Advances in Cancer Treatment

I am in awe of the changes in cancer treatment that have occurred since I was first diagnosed with prostate cancer in 1998.. At that time, I had three options: (1) Surgery (the "gold standard'); (2) radioactive seeds; and (3) watchful waiting. Now, surgery, in most cases, is the last choice.

In 2003 when I was first diagnosed with melanoma, I had four choices: (1) Surgery; (2) radiation; (3) chemotherapy; and (4) watchful waiting. Surgery meant whacking out cancerous body parts, when necessary replacing critical parts, if available.

Chemotherapy consisted of injections of various and sundry combinations of highly toxic chemicals which killed cells, both mutated and normal, with the hope that with the correct dosage, you wouldn't die from the treatment before the normal cells had time to regenerate.

Radiation was, similarly, a shotgun approach - fire a beam through the tumor to kill it and every other cell in the beam path before and after the targeted tumor.

Now, in August 2009, I still have the same four choices at the macro level: (1) Surgery; (2) radiation; (3) chemotherapy; and (4) watchful waiting, but a world of difference at the micro-level.

Surgical options now include minimally invasive procedures, for example, in 2007, when a lesion was found in my lung, I had it removed by Video Assisted Thoracic Surgery (VATS), procedure which require three 1" incisions for the insertion of a fiber optic connected video camera and two resection tools, used a bit like chopsticks, to remove the tumor. I was out of the hospital in three days and playing golf in less than 4 weeks. The surgeon had suggested a shortened back swing would probably help my golf game. In my case, the surgeon was physically present, but similar procedures, and even much more complicated ones, are now done routinely using robotic surgery during which the surgeon may be hundreds, even thousands of miles distant.

Radiation need no longer only be a through-and-through blast as from a shotgun. In my May 23 entry, I described my experience with Cyberknife, a way to deliver multiple low doses of radiation with very narrow beams intersecting at the tumor site. The dose level for each beam is so low that it is lethal to cells only at the point of intersection where all the beams, 270 in my case, converge to kill cancer cells with their cumulative effect.

If this is not enough, you can bring out the really big gun - proton beam therapy - which uses a particle accelerator, once called an "atom smasher," to fire an atomic particle (proton) at a tumor where it "explodes" releasing its energy to kill the tumor cells without affecting the surrounding tissue. Like Cyberknife, the entire process is computer-controlled and the proton delivery can be controlled in 3-D to the exact size and configuration of the targeted tumor.

Although not a treatment option, cancer care has been dramatically improved by the use of radiation for scanning for both diagnosis and during treatment to track progress. While X-rays are still used for two-dimensional imaging, computed axial tomography (CAT or CT scans), Positron emission tomography (PET scans), and magnetic resonance imaging (MRI scans) offer 3-D images in great detail. Although similar in concept, each has its strengths , and in some instances are used sequentially for greater resolution or in different areas of the body. For example, a brain scan is usually done with MRI. Scans may be done with or without "contrasts," which are injected or swallowed fluids which include a dye, radio-opaque substance, or radioactive tracer used to improve the tumor image.

I've had them all multiple times and can attest to the fact that they are not invasive or painful. Yes, there may be discomfort from lying still for 30 or 40 minutes or from an MRI's loud thumping (ask for earplugs if they are not offered), or the threat of mild claustrophobia from the tight quarters of the short tunnel through which you slide during the process. My strategy is to ask how long will the process take, figure out how many seconds it will be, close my eyes, and start counting breaths. If I don't fall asleep, which usually happens, my count never reaches the estimated number of seconds before the process ends, so the end comes as a pleasant surprise.

The advances in Chemotherapy are so numerous that they warrant a post of their own. That's next.