Cancer Cartography

I’m writing this while waiting for my radiation planning session. Science is creating some really interesting opportunities for new or improved treatments for cancer. Here’s what my treatment involves.

I’ll be having simultaneous radiation therapy and chemotherapy. Each of these treatments is, by itself, a cancer killer. For squamous cell carcinoma (SCC), they also work synergistically, in that a cancer cell that has received chemotherapy is much more vulnerable to radiation. That’s especially true for HPV positive SCC. I like to think of it as a curative version of Mortal Kombat, where the chemo gets in some strong kicks and punches to set up the final strike from radiation. FATALITY!

The radiation therapy is pretty amazing. It’s called Intensity Modulated Radiation Therapy, or IMRT. My radiation oncologist (Dr. Dee) maps out everything inside my head (or at least the bottom half of it), based on my original PET scans and ongoing CT scans.

nyt-imrt-graphic

Based on the maps, they create a 3D model of my head and shoulders. Based on that model, the system modulates and shapes the radiation to hit the cancer and surrounding area (called margins) while minimizing the effect on surrounding tissue. Some of my salivary glands are in the direct path of the radiation so I may or may not regain the use of some of them over the years after the treatment, but that’s a small price to pay (if it even happens).

To build the maps and make sure my head is in the exact same place every treatment, they make light plastic mesh mask. Today, I had the mask fitted. I also had a very small tattoo placed on my chest, so they can line the radiation up precisely each time I come in. The mask looks something like the one below.

The chemo is Cisplatin, a platinum-based drug with a great track record and lots of data behind it, specifically for this kind of cancer. Cisplatin is also likely to cause oral mucositis (sores in the mouth and throat) and nausea, so I’ll be using a couple different medications to counteract those (or hopefully even prevent them). The drug most effective for relieving (or even preventing) oral mucositis isn’t covered by my insurance… and neither is the second choice. I’ll get them anyway, but I’m pursuing an appeal because I don’t want someone less fortunate who can’t afford the out of pocket payment for them to not receive the treatment. Expect a rant about that when I have a bit more energy!

I’ll have 7 weeks of treatment, starting April 17th. I’ll have radiation therapy every day, and chemo once a week, starting the first day of radiation. The doctors are doing a rush job to get this moving, just like the dentists did, and I’m very, very grateful. Everyone at Mills Peninsula and California Cancer Care Center has been very kind.

Next post will be about one of the treatment facts that causes the most visceral effect from everyone who hears about it, so stay tuned!

Related Posts

Be Your Own Advocate

I routinely encounter folks dealing with serious illness (mostly cancer, in my circumstances) who accept whatever the first doctor they meet tells them, even if what they’re told is that there is no hope. I

Read More »

Head and Neck Cancer Awareness Month

April is head and neck cancer awareness month! Be aware of the causes and symptoms, summarized in the graphic at the bottom. For me, it was a swollen lymph node below my jaw that didn’t

Read More »

Clinical Trial Math

Clinical trial math example: Monday + every two months = time to start worrying about my scan the following Monday. Tuesday + pain below my right ribs = worry about that AND the scan the

Read More »

My Best Days Are Ahead Of Me

Last year, I was in the hospital from chemo for my birthday, not knowing the cancer would blossom again months later. This year, I’m walking around San Francisco–short of breath sometimes, but walking–looking forward to

Read More »

Unpredictability and Patterns

The every-other-week treatment schedule has become habit at this point. In at 7:45 am, IV and blood draw, discussion with the trial nurse, meet with Dr. Ani, get the blood test results, then infusion and

Read More »

Speaking Out and its Price

I’m exhausted and stressed and sad and angry. I try to keep my posts here focused and positive, but it’s really hard at this point. I was contacted last week by the Organizing Director of

Read More »