The results are in. Then again, the results are continually coming in. But we are only talking about the results for a specific time on a specific day, ones we can verify. Things change, are changing. Just like it was 5:30 pm on Feb 7th when I started this and now it’s 5:33 pm. The results from the Jan 24th scan show significant “improvement” or significant reduction in both affected locations.
Today I had an appointment with surgeon, head/neck oncology specialist Dr. Adam Jacobson. He says, to be declared free of cancer, it takes at least five years (from first evidence that it’s gone after treatment). He and Dr. Rad are part of Beth Israel Medical Center Oncology Dept. They like to see their patients once per month after treatment for the first year, second year once every two months, third year once per quarter, fourth year every six months, and the fifth year, given that tests and scans during those years show positive results, then they declare the cancer beaten. Still, after year five, they highly recommend patients get checked yearly.
My recent CAT scan showed a clean base of tongue and a small lymph node in level three on the left side. In other words, the tumor appears to be gone and there is a small residual mass in the lymph node of the neck. Overall, good results (for that specific time period).
There was some confusion with Dr. Rad when I finished 33 straight days of radiation in November. At that time, he said that the radiation dial was set to full normal dosage thereby hopefully avoiding the need for brachytherapy and neck dissection surgery. He double checked during my appointment with him last week and determined that the base of tongue external beam radiation dial was not set at full dosage as the plan was always to do a follow up brachy “boost”. Oops.
Brachytherapy is not done in many parts of the country (or world) for base of tongue cancer. This type of radiation seed implant therapy is done much more frequently for prostate, breast and other types of easier to get to cancers. In fact, there are very few doctors trained in brachytherapy for head/neck.
The benefit of brachytherapy is that the external radiation dial can be turned down, thereby minimizing the damage done to organs by full dosage. And, by following slightly stepped-down external beam radiation with internal radiation placed at the tumor site, there is a better chance of eradicating the culprit cells for good. In other words, if the success rate for typical external beam radiation is 80%, adding brachytherapy increases the success rate to 97%.
The question becomes, would one who has (or had) neck cancer be willing to pay the price to go from 80% to joining the 97% crowd? Dr. Rad recommends it strongly. He is, in fact, one of the ones who has been trained and does several of these every month, and has had for several years. Dr. Rad’s name is Dr. Hu, who appeared on Good Morning America last year answering questions about M. Douglas and is shown a couple of minutes into the clip on the following link:
The thing is, brachytherapy involves surgery, and almost one week in the hospital. To implant the seeds, it takes feeding metal tubes under the chin which are wrapped around the back of the tongue and back out the chin. These tubes hold the radiation pellets which stay in for a day or two. To get that done, one needs a tracheostomy. Why? Because if the tongue gets swollen or bleeds, you need to be able to breath. And if going under general anesthesia, then it makes sense to also take out any lymph nodes that appear abnormal on the scan. That would be a neck dissection done at the same time to remove the affected (and perhaps some unaffected) lymph nodes. From paying-for-an-anesthesiologist point of view, and believe me they are expensive, it’s two for the price of one.
The lymph node could be clean and the base of tongue could be clean. But both doctors are highly recommending that I have the procedures done and answered that they would not hesitate having the procedures done themselves if they were in the same position. The success rate they say, is simply much higher and an insurance policy well worth the few weeks invested in getting sliced up coupled with recovery time.
Bottom line, I’ll be checking into the hospital early this Friday morning for three operations. First, the surgeon guy will be doing the neck dissection and taking out the nodes on the left side in level 2, 3 and 4. He’s got to make a slice of several inches to get at them. Then, he’ll be doing the tracheostomy. After he’s finished, Dr. Rad takes over and makes the holes, about 8-10 below the chin where the wire tubing gets woven through up and around the back of my tongue and back out again. While I’m asleep I believe they’ll insert a feeding tube up my nose and down to my stomach.
After all this I go to my room and wait for a couple of days until I’m accustomed to the trachea hole and can suck mucus out through a mirror. When I’m quite comfortable with that, and the lead-lined room is available, he then loads the radiation pellets and I stay in isolation for about two days. After that, the pellets come out, the tubes come out, (of the chin, neck and nose), and I can go home. Simple as that.
It would be easy to say to anyone young, don’t abuse smoking and drinking for this could cause a not so pleasant neck tumor. But how does one avoid HPV? It’s not simply a matter of abstaining from muff diving. The doctors I’ve talked with didn’t have the answer. In fact, the surgeon today as well as one of the other doctors in the team have told me prior, that they also may have HPV as this virus is so prevalent. It’s just a crap shoot.
I do know that for many years I’ve been fairly picky about what I eat and how I live, in terms of being very health conscious. Still, a virus can sneak in and stay a while. What could have birthed the tumor? Stress? Perhaps, but no one knows (yet). Or at least no one that is admitting they know.
Regardless, the results keep coming in. My neck is still a bit swollen and Dr. Rad, after scoping my throat last week, found a yeast infection–saying that it’s not uncommon due to the dryness. He gave me medication which may have cured it by now. Wouldn’t know without getting another camera shoved up my nose and down my throat. Point is, it’s now 7:00 pm on Feb 7th. It won’t be 7:00 pm on Feb 7th, 2011 ever again. It’s come and gone. A new second, minute, day, and result is here. Now it’s gone and new ones are here. The result tomorrow, Feb 8, is JK’s (my son’s) birthday.