Friday, March 28, 2008

Explanation of Oral Cancer Treatments

There has been a lot of question as to what exactly the treatments will entail. Most of you want to know the specifics of the treatments involved. So I will tell you to the best of my own understanding.

First off the Chemotherapy drug being used is called Erbitux. This drug is used for not only head and neck cancers but for colorectal cancer as well. It blocks the HER 1 pathway which is the pathway in the nucleus of the cancer cell that allows it to reproduce. There is a receptor on the outside of the cell that sends a message t0 the inside of the nucleus to reproduce. Erbitux often misspelled as herbatux blocks that message hence the cell can not reproduce. This has come a long way from the old ways of fighting it with the DNA approach.

Along with erbitux they also give two premeds. Diphenhydramine ( benadryl) and Dexamethasone ( a Steroid). The Benadryl is given because in the midwest with a high pollen count they have has issues with mild to severe respiratory distress. This stops that from happening. The steroids help eleveate any anaphylactic reactions like hypersensitivity. Erbitux has proven very well in stopping the growth and reducing the tumor for sqamous cell carcinoma.

The common side effects of the erbitux are an acne-like rash, diarrhea and low levels of electrolytes (magnesium, calcium and potassium) have been reported. More commonly Magnesium. There is a host of other side effects but these are the most common. Ironically, it can cause hair to growth vs. hair loss. We shall see if it helps my male pattern baldness. ( THANKS to the gene I inherited! )

The drug has reported to have reduced squamous cells by one half or more by it self. VERY encouraging compared to others drugs used in the past. The treatment takes about 1.5 - 2 hours and is administered once a week through a port in my chest.

As you can see, the titanium port is embedded into my chest and a plastic catheter that travels up my neck and into the Jugular Vein. This way, there is less chance for infection and there is no popping of veins due to sticking you too often and a whole mess of other complications are removed as well.

The second treatment is radiation. It takes so many rads to kill a squamous cell. For squamous cell it is 6000 rads. It is one of the highest rads for any cancers. It is one of the hardest cancer cells to kill. Breast Cancer only requires 2400 rads to kill it. And the list can go on. First the make a mask, kind of a fish net material that is made for your head to hold it still and in the same position every time. It will take 1-1.5 weeks to map it all out on the computer. The mask insures the same positioning once the beams have been programed to each target area. The radiation is started off slowly, peaked and then brought back down again. The Peak is 6000 rads. This will cause basically a burn on the outside and inside. Looks like a a bad sunburn on the outside. This is why it can make it hard to swallow during radiation treatments. The radiation takes 8 weeks to complete.

I started the chemotherapy today. It will continue until the radiation treatments are complete. After that I will get another pet scan about 2 months later or so to see if all the cancer was killed off. Then I will have that done on an annual basis for 5 years.


Wendy S. Harpham, MD said...

Dear John,

My mask from my 1992 round of minimantle XRT is now nailed to the wall in my closet. Quite the artsy wall hanging, it reminds me how far I've come.

If the techs say you can keep your mask after your XRT is completed, imagining potential uses for it might be something fun to distract you as you go through treatment.

With hope, Wendy