The founder of the Cork Cancer Research Centre is upbeat about the changes that lie ahead in the treatment of the disease

‘I LIKE wide-open spaces,” says consultant surgeon Prof Gerald C O’Sullivan, looking out at the panorama of sky and rooftops from his office at the Cork Cancer Research Centre as we settle down to talk.

It’s a commanding view, and a suitable perch from which to reflect back on a career during which our understanding and treatment of cancer has changed fundamentally.

In his time, O'Sullivan has gathered accolades from many quarters – most recently he was named last week by US newspaper the Irish Voicein its list of 50 top Irish and Irish Americans in the life science industry, he has just finished his presidency of the European Surgical Association and last year the Irish Journal of Medical Sciencehonoured him with a lifetime achievement award.

It all started back in 1963 when he began studying mathematical science in University College Cork. He switched to medicine two weeks later, but the interest in science remained, and he moved to Canada to take up a post that combined surgery and biochemical research on gallstones in the lab.

“It was a difficult area,” he says. “But the joys and sorrows and all the discipline and hard work that’s required, they were part of it and they all stood to me later on.”

O’Sullivan moved to Chicago, where he developed his skills in surgery of the upper gastrointestinal tract, yet when he brought them back to Ireland, there was little opportunity.

“In 1983 I was still waiting for a job,” he recalls. “But I got a call one night to ask would I consider going to Dublin to discuss my career opportunities, which involved moving to Iraq.”

There he helped to set up and run a kidney transplant programme. “When we left it, we were doing two a week and the results were the same as the best of the western world,” he says.

But the programme ended with the first Gulf War: “The hospital was shut down and it was never re-established. It’s a great pity because it had a tremendous amount to contribute.”

Meanwhile, O’Sullivan had come back to Cork and started work at the Mercy Hospital, where over a quarter of a century he has witnessed the move towards minimally invasive techniques.

“There’s probably not a disease or an operation that we do today that by comparison with 25 years ago that hasn’t been changed significantly for the better,” he says.

“There are many conditions that before may have involved major surgery that are being managed now by radiologists and using catheters.”

Medical imaging, too, has improved dramatically. “Previously we didn’t have ultrasound, CT scans, MRI, quantitative imaging and 3D reconstruction. When we reflect back you’d wonder how we practised at all,” he muses.

In his own field, O’Sullivan has seen a trend towards more younger people developing a type of oesophageal cancer called adenocarcinoma, and lifestyle could be partly driving it.

“There has been a change in diet and people are heavier than they used to be, but not everyone is sure that is the complete explanation,” he says.

And more generally, cancer treatment has been revolutionised by the discovery of drugs to target specific cancer pathways, although O’Sullivan notes there is still work to do.

“Unfortunately in cancers, there can be a lot of redundancy in the background, where if you block one pathway, another takes over,” he says. “So for most cancers, single modality treatments or agents don’t work.”

A decade ago, he founded the Cork Cancer Research Centre at UCC, which relies on charitable donations as well as funding from Science Foundation Ireland, the Health Research Board and the EU.

Ongoing research there looks at why tumours can harbour resistance against drugs, how to recruit the patient’s own immune system to aid chemotherapy, whether we can deliver anti-cancer therapies using bacteria and viruses and developing a device to coax drugs into tumours that don’t want to open up to them.

Recently though, O’Sullivan took a break from surgery after he was diagnosed with cancer himself.

“I don’t dwell on it every day,” he says. “And it means that instead of being a part-time researcher I have become a full-time researcher. But I haven’t been researching my own illness, I give that a skip.”

He is upbeat about the changes that lie ahead through cancer research. “What is coming down the road? There’s the whole era of drug discovery, discovering new pathways, new molecules that may be recruited with the ability to be able to design drugs and molecules, and gene therapy is going to be explosive,” he says.

And O’Sullivan plans to stay in the action. “There are many roles that people can have in scientific research. We have a very active educational and PhD programme here, and to do that properly it requires a lot of mentorship and support. Hopefully the brain will remain capable of doing that,” he says wryly.