Oncologist
Wednesday I met with the radiation oncologist and the plain old oncologist. They explained what the plan was to treat my cancer. The plan was different than what I expected, but not excessively so.
The radonc wants to do a short course of radiation right away. This means 5 treatments over the course of 5 days. To do that, they first need to model my body and tumor a bit. So I'm scheduled to go in Friday AM and have that done.
The usual course of TNT treatment for rectal cancer is chemo then long course (4 weeks) radiation then more chemo, but Duke has to be different. The reason they're big on the short course up front is that 1) it seems to work, and 2) folks tend to do better at getting the whole chemo dose in if it isn't interrupted.
Once they get that done, there's about a week long process to get the plan in place so the correct radiation dose is sent to the right body tissue. With the dose and plan set, they run that dosing on the 5 million dollar machine, running the x-rays into some kind of crash test dummy. This serves to verify that the radiation program is aimed at the right spot, etc. Don't irradiate my lungs, please.
Once that's all validated, I go in for treatment. The radiation treatment only lasts for about 5 minutes, but the indignity of it should be lifelong. I'll be positioned ass-up on a table, with my butt cheeks spread apart with tape. I'm not sure of the rest of the details yet. It's nice to have something to look forward to.
So 5 days of radiation in a row, then a week of rest, then start on the chemo.
I got the choice of Xeloda (pills) or IV chemo. I've preliminarily picked the IV chemo. That means every 2 weeks I go in, get a 2 hour infusion of a searing neurotoxin called oxaliplatin, and then leave with a pump that jams in the rest of the chemo over 48 hours or so. I believe they want me to do that for 9 cycles, which adds up to 18 weeks. Then a short break, then surgery.
What we're hoping for (and this sometimes happens, but damn sure not all the time) is pCR - pathological complete response. That would mean that they do the surgery and send off the bits that are removed, and those bits appear to have no cancer.
You might think 'Well that would suck - Surgery for nothing'. And yes, some folks/doctors are willing to take a wait and see approach if the chemo and radiation is particularly effective. The problem is that without pulling out the chunk and slicing it up, you'll never really know if they got it all. Or the way that you find out is when the cancer re-appears - Maybe in the same spot, maybe elsewhere.
So pCR is the best case scenario. Even under the best case, I've still got 6 months of chemo treatments, plus 3+ months of surgical process ahead. Plus additional side effects, some of which will be long term or permanent. Also, 3 to 5 years of scanning just to make sure nothing else is cropping up. Best case.
Worst case, you're reading this sometime in 2024 trying to figure out when exactly everything went to shit. Not yet. Skip ahead.
I have not yet inquired on the odds of developing some form of superpower due to the radiation treatment. Bringing a spider 'just in case' would likely strain the relationship between patient and radiation oncologist.
I'm feeling OK physically. A bit stressed mentally, but still sane. They say people have good days and bad days, and that seems true. I'm not thinking only about cancer all the time - Still enjoy the challenges of my work, and the company of friends and family.
It is mildly reassuring to have a plan. Then again, Iron Mike Tyson once said 'Everyone has a plan until they get punched in the mouth'. Maybe give the radonc one free shot before we start, just to get it out of the way.
Thanks for all the well wishes, comments, etc. I won't respond to each one, but they are appreciated.
~Ed