Like many of his colleagues who devote their careers to treating cancer, Derek Power, a consultant oncologist at Cork University Hospital, is sometimes faced with the agonising task of telling patients their lives are about to be cut unbearably short.
He had that same conversation with a young father earlier this year -- a man who had never been sick a day in his life, the sort that often succumbs to cancer. Dr Power had to break the news that a sun-inflicted tumour had riddled his body with cancer and that his prospects were very bleak.
Easily treatable if caught early, malignant melanoma has an average survival rate of less than one year once it spreads to multiple sites beyond the skin.
Three years earlier, John, in his mid-40s, had spotted a wart growing from a mole on his thigh while he was in the shower. He ignored it for a couple of months, sticking plasters on it when it bled. But one day, a pool of red seeped through his jeans and he knew it was time to visit a GP.
The mole turned out to be cancerous and was removed along with the lymph nodes in his groin. John was given a clean bill of health. But in April of this year, he discovered a lump in his armpit and another on his neck. Days later, a scan revealed widespread advanced tumours in his lungs, chest and abdomen.
John crumbled as Dr Power broke the news that the longest he could expect to live was less than a year. But there was one glimmer of hope.
Dr Power is one of a number of Irish doctors at the forefront of clinical trials involving new cancer treatments. The trials are run under the auspices of ICORG, the All-Ireland Co-operative Oncology Research Group, the only group of its kind which gives Irish patients, some in the late stages of cancer, early access to cutting-edge treatments.
Working with ICORG, Dr Power, who returned from the US last year where he was based in New York's prestigious Sloane-Kettering Cancer Centre, was about to begin testing a radical new drug on Irish patients with terminal skin cancer. Designed to attack a genetic mutation called B-RAF, found in half of all melanoma and in other cancers like colon and thyroid, the new treatment had produced remarkable results in the lab, shrinking tumours in its path and keeping them at bay. Remarkably, it also seemed to induce no side effects.
In June, John became the first of just four patients in Ireland to take the compound, still known only by the number 113683 because it is still unlicensed for use. Twice a day, he swallowed the tablet at home, but within a week, he started to notice a change.
"I was like a camel with too many humps I didn't want but within about four days, the lump in my neck seemed to disappear. Then the one under my arm went. It seemed to be doing as much inside as it was outside. My appetite came back and I started to feel much better."
Some six weeks later, John returned to the hospital for his first scan.
At first, doctors thought they were reading the wrong patient's images.
"It was like the tumours had been rubbed out," Dr Power recalls. "The disease in his body had reduced by about 50pc in all areas, which is just unheard of in melanoma. I was amazed to see the scans side by side. There was such a big difference between the two.
"We couldn't feel any of the lymph nodes and when we did our most recent scan in August, there was a further 40pc reduction and no new disease.
"It's difficult to say anything concrete because it is still a clinical trial but we now have a handle on his disease," says Dr Power.
"He has gone from someone who was crippled with widespread disease a few months ago to being essentially normal now. I have never seen anything like it in my life."
As for John, four months into his treatment, he feels strong and healthy.