Tag Archives: IMRT

Cancer #4 for My Tumor Collection

Leave a reply

I’ve found that one of the best ways to think is to write. Writing is thinking. This is why I sink so much time into writing this damned blog: To think my way through questions. It seems to work, though my conclusions aren’t always right.

=================================================================

To date I have been diagnosed with basil cell cancer, two squamous cell cancers and prostate cancer. What I have learned is what others have said all along- cancer is often a long-term affliction rather than an immediate death sentence. I’m in remission 4 times over.

Most of the time it is hard to appreciate simple and routine activity. The pertinent example here is how, during the process of chewing and swallowing food, we shift food around in our mouths with our tongues and use other musculature we are ordinarily unaware of. This is true for solid food and liquids. Highly automatic activity that we rarely think about. Then one fine day we can lose much of our ability to chew and swallow. I recently had that fine day.

Aspects of chewing and swallowing are two parts of our anatomy rarely considered: The epiglottis and the uvula. Radiation has damaged a swath of tissues and neck surgery has disrupted nerves that control of these two throaty bits of tissue. In 2013 I had a cumulative radiation dose of about 50 Gray to my neck in 1.8 Gray doses over 4 weeks. The Gray is a unit equal to 1.0 Joule of energy absorbed in 1.0 kilogram of tissue. Your onco-doc will prescribe a daily and cumulative dosage to a specific 3-dimensional section of tissue. The damage to tissue that radiation produces is grossly similar to sunburn (which is also radiation damage), but to the entire volume the beam passes through.

A digression into radiation

The clever machine that delivers the therapeutic x-radiation is called an IMRT- Intensity Modulated Radiation Therapy. It has an electron accelerator that slams high speed electrons into an angled copper target which causes the electrons to abruptly lose energy in the form of x-radiation. Prior to every treatment the tattoos on the patient are aligned with external laser beams and then an x-ray CT scanner mounted on the IMRT rotates around the patient lying on an adjustable table. This is to assure that the patient is properly placed for the IMRT to dose the desired volume yet limit the radiation dose to surrounding tissue.

What is the difference between x-radiation and gamma radiation? Gamma photons are much higher in energy and are ejected by the atomic nucleus. When the nucleus undergoes a transition from a higher energy state to a lower energy state, the conserved energy is ejected as a gamma photon. Often time when a nucleus undergoes a nuclear transition by particle emission or fission of the nucleus, the remaining nucleus is not at the lowest energy level possible and is metastable. Over time the nucleus can drop to the ground state energy, emitting a gamma photon. The gamma emission can be prompt or not.

X-rays result from an inner orbital electron being ejected by collisions with impinging outside electrons to leave a partially empty low energy orbital which is immediately refilled by upper level, higher energy electrons dropping to a lower energy orbital and conserving the energy change by emission of what we call an x-ray. There does not seem to be a sharp energy dividing line between x-rays and gamma rays.

The latest tumor

If you knew me anytime before September of this year, you’ll note that I spoke normally, absent slurs or other speech impediments. Today I speak with a distinct slur when attempting to speak certain sounds like s, ch, sh and words. I am as yet unable to lick my lips or stick out my tongue. You know that smacking sound you make while giving a short kiss? That’s gone too.

In August 2025 I was diagnosed with having a tumor on the left side of my tongue. Two years earlier what was to become a tumor was just a dysplasia and it was removed surgically. In September of this year, I had the tumor removed as a slice off the side of my tongue the width and thickness of a dime during a partial glossectomy procedure.

Another brief digression

In our college library during grad school, I would check the book carts to see if the book I sought hadn’t been shelved yet. One day while perusing the book cart I found a medical school text on maxillofacial surgery (1960’s). Being a curious person, I picked it up and thumbed through it. I was shocked and sickened to the point of hurling by what I saw. For the first time ever I had to run immediately to the restroom to vomit. Never again did I look into this topic.

The maxillofacial textbook detailed surgical techniques, the results of large-scale removal of large facial sections and underlying bone structures, and facial protheses. This often-left gaping, gruesome holes in the faces of patients, revealing parts of the anatomy never meant to be on display.

Circling back

So, imagine my dismay when, in 2013, I was diagnosed with stage 4 throat cancer. Then again 2 months ago I had another squamous cell tumor pop up on my tongue. Images of the maxillofacial textbook came back afresh. The throat cancer was HPV-induced and highly treatable but the tongue cancer was not, so they were not considered to be related.

My guess is that, of the 4 different cancers I have, the cancer that sends me into the crematory will likely be the stage 4 prostate cancer. My quest to remain above the grass will be at an end.

From all of this I have learned that swallowing difficulties with food inhalation can lead to pneumonia. My pneumonia wasn’t horrible, but it kills a lot of senior citizens. It’s been called something like the “the old man’s friend” since it can sometimes lead to a softer death.

The immediate effect that a cancer diagnosis has on most folks is to believe that you’re a dead-person-walking. Sometimes true, but not always. I’m in remission 4 times over. I’m always amused when at the dentist they put a radiation shield over me to get a low dose dental x-ray. Big whoop. A dose of 20 Gray all at once is considered to be an LD50 dose. Since 2013 I’ve absorbed over 100 Gray between 3 separate x-ray therapy treatments, two PET scans, and multiple CT scans too numerous to mention.

One final paragraph. While taking chemotherapy in 2013 for throat cancer, I spent 6 sessions in the infusion ward with cisplatin dripping into my vein. My chemo experience never had an adverse effect on me. However, each visit there were women a few seats away with breast cancer, presumably, getting their chemo. Often they were moaning and vomiting in heartbreaking discomfort. It was a picture of what some unfortunate folks have to endure, and I felt guilty about the ease with which I was receiving chemo. So far, I have been very, very lucky.

And so it goes.

Adenocarcinoma Chronicles. After the Radiation.

3 Replies

Last week I finished 38 x-ray treatments on the Varian Linear Accelerator with IMRT for my prostate cancer. This device uses a variable leaf collimator for continuous dose adjustment as the beam rotates around the patient. Each treatment is preceded by a CT scan with a built in CT scanner mechanism on the accelerator. This is performed for purposes of alignment of the target area to the beam which rotates about a fixed axis, coincident with the center of the target.

Along with the 76 Gy of x-ray therapy is hormone ablation with Lupron. The standard treatment for advanced prostate cancer, Gleason 8 in my case, is hormone ablation and radiation therapy to the prostate.

Initially, the trick to impeding the growth of the cancer is to suppress testosterone which is needed for reproduction of the cancer cells. The pituitary controls the signaling for testosterone secretion from the testes.  The adrenal glands secrete a small amount of testosterone as well.  Lupron suppresses the signaling by the pituitary gland. This is effective for a period of time, perhaps as long as 24 to 36 months.

Eventually the cancer becomes resistant to this approach and enters the so-called refractory or castration resistant stage. In response to the lower testosterone titer in circulation the cancer cells produce more testosterone receptors, called AR for Androgen Receptor. The number of AR’s multiply by 3x to 5x, increasing the sensitivity of the cells to what little testosterone (or dihydrotestosterone) there may be in circulation.

Blocking the androgen receptors is an approach to treating castration resistant cancer, but it does have limitations. This will be explored in a later post.

An observation from a patient’s perspective. Insurance will generally not pay for off-label or experimental therapy. So unless the patient is self-insured, the treatment profile will follow the board approved protocols for a given diagnosis. This isn’t a bad thing, but often a medication or other treatment will show effectiveness in other applications.  While the doc has some discretion here, the insurance company may not approve payment. And, they may decline to pay months down the timeline when their internal review staff have had a look at it. They make their profits by declining services, not offering to pay for it.

Initially I had hoped for the possibility of participation in a treatment study if this disease went south, as it is likely to do. What I was told is that because I have had 2 cancers, throat and prostate, I am almost certainly disqualified from participation. This was disappointing but I understand the reason for it. Even so, I am barred from a Hail Mary pass down the road.

So, what now? Well, it is watchful waiting. While PSA numbers are given less importance in checkups for ordinary patients owing to the history of overtreatment, for a post-treatment Gleason 8 patient like myself, the PSA number is a direct indicator of disease progression. Once the disease becomes castration resistant, I  suppose that some kind of AR therapy is next. The docs have been evasive when asked. Apparently there are several paths available. But I suspect they would rather the patient focus on the present and not the damaged bridge miles ahead of the train. We’re all headed for that bridge, it’s just that some are further up the tracks.