduate/taught/med/clinical-oncology-full-time.aspx). The course has enabled School of Cancer Sciences to engage pro-actively with the agenda of international recruitment. I was awarded the Teaching and Supporting Learning Award for 2011-2012 for this work from School of Cancer Sciences and was nominated Cancer Sciences’ Star of the Year’ for 2011-2012.

Surgical Oncology module, MSc in Clinical Oncology, 2012.  

Working with Olga Tucker, Senior Lecturer in Surgery, I helped devise and deliver the first blended learning module in the School of Cancer Sciences. The ‘Surgical Oncology’ module comprises electures accessible by students prior to attendance at the face to face contact days. The module was well received in 2012 with a course evaluation of  3.5 out of  5. I also deliver lectures on gynaecological oncology during the Pathology module of this course.

Career to Date

Present Appointment

I have a busy clinical practice (50% of time commitment) as a gynaecological cancer surgeon based at the Pan Birmingham Gynaecological Cancer Centre at the City Hospital - a large tertiary centre for gynaecological malignancy with a catchment population of over 2 million patients that currently receives in excess of 600 new cases of gynaecological cancer annually. Our centre has currently the best 3 year, 5 year ovarian cancer survival in the country (http://www.ncin.org.uk/profiles/gynae/cancer_networks/health_profile_map/atlas.html). I have been awarded 2 clinical excellence points for my contributions to clinical service in 2011.

Previous Appointments

Subspecialty Trainee in Gynaecological Oncology (12.07.2004 to 14.10.2007)

Cheltenham General Hospital

Cheltenham

Programme Director: Mr RJ Gornall

This is a 3 year programme recognised by the RCOG for subspecialty training. This centre serves the 3 counties cancer network comprising Gloucestershire, Herefordshire and Worcestershire and treats 250 new cases of gynaecological cancer each year.

CRUK Clinical Research Fellow (01.05.2002 to 30.04.2004)

Ovarian Cancer Group

Weatherall Institute of Molecular Medicine

JohnRadcliffeHospital, Oxford

Cancer Research UK

Supervisor Dr T S Ganesan

This period of research in Molecular Oncology was funded by Cancer Research UK and a fellowship from the Oxfordshire Health Services Research Committee.

Visiting Specialist Registrar Years 1 - 5 (March 1998 to July 2005)

I completed 4 years of Specialist Registrar training in Obstetrics and Gynaecology in the Oxford Deanery.

Senior House Officer/Acting Registrar in Obstetrics and Gynaecology. October 1995-Feb1998. (16 months SHO, 12 months senior SHO)

Birmingham Heartlands and Solihull NHS Trust (Teaching).

West Midlands

Knowledge Exchange

I was invited as part of a select group representing stakeholders in the care of women with gynaecological cancer to the House of Commons by the Chair of the All Party parliamentary group on Ovarian Cancer, Member of Parliament Sharon Oates in January 2013 to hear the results of the Pathfinder study on Ovarian Cancer. This study conducted by the charity Target Ovarian Cancer focuses on patient experiences in ovarian cancer diagnosis and treatment.

I was interviewed by BBC Midlands television and radio on endometrial cancer in April 2012 focusing on the link between endometrial cancer and obesity, following my publication in the British Journal of Cancer.

WIDENING PARTICIPATION

I participated in the Cancer Research UK Race for life in 2012, representing the University and have volunteered in the race in previous years.

CITIZENSHIP

EXTERNAL ENGAGEMENT - MARKERS OF ESTEEM

I am an opinion leader in my specialty with a significant national profile.  

1. Council member – British Gynaecological Cancer Society. April 2011- date. This is the professional body representing surgeons, oncologists and nurses involved in the care of women with gynaecological cancer.
2. Chair guidelines committee of the British Gynaecological Cancer Society. November 2012- date. Lead for BGCS Endometrial cancer guideline
3. Member Ultraradical Surgery in Ovarian cancer Steering committee, 2013 to date.
4. Member of NCRI Gynaecological Cancer Clinical Studies Group. 2008 – 2013. Current Member of ovarian and endometrial cancer subgroups of the Gynaecological cancer CSG.
5.  Grant panel member Wellbeing of Women charity ( 2014 September for 3 years)
6. Reviewer for British Journal of Obstetrics and Gynaecology, International Journal of Gynaecological Cancer, European Journal of Obstetrics and Gynaecology and Reproductive Biology, Science Translational Medicine, British Medical Journal
7. Reviewer for grant applications to Wellbeing of Women and Research for patient benefit, NIHR
8. Invited Speaker at national and International conferences

• Invited panel guest (4 member panel) for the ‘Wellbeing of Women’ charity meeting on Ovarian Cancer, June 27th, 2013.
• September 2013 – European Society of Gynaecological Oncology biannual meeting, Liverpool. Sentinel nodes in Vulval Cancer
• March 2014 – RCOG World Congress, Hyderabad India. Laparoscopic surgery in gynaecological cancers.
• July 2014 – British Gynaecological cancer society annual conference, London. Insulin Resistance and Metformin in Endometrial and Ovarian Cancer
• January 2015 - Federation of Obstetrics and Gynaecological Societies in India ( FOGSI) annual conference. Keynote speaker on Conservative management in Endometrial Cancer

GRANT FUNDING

CONTRIBUTION TO UNIVERSITY MANAGEMENT

India Champion for Medical and Dental School October 2011 to January 2013

In this role, I contributed to Research and Teaching engagement activities with India as part of the College international engagement committee to guide the College of Medical and Dental school on research links as well as promotion of recruitment. I represented the College of Medical and Dental Sciences at the India group chaired by Prof Adam Tickell, along with representatives from other Colleges. I organised a high profile international visit by Dr Sankaranarayanan, Head of the Early detection and Prevention section, International agency for Research in Cancer/World Health Organisation in May 2012 to foster research collaborations in India.

Contribution to international student recruitment agenda

I visited Saudi Arabia, on behalf of the University of Birmingham to promote postgraduate recruitment in April 2012. I explored collaborative links with King Saud University, the most established University in Saudi Arabia at their behest - the international office are now working to build on these links.

CONTRIBUTION TO DEVELOPMENT OF OTHERS

I regularly act as home supervisor for international and domestic electives for students. In my role as an academic, I support NHS colleagues in grant applications and advice. For instance, I helped develop the concept of Folic acid supplementation for menopausal women with contraindications to hormone replacement therapy (PI – Ayman Ewies, Consultant in Obstetrics and Gynaecology, SWBH trust) from a concept to an NIHR funded trial. I am also local PI for Phase 1 of CRUK Stratified Medicine and BRITROC studies.