I’ve had a few conversations recently where people have sheepishly revealed to me “I don’t really know what chemo actually IS” — and I’m fairly certain NO-ONE understands what radiotherapy is or how it works (including me).
So today, pals, I am going to tell you about treatment.
Poison and lasers (kinda) is how I tend to flippantly describe my current treatment plan.
My doctors have decided to use radiotherapy (or radiation treatment) first up, as a neoadjuvant treatment on the cancer (that means that the purpose isn’t to rid my body of cancer with this lot of treatment— I wish! — but to shrink the primary tumour so it is easier to remove through surgery). At the same time, I am taking a course of oral chemotherapy (as an adjuvant therapy — meaning it is intended as an additional booster therapy to help reach the main goal). The chemo pills will help the radiation do the job it needs to do: shrink Chunt Gudley, so my super cool surgeon can evict him.
Radiation is the lasers (kinda) part of poison and lasers (kinda). The radiation therapy I’m having — external beam radiation — uses intensely focused, high energy radiation beams specifically aimed at the location of the cancer to attack cancer cells that are dividing and DESTROYYYY THEM. There are no actual lasers; the electron beam is entirely invisible, devoid of heat, light, bells or whistles, so it literally feels like NOTHING IS HAPPENING while you lie there on the machine for your allotted minutes a day.
A lovely nurse showed me scans of my own body last week to explain to me how radiotherapy dosimetry works. There was my pelvis, in black and white, with a bullseye of rainbow lines blossoming outward from the centre. An inner circle represented the “target” zone, containing the tumour, which should receive the highest percentage of radiation. Around it, circled in red, was the outer buffer zone, the area that would receive a slightly less potent dose. Various different coloured rings represented different percentage doses of radiation received by each bit. The nurse showed me the importance of drinking the daily 500mls of water before each zapping appointment: it inflates my bladder and “lifts” it outside of one of the crooked concentric circles of the target dose area. If I don’t drink the water, my bladder drops into the red zone, getting a hefty dose of radiation every day.
And that would not be ideal, since the side effects that come from radiation stem not from how it blasts the cancer cells, but how normal healthy cells are unfortunate collateral damage (luckily the normal cells can heal, while the cancer bastards can’t). The major side effect is fatigue while the normal cells start to heal themselves from the zaps; I’m already needing to take pretty decent naps every day when I get home from treatment (it hits that fast — within an hour or so I can’t keep my eyes open). Radiation is cumulative; the effects build up in the body over time, so the side effects are expected to really start sometime round week 2 or 3 and peak 2–3 weeks after my treatment finishes. I can apparently look forward to (hopefully mild) radiation burns (!) on my bits. Like, whoa.
Chemotherapy (what my mother affectionately calls poison) is simply treating cancer with chemicals. Chemo drugs are called cytotoxic drugs — they’re chemicals that are used to kill cancer, by targeting cancer cells and disrupting how they divide and multiply. The aim of chemotherapy is to do the most damage to the cancer cells while doing the least damage to the normal healthy cells of the patient — but as many people are aware from chemo’s depiction in pop culture, chemotherapy tends to go hand in hand with a slew of not so pleasant side effects that make some people say the treatment is worse than the disease at times.
Chemotherapy is usually administered as a combo of two or more drugs, usually through an IV drip (which is called an infusion) at the hospital in the day ward. This is what most people think of when they think chemo, along with the common side effects: vomiting and hair loss.
I’m only on one drug — Capecitabine — which I get to take at home 5 days a week as tablets (I get weekends off, which is awesome). It’s a relatively well tolerated drug, I’m told, and I’m on a pretty low dose too (though 3300 mg a day doesn’t really sound it) so it’s not really knocking me around too much. I won’t lose my hair — I actually just had a haircut because my hair is growing like weeds; I’m (thankfully) not puking up a storm — just a bit queasy, like when you eat too many lollies and regret it. The worst side effect so far is that it has done something to my tastebuds so that water — plain old, tasteless water — tastes like metal.
The big risk with chemo is that it is a systemic treatment: unlike radiotherapy which is targeted to a specific area, chemo gets in your bloodstream and affects your entire body. I have to have regular meetings with my oncologists to monitor my bloods because chemo can affect things like platelets (making you prone to either bleeding and bruising), and lessen the number of white blood cells (making your immune system more prone to infection).
But, so far, so good, pals! I’m on Week Two of my 5 week treatment — 20% done already!