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.


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!

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