The Preliminaries Part 1
I'm not quite sure what I thought would happen, but I didn't expect the wait over three weeks before I started my treatments to "cure cancer". Oughtn't this happen as soon as possible? Well, once you realise the complex set of tests and scans that need to occur before hand, even three weeks seems rather a short time. Let me begin...
The timeline to starting therapy is complicated; looking back I can see that it all makes sense, but at the times it was bewildering. For my particular oropharyngeal cancer (in the right tonsil), three treatments, and their combinations, were possible. Surgery, radiation therapy and chemotherapy. I must admit I was a bit excited when my ENT surgeon suggested that they may be able to do robotic surgery (transoral robotic surgery (TORS)) to remove cancerous tissue, depending on my final test results. But because the cancer has spread to too many lymph nodes, this was not possible. I swear he looked disappointed! So it was made clear that my remaining option was chemoradiation therapy (CRT), and that I would now be referred to the oncologist, who I am seeing at Barts Hospital.
The specific treatment I am having is called concurrent chemoradiation therapy (CCRT), which means that chemotherapy and radiation therapy are given at the same time. This approach is the preferred treatment for locally advanced oropharyngeal cancer. Specifically I will have daily doses of radiation (Monday - Friday) for 7 weeks, with concurrent weekly intravenous doses of cisplatin, every Thursday for 7 weeks. All this detail is important, as this is what sets the scene for the preliminaries that needed now to happen.
Fitting of the mask
The backbone of my treatment is through the use of radiotherapy. Radiotherapy will work by accurately targeting high-power radiation towards the tumour and cancerous lymph nodes. This radiation causes DNA to break up, but also triggers the formation of very damaging reactive molecules. So while healthy tissue becomes collateral damage, healthy tissue can at least repair itself, cancerous cells cannot, which is why they are eventually killed off.
For external radiotherapy to accurately hit the cancer in my tonsils and lymph nodes however, I must keep my head and shoulders *absolutely still*, and in the same place for every one of my 35 treatments. To do this, last week I had to go to Barts to have a mask specially fitted to my head and shoulders. A radiographer softened a sheet of meshed thermoplastic in a warm water bath, and then moulded this over my face and upper body until it cooled and became very tight fitting. So tight fitting that I have to be clean-shaven during fitting and subsequent treatments, and so tight fitting that I'm not able to open my eyelids 😳.
I was then taken to have a 'planning scan', where I had to wear the mask, before being injected with a special dye, and having a CT scan that will allow careful targeting of the radiation beams once treatment starts.
Radiation therapy to the head carries with it major risks to the jaw bone and dental health, which really worried me. Osteoradionecrosis, or bone death, of the jaw occurs when the small blood vessels in the jaw bone are destroyed by the radiation, so they are no longer able to help the bone to heal itself. Before radiotherapy takes place therefore, I had a check-up with a consultant dentist at Barts Dental Hospital, and a 360 degree x-ray scan of my mouth! Thankfully this showed that I needed no teeth to be extracted, and after a quick clean by a hygienist I was allowed to go home. However, radiation therapy may pose multiple problems for my oral hygiene in the future, through both osteoradionecrosis and reduction in saliva production, but more on that later.
In the next post I'll cover Pretreatments Part 2: a day of kidney function tests, speech therapy, and what I am least looking forward to, the fitting of a gastric tube 😭.
To sign off finally, it's a bit odd re-reading this post. It's quite descriptive and matter-of-fact. But that I think reflects my attitude to being diagnosed so far. I feel like I'm treading water a bit, just waiting for the treatment to start.