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As the Princess of Wales reveals cancer was found during her abdominal surgery in January, experts explain what preventative chemotherapy is, how it works and when it’s used. 

What is preventative chemotherapy?

The Princess of Wales says that at the time of her surgery, it was thought her condition was non-cancerous.

But tests following the surgery revealed that cancer was present.

Also known as adjuvant therapy, preventative chemotherapy is often used after surgery to reduce the chance of cancer coming back and spreading.

Lawrence Young, professor of molecular oncology at the University of Warwick, explains: “Even after successful removal of all visible cancer by surgery, microscopic cancer cells can remain lurking in the body and can’t be detected by current tests.”

When is preventative chemotherapy used?

Leading cancer specialist and consultant oncologist Dr Karol Sikora says it can be used when “risk of recurrence is high”.

He told Sky News: “The way treatment is delivered is so much nicer now and it is really done very professionally and she will be getting the best care possible.”

He explains that doctors are able to predict the “right treatment for the right patient”.

“Although it is unpleasant, chemotherapy is of great benefit”.

Thomas Moore, Sky’s science correspondent, explains the usual procedure following many surgeries.

“They do tests on the cells and that’s when they would have discovered that it was cancerous,” he says.

“When they are talking about preventative chemotherapy, that is in case there are any other cells that were left behind after the surgery, to make sure those are not the seeds of a cancer that grows back.”

The NHS describes adjuvant chemotherapy as chemotherapy used to “reduce the risk of the cancer coming back after radiotherapy or surgery”.

Sometimes cancer can ‘escape the organ of origin’

Dr Mangesh Thorat, Honorary Reader, Queen Mary University of London and Consultant Breast Surgeon, Homerton University Hospital, says tests and scans can’t detect microscopic cancers, so preventative treatments are used when cancer is known to be present.

On discovering cancer was present following her surgery, the decision will have been taken to give the princess chemo to make sure any lingering cancerous cells are killed.

“Surgery is the most curative form of treatment for early-stage cancers of solid organs.

“However, occasionally some cancer cells escape the organ of their origin and start residing in other organs such as lung or liver.

“Tests and scans currently available are unable to detect such microscopic spread and therefore to improve chances of cure, presumptive treatment of such likely spread is often undertaken even after the cancer in the solid organ of origin is completely removed.

“Depending on the type of cancer, a range of drugs that can reach all organs of body where such spread might have occurred are used.

“Chemotherapy is one such type of treatment that uses drugs which particularly act on rapidly dividing cells, for example, cancer cells, and kills such cells.”

Does it work better on certain groups?

Andrew Beggs, MRC Senior Clinical Fellow and Consultant Colorectal Surgeon, University of Birmingham, describes preventative chemo as “a bit like mopping a floor with bleach when you’ve spilt something on it, chemotherapy kills any spilt cells”.

“Age has no effect on the success rate of chemotherapy except when the cancers are ‘immune hot’ which are commoner in young people – in this case a type of chemotherapy called immunotherapy could be given.”

He says that younger people can “tolerate higher doses of chemotherapy” better, so can be given stronger treatment plans that are “more likely to kill any leftover cells”.

He says chemotherapy “is generally given for between three to 12 months, depending on what type of cancer it is”.

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How long does preventative chemotherapy last?

It depends on the type and stage of cancer, but the princess has not revealed these details.

Professor Lawrence says: “The sort of chemotherapy and the time length of treatment depends on the type and stage of cancer as confirmed by examining the cancer removed at surgery.”

Prof Lawrence explains that the side effects of chemotherapy “also depend on the type of drugs used but commonly include tiredness, nausea, increased risk of getting an infection and loss of appetite”.

While we don’t know what stage the princess’s cancer is, Prof Lawrence says “an incidental finding of cancer during surgery for other conditions is often associated with the tumour being detected at an early stage when subsequent chemotherapy is much more effective”.

How is preventative chemotherapy usually administered?

Pat Price, chair of Radiotherapy UK and leading cancer doctor, said the surgery itself will have removed the cancer.

“Sometimes in some tumours there’s a little bit of a concern about whether there’s anything that’s been left behind or whether there’s a risk of it coming back,” she told Sky News.

Doctors will then often use preventative chemotherapy, usually in the form of tablets or injections, she says.

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This will often be given for a period of either four or six months and then it is finished, at which point things would “hopefully” be ok.

She explained that chemotherapy hits all of a person’s cells – both the cancer cells and normal tissue.

This can then cause issues with bone marrow and the gut, causing symptoms such as feeling sick or low blood count.

Some people tolerate it well, she says.

The Princess of Wales said she is “well and getting stronger every day”, paying tribute to her husband as a “great source of comfort and reassurance too”.

She called for “time, space and privacy” as she completes her treatment.

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Head of Southport attacker’s former school tells inquiry he was ‘building up to something’

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Head of Southport attacker's former school tells inquiry he was 'building up to something'

The head teacher of the Southport attacker’s former school has told a public inquiry she felt like he was “building up to something”.

Joanne Hodson, head of The Acorns School in Ormskirk, said she had a “visceral sense of dread” that he would do something.

“I felt like something was going to happen and there was a level of agitation with direct challenges to staff, the way he was with other pupils. I felt like every day it was building and building and building,” she told the inquiry at Liverpool Town Hall.

Axel Rudakubana, then aged 17, killed six-year-old Bebe King, seven-year-old Elsie Dot Stancombe, and nine-year-old Alice da Silva Aguiar and attempted to murder 10 others at a Taylor Swift-themed dance class in Southport on 29 July last year.

He was later jailed for a minimum of 52 years.

Families of the victims with their legal team arrive at Liverpool Town Hall for the Southport Inquiry.
Pic: PA
Image:
Families of the victims with their legal team arrive at Liverpool Town Hall for the Southport Inquiry.
Pic: PA

Rudakubana, referred to during the public inquiry as AR, came to Ms Hodson’s school after he was permanently excluded from the Range High School, in Formby, due to taking knives to school in October 2019.

‘Devoid of any remorse’

Ms Hodson said she first met Rudakubana at his admissions meeting for the Acorns, when she asked him why he had taken a knife to his former school.

“He looked me in the eyes and said ‘to use it’. This is the only time in my career that a pupil has said this to me or behaved in a manner so devoid of any remorse,” she said.

“What also surprised me was that AR’s parents did not flinch at this comment.”

She said the parents saw Rudakubana “as the victim” and believed he had taken the knife to school as a response to being bullied.

His parents thought he was a “good boy” who never did anything wrong and that “any issues were someone else’s fault”, according to Ms Hodson.

Members of the public leave flowers at a memorial site for the victims of the Southport stabbings. File pic
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Members of the public leave flowers at a memorial site for the victims of the Southport stabbings. File pic

Ms Hodson said she had feared Rudakubana was going to “bring something” to the Acorns.

Instead, he returned to the Range in December 2019 to assault another student with a hockey stick while carrying a knife in his bag.

‘Sinister undertone’

Ms Hodson described Rudakubana as the “most unusual” pupil she had experienced during her career, adding in a statement: “There was a sinister undertone and it was difficult to build rapport.

“He had no respect for authority and generally a lack of respect of other pupils and staff. He was insistent that his views alone were correct and everyone else was wrong. There was never any sense of remorse or accountability for his actions.”

In his education, health and care plan, it was noted there were concerns that Rudakubana said or did things which had been described as “sinister”, the inquiry heard.

More from the inquiry:
Rudakubana judged as posing no risk to others
His parents struggled to deal with outbursts

Taxi driver waited 50 minutes to call 999
The missed chances to stop Rudakubana

A three-minute silence was held in Town Hall Gardens, Southport, marking one year since the attack. File pic: PA
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A three-minute silence was held in Town Hall Gardens, Southport, marking one year since the attack. File pic: PA

Ms Hodson said she was asking other agencies for help, but the word “sinister” was crossed out in the report and changed to “inappropriate” after professional views were submitted by the child and adolescent mental health service (CAMHS).

“I was challenged quite heavily and told no child should ever be described as sinister and as a professional I should not be using those words,” she said.

‘Let down’ by Prevent

Ms Hodson said school staff were concerned about Rudakubana attacking his peers and made three referrals about him to the government’s anti-terror programme Prevent.

The head teacher said staff felt “let down” after their third referral caused in the school’s relationship with Rudakubana and his father, but was not acted on by Prevent.

When Rudakubana made comments thought to be antisemitic in school in January 2022, teachers did not make another referral to Prevent, with Ms Hodson telling the inquiry: “On reflection, whilst I regret not submitting further Prevent referrals in 2022, I think by this point Acorns had lost faith that anything would be done.”

She said staff were concerned about Rudakubana being radicalised, but “he was so socially isolated that I could not conceive of the idea that he might attack a group of strangers, let alone young children”.

“The tragic events are so far removed from what I would have associated AR with in terms of risk,” Ms Hodson said.

The inquiry was adjourned until Monday.

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Post Office compensation ‘worse than original injustice’, victims’ commissioner says

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Post Office compensation 'worse than original injustice', victims' commissioner says

A leaked letter, seen by Sky News, warns government that victims of the Post Office scandal find compensation schemes “worse than the original injustice”.

The letter was written by victims’ commissioner Baroness Newlove and sent to the Post Office minister Blair McDougall earlier this month.

“Far from offering catharsis,” she writes, “the compensation process was seen to be as bad as or even worse an experience than the initial investigation, prosecution and injustice itself.”

She adds that “hearing this from victims, time and again, shocked me”.

Victims told her that initial offers were “insultingly low” and that constant delays and requests for decades-old paperwork had left them offended and “distressed”.

Some described the process as “adversarial”, with Baroness Newlove comparing it to fighting an insurance company rather than receiving justice from the state.

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‘Unbearable’ wait to clear names for Post Office victims

The letter urges the government to abandon “commercial tactics” such as making low initial offers – approaches the Commissioner says are “not appropriate when dealing with traumatised victims”.

More on Post Office Scandal

“It might be better to come back with a request for more information, rather than make an offer that is guaranteed to offend the victim,” she said.

The letter was sent on 3 October, shortly before the government outlined its official response to part one of the Horizon inquiry report.

It announced that it would accept most of the recommendations, including on redress, put forward by the chair of the inquiry Sir Wyn Williams.

In her four-page letter, Baroness Newlove also welcomes access to “free legal advice” to help victims with claims but calls for earlier cases to be reviewed.

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Minister: No deadline on Horizon scandal compensation

She explains that where advice had not been available, some victims “might have been disadvantaged as a result”.

“Is it possible these early cases can be reviewed to ensure everyone has been treated fairly and equally?” she asks.

The letter also raises concerns that some current serving sub postmasters feel “under pressure” from managers not to pursue claims, urging the department to ensure this “is not the case”.

Baroness Newlove also relays victims’ frustration that Fujitsu, the company behind the faulty Horizon system, continues to work with the government and asks whether this is “an issue the government is looking to address”.

Post Office Minister Blair McDougall said in response to the letter: “We pay tribute to all the postmasters who have suffered from the Horizon scandal, which is why we have increased the total amount paid to postmasters fivefold to over £1 billion as part of our ongoing commitment to deliver justice to victims as swiftly as possible.

“Since this letter was sent we set out our response to Sir Wyn Williams’ inquiry proposals, which will help us further speed up claims, and which offers legal advice to sub postmasters.

“I look forward to working with postmasters in making further improvements to the redress schemes so that they get the compensation they deserve.”

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A Post Office spokesperson said: “We have and continue to actively support all Post Office colleagues, but particularly those with direct contact with Postmasters, to encourage them to submit a claim to the Horizon Shortfall Scheme if they believe they suffered losses in the past.

“Our Area Managers are playing a pivotal role in guiding Postmasters on how to submit a claim and signposting where there’s additional support to do so. We have a dedicated claimant support team available on the phone to discuss options, provide support, and answer any questions a Postmaster may have so that we can begin to process their claim right away.

“We would welcome contact with the Victim Commissioner directly so that we can understand more about what they have been told and to ensure all of us work together so that current and former postmasters get their claims in as soon as possible.

“To assist this, we will shortly be launching a national advertising campaign urging any current or former Postmaster who has not submitted a claim to do so as soon as possible and by 31 January 2026.”

A Fujitsu spokesperson said in a statement: “We continue to work with government to ensure we adhere to the voluntary restrictions we put in place regarding bidding for new contracts while the Post Office Inquiry is ongoing, and we are engaged with government regarding Fujitsu’s contribution to compensation.”

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Ringleader behind arson attack and kidnap plot was ‘groomed’ by Russian chatbot, court told

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Ringleader behind arson attack and kidnap plot was 'groomed' by Russian chatbot, court told

The ringleader behind an arson attack and plot to kidnap a billionaire Russian dissident had been “groomed” by a chatbot, operated by Wagner mercenaries, a court was told.

The Old Bailey heard the fire at an industrial estate in Leyton, East London, on 20 March 2024, caused an estimated £1m of damage, including to vital Starlink satellite equipment destined for Ukraine.

Dylan Earl, 21, a builder and part-time drug dealer who lived with his parents in Elmesthorpe, Leicestershire, has admitted his role in orchestrating the attack by recruiting others to carry it out.

During his trial, the court heard he also tasked two people to burn down an exclusive restaurant and wine dealership in Mayfair and to kidnap Evgeny Chichvarkin, the billionaire owner.

Two units in the Cromwell Industrial Estate were set on fire in March 2024. Pic: London Fire Brigade
Image:
Two units in the Cromwell Industrial Estate were set on fire in March 2024. Pic: London Fire Brigade

Damage to an east London warehouse that was shown to the jury at the Old Bailey.
Pic: PA
Image:
Damage to an east London warehouse that was shown to the jury at the Old Bailey.
Pic: PA

However, Paul Hynes KC, defending, told a sentencing hearing on Thursday that the Russians were “trash fishing” using a Russian language chatbot called PrivetBot on the encrypted Telegram platform and Earl was “easy meat”.

“Our prime submission is that he is, or was at the time, a sad individual who sat for lengthy periods alone in his bedroom at his parents’ house.

“His minimalist existence was taking drugs, particularly cannabis and involving himself in online gaming.

“We do not seek to characterise Dylan Earl as a victim in this case but there are vulnerable elements in him that were used by PrivetBot, acting on behalf of the Wagner Group, as a proxy for the Russian Federation.”

In April 2024, PrivetBot messaged Earl. His replies had been deleted, but the Wagner contact said: “I see that you know what you want. It’s a great happiness that you have realised so early that you are a WARRIOR. We need your connections and your capabilities.”

Mr Hynes told the judge, Mrs Justice Cheema-Grubb, Earl was “very much a sad individual” who “had a certain detachment from reality” and “sought praise, importance and significance”.

“The potent effect of the messaging is shown in his desperate, pathetic and delusional responses,” he added.

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Earl messaged the contact, offering to recruit thousands more to join their operation and boasting of his underworld contacts.

“If you need connections with IRA, I can sort it. You want criminal connections with murderers, kidnappers, soldiers, drug dealers, fraudsters, car thieves, I can sort it all,” Earl wrote.

But the court heard Earl never left his bedroom and never met the people he recruited.

Earl and five other men are being sentenced for their part in the Russian-ordered arson attack on behalf of the Wagner Group, a Russian mercenary company, which is proscribed as a terrorist organisation in the UK.

The Kremlin denies accusations that it is involved in any such acts of sabotage.

The men will be sentenced on Friday.

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