I’m open to answering any questions folks might want to know about going through cancer treatments. I figured I’d take on a couple of the central questions first: what are radiation and chemo like? If you have questions, feel free to ask them here in the comments or ping me via Facebook or Twitter.
Radiation is a fairly simple process for the patient. There are a bunch of different types so what I’m describing applies mostly only to IMRT (intensity-modulated radiation therapy). IMRT is targeted radiation, meaning the beams are shaped and focused to hit only the cancer and (hopefully) avoid areas that don’t need or should not have radiation, like the heart and liver in my case.
Before you have IMRT, you have the CT planning session. This is in a small, specialized CT room where you lay on a table, they mark your body with Sharpies to indicate positioning points, then they use lasers on the ceiling to track those points while they run a CT with contrast. Once they’re done, they make permanent tattoos (tiny dots) out of the Sharpie marks.
They also usually set up some kind of system to hold your body in place. Sometimes it’s not intrusive, like the bag of inflatable plastic they used for me this time. It holds the shape of my body so I (and the therapists) can feel if I’m laying in the same position every time.
Last time, with my head and neck cancer, it was a plastic mask softened and conformed to my face, then used to “strap me down” for each treatment.
The doctors and specialists then take all of your scans (CT and PET) and make a map of the treatment areas. They use special software that will eventually control the IMRT machine’s beam and path. The machine has the ability to send the radiation beam from multiple angles (360 degrees in the case of Tomotherapy) and it can also shape the beam with little lead leaves.
Treatments can begin when the planning is done. They’re pretty straight-forward and quickly become routine since most IMRT patients are treated every weekday for about 6-7 weeks.
The Tomotherapy suite at UCLA is very nice–warm wooden cabinet walls, recessed lights that change colors some days, and a black circular area over the table with glowing LED “stars” that reminds me of the library ceiling in Myst. When I come into the room, my plan is already in the machine and my pre-formed bag is on the table.
I have to change into a gown for the treatments, and after I lay on the bag and they put a leg rest under my knees, I take my arms from the gown. They need a clear view of my chest and the tattoos, so they put little washcloths over my nipples (which one therapist dubbed the “worst pasties ever”) then they start using the ceiling and side lasers to line me up identically to the CT planning setup. The bag makes it easier for them to push and pull me on the table to get me in position.
I lay on my back with both arms over my head (so they are out of the radiation field). They put warm blankets on my body which at that point feels like pretty much the best things ever. My arms got cold so often I cut sleeves out of an old turtleneck so I wear them, and sometimes still need a blanket on my arms because the room is chilly some days.
Once I’m in position, they leave the room and turn on some music for me, and treatment starts! Today they asked if I wanted Christmas music and while I’m not opposed to it in general, Christmas music while trapped in a tube for a half hour is not how I want to start my mornings. They generally just switch over to some form of classic rock for me.
The first part is CT scan that takes about 5 -7 minutes. The table slides into the tube to the start position, then slowly moves further in, taking the scan from my throat to just below my right lung. I know it’s done because at the end of the scan, the table pulls back out of the tube.
They call in my radiation oncologist when the scan’s done, and he makes any manual tweaks to better conform to slight positioning differences, or to compensate for changes in my body (which I’ll explain in a minute). This can take around 5 minutes or longer depending on how many changes they need to make. I know they’re done because the lasers reset for the actual treatments, and the table goes back into the tube.
The treatment itself is uneventful. The table moves very, very slowly this time. I can hear the whirring of the lead leaves as they reconfigure and circle around my body. There is usually little or no sensation during radiation. I sometimes feel a little bit of pain around my lower lung, but that may be in my head. My treatment is on the long side for IMRT, generally lasting around 15-20 minutes. I usually just close my eyes and try to occupy my thoughts with something interesting, like ideas for work or my side projects. I track the progress against two AC vents I can see out the front end of the tube as the table moves back. When they are almost out of view, the treatment’s done.
When treatment is complete, the table moves out of the tube and I’m done for the day!
Over the course of treatments, your body can change. As this happens, great doctors go to the effort of re-planning. I had re-planning once last treatments, and I’ve already had two re-plannings this time. The first was at the beginning of the second week, because more fluid had accumulated around my lung and it moved the location of the mass. At the beginning of the third week, though, the treatments had kicked in and the fluid disappeared, so they went back to the original plan.
I started having esophagitis during the third week and the mass had shrunk enough that Dr. Lee thought I would benefit from a third planning session. He could retarget the smaller mass, and miss a few sections of esophagus. So when I go in every day now, it’s that third plan that runs the machine. Doctors also re-plan when patients lose a lot of weight, if the weight loss affects the positioning items (the bags and masks).
I’ll follow up with another post about radiation side effects later this week. As I said, if you have any questions, I don’t mind answering. Just ping me!