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This afternoon I’ll get my 7th dose of 1.8 Gy of x-rays on the way to 54 Gy. The machine doing the deed is a Varian IMRT. It is a very impressive bit of technology. It has a continuously variable aperture and intensity. The rad tech opened the access panels up for me yesterday and showed me the innards. There is a rather large microwave generator inside with waveguides piping energy … somewhere. She said this TrueBeam system could also do electron beam therapy. The machine has a built-in CT scanner to verify that the sorry sod strapped in is aligned properly.

Last Monday I officially became a ligand for platinum. Got the first dose of cis-platin. Somewhere I have molecules- DNA- that are ligated as Pt complexes. The first dose hasn’t been much of an issue. The anti-nausea meds definitely have side effects though.

Five more weeks and 5 more cis-platin doses to go. Week one was without serious side effects thanks to Dulcolax.

My adventure with Head and Neck Squamous Cell Carcinoma, HNSCC, soon enters a third phase.  A week from this writing I’ll don my custom prepared plastic mesh mask and they’ll strap me onto an x-ray machine. Oh yes, one other thing. There’ll be a weekly dose of cis-platin coincident with irradiation. Turns out that there is a synergistic effect with radiation and platinum poisoning cis-platin chemotherapy. No doubt it is related to the fact that platinum is a heavy atom with a lot of electron density ripe for scattering. Platinum ligated to DNA during irradiation is a bonus as well I suppose. Your own DNA as a ligand for platinum. A funny thought for someone in the catalyst business.

The first phase was the identification of a swollen lymph node and its subsequent removal from its cozy perch on my right carotid artery. Here I learned first hand why cancer is destructive. Mutant squamous cells from some molecular-genetic train wreck are washed away from their birthplace to lodge in distant locations. In my case, the aloof cells got hung up in a lymph node. There, they invaded the node and proliferated to the point where much of the lymphatic tissue became necrotic, likely from blood starvation. The node was not especially painful. Well, until the biopsy needle went in. Then it became very, very angry. But I digress.

The second phase, post surgery, was the adventure of finding suitable oncologists. This is a little bewildering. It is easy to get overwhelmed by information. I went for a second opinion and soon thereafter chose the Anschutz Cancer Center at the University of Colorado in Aurora. I’ve already had medical students and residents sitting in on consultations and exams.  The medical oncologist is a research professor specializing in head and neck cancer. He sees patients on Fridays too. The radiation oncologist sees a lot of HNSCC and seems knowledgeable and confident.

More to follow.

A month ago I went in for some surgery to have an enlarged lymph node removed from my neck. During the procedure a pathologist examined the excised node and determined it had cancerous squamous cells in it. So, the dissection was expanded and the ENT surgeon removed 32 more lymph nodes, all of which were clean. The lymph node was a secondary tumor with an occult primary. Thus begins my journey to find the primary.

Being new to the cancer industry, I have been trying to find a high point above the thicket to get my bearings. Here are a some early observations from down the rabbit hole.

  • The cancer industry is spread over the landscape in many forms, all boasting of individual care and of powerful means of treatment.
  • Cancer treatment seems to be partitioned into three domains- surgery, radiation oncology and “medical” oncology, meaning medicinal treatment. These domains are further subdivided into groupings that specialize in particular body parts or particular modalities of irradiation.
  • An oncology department can consist of as few as a couple of docs and several PA’s or nuclear medicine techs.
  • An oncology department can be rather large at a university hospital with docs serving in the role of professor, researcher, and clinician.
  • If you have a hammer, everything looks like a nail. There seems to be a little of this inclination in medicine. This is understandable. Clinic payroll has to be met and the payment on the CT scanner has to go out.
  • There is no “undo” button for a large radiation dose. The option menu is restricted for previously irradiated tissue.
  • It is important for the pathologist to determine if the squamous cell cancer is of the HPV type or not. The outcomes may be different.
  • “Cure” means 5 years of survival.
  • CT scans are used to position the patient in the irradiation device in order to aid in precise dosing of the desired tissues.
  • CT scans are superimposed over 18F PET scans to correlate metabolic hotspots with the affected anatomy. Expect a lot of CT scans.

Minutes after the PET scan was collected I walked out to the car and switched on my Geiger counter. I was hotter than blazes. Realize that with the penetrating power of 0.511 MeV gammas and 2 gammas with reciprocal trajectories per 18F decay, the GM counter was understating the activity. I watched the decay rate taper off substantially after ~20 hours. The rad tech injected 15.4 millicuries of 18F glucose into my veins. A day later I was at approximately background by the GM counter.

A person with cancer has to consider that they have a disease that they must shop around to the cancer industry. There is no substitute for background information in this arena. If you indicate to the physician in the consult that you have some rudimentary knowledge, they may be more likely to avoid poor analogies and misleading or confusing expectations.

The first doc recommended 68 Gy of radiation to a suspected hotspot in my throat. She also recommended simultaneous chemo (cisplatin) to take advantage of some kind of synergistic effect.

I’m presently working on getting a second opinion on radiation and drugs. We’ll see what happens next.


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