Professor Sir Huw Thomas made Knight Commander of the Royal Victorian Order

We speak to Sir Huw Thomas on receiving a knighthood, his cancer research at Imperial, and his role as Head of the Royal Medical Household.

Imperial's Professor Sir Huw Thomas, who is also Head of the Medical Household and Physician to the Queen, has been awarded a knighthood in the 2021 New Year Honours. Sir Huw’s honour – Knight Commander of the Royal Victorian Order (KCVO) – is the personal gift of the monarch.

Sir Huw has been Professor of Gastrointestinal Genetics at Imperial’s Department of Surgery & Cancer since 2007, working closely with Lord Ara Darzi and Professor George Hanna.

He is also Consultant Gastroenterologist at St Mary's Hospital, Imperial College Healthcare NHS Trust, and Director of the Family Cancer Clinic at St Mark's Hospital.

We speak to Sir Huw Thomas following the news of his knighthood:

Congratulations on being knighted. How did you feel when you received the news?

It was a very nice surprise! I’ve been working in the Royal Medical Household for 15 years and I’ve been Head of the Medical Household for the past seven years. It's been a busy couple of years in this role, so I feel very grateful to have been recognised for my service to date. 

What do you enjoy about your role as Head of the Medical Household and Physician to the Queen?

It is a great honour to be Physician to the Queen. It’s a very enjoyable and rewarding role – completely different from what I would normally be doing.

The nature of the work is interesting because you see how a whole different organisation, the Royal Household, operates. You very much become part of that organisation and become the personal doctor to the principal people in it, who are patients just like other patients. With the pandemic, the key priority of the Medical Household is trying to make sure that the people under its care are kept safe.

You also have an academic role at the Faculty of Medicine and clinical roles – how do you balance your different interests? 

I compartmentalise my life in a way. I have some sessions at St Mary’s where I’m an NHS Consultant in Gastroenterology, and then I have my research interests through Imperial that I do at St Mark’s Hospital. I’ve had this arrangement for almost 25 years, so it’s second nature! My role at the Medical Household doesn’t have fixed sessions, and it’s as and when I’m needed. 

Why did you choose to specialise in gastroenterology?

I think gastroenterology has a huge amount of variety. Gastroenterology includes everything from the oesophagus, the stomach, the small bowel, large bowel, pancreas, liver, and it includes infections, inflammatory conditions, and neoplastic conditions. I still see things I've never seen before, even after I've been doing it for a long time! There's also a slightly surgical side to it as it involves doing endoscopic procedures which are quite satisfying.

Looking back at your career, do you have any defining moments?

I feel very lucky to have been working in the field at a time molecular genetics was in its infancy, which has since completely changed our understanding of cancer and genetic predispositions. 

Back when I was doing a Clinical Research Fellowship at the Imperial Cancer Research Fund (ICRF) in the late 80s, molecular genetics was very new. Scientists at the ICRF mapped the location of the bowel cancer gene APC to chromosome 5. This was a huge step in understanding people’s increased risk of developing bowel cancer. It was a very exciting time to be involved in the field. All the people I've collaborated with ever since have been people from the ICRF era.

How has this development translated into better treatment options for cancer patients?

The interesting thing is that the inherited genetics of colorectal cancer have shown that there are different molecular pathways by which colorectal cancer can develop, and with the recent onset of immunotherapy, some rare colorectal cancers have been responding well to immunotherapy.

For example, one of the groups we're particularly interested in are patients with Lynch syndrome, who get colon cancers often at a very early age. They are a group that respond well now to immunotherapy. Around 15% of ordinary or sporadic colorectal cancers have a similar genetic pathway and also respond well to immunotherapy too. This has been a big breakthrough and something that's happened in the last few years.

Are you currently involved in any exciting projects?

We have a new database funded by Cancer Research UK for managing our high-risk patients who have regular colonoscopies We've just signed a new data-sharing agreement with NHS Digital where we have our patients flagged. We have a long-standing collaboration with Professor Peter Sasieni at King's College, who's a statistician, and we can analyse pseudonymized data with him for all our patients, and look at the outcomes of colonoscopy in different risk groups and in different genetic groups. This is very useful for contributing to evidence-based guidelines on who should be having colonoscopies based on risk.

How has the pandemic impacted your clinical work?

At St Mark’s we have hundreds of patients who have regular colonoscopies. Inevitably, these procedures stopped for a few months during the first lockdown, so we were faced with a large backlog of patients. The challenge has been to prioritise those people at highest risk to make sure they get their colonoscopies. Luckily with our new database, this work was made a lot easier.

I've also done a couple of General Medical Ward rounds at St Mary's to help with staff shortages, which is something I haven't done for over 20 years. Even in these challenging times, St Mary's is a friendly, cohesive and collaborative place to work, and that character hasn't changed over the years. 

Away from medicine, how do you like to spend your spare time?

I do like to get away from London with my family. My favourite spots are Italy and West Wales, where my father was from. I also enjoy the theatre and going to the opera.