Sharp Blue: Adventures in Oncology

One of the things I’ll be writing about here is my dad’s treatment for cancer. Five and a half years ago, he was diagnosed with renal cancer and shortly afterwards had a kidney removed. Between then and July 2002, there was no sign of cancer. Shortly after his five-year all-clear he started suffering from back pain and weakness in his legs. At the start of December last year, he was diagnosed with tumours in his back and brain. The oncologist decided to treat the tumour in his back with radiotherapy but didn’t know at that time whether surgery or radiation would be best for treating the brain tumour, which was only a couple of millimetres across.

The day after the diagnosis, I returned to my parents’ house in Bristol so he’d have someone to go to all of his oncology and radiology appointments with him. Before Christmas he had a course of four radiotherapy doses to the tumour in his back and several whole-body CT scans, which found two enlarged lymph nodes in his lung that might also be cancerous. Earlier this month, they decided against neurosurgery in favour of precision radiosurgery using a machine related to the more famous “gamma knife”.

Yesterday was the planning session for this radiosurgery. First, we had to go to the dental hospital so he could have dental impression taken and then the radiotherapy specialists fitted a head frame. The frame locks onto his teeth and is secured to the back and top of his head, and is used to anchor a coordinate system to both his head and the CT scanner and radiosurgery machines. With the frame fitted, they can measure the position of things inside his head to an accuracy of less than 0.1mm and position high-energy x-ray beams to about the same precision. After that, he spent the next three or four hours having head CT and MRI scans. (I never got the chance to ask why he needed both types of scans, but I know that CTs are good for showing bone and MRI for soft tissue.)

He also got to see his oncologist again. Last time, my mum insisted that my dad have an x-ray of his leg because he has quite a lot of pain there. The oncologist thought that it was probably pain caused by pressure on a nerve in his back, but the x-ray showed a small cancerous region there. This means he’ll have another batch of radiotherapy on that tumour too. On the positive side, the symptoms from the tumour in his back have much subsided and the oncologist thinks that we’ve probably dealt with that completely now. (It will take a month or two for all the pain from it to subside though.)

The machine used for precision radiotherapy in the Bristol Royal Infirmary isn’t quite the same as a gamma knife. Gamma knives use 201 cobalt-60 sources and a whole bunch of collimators to pass beams through the tumour. The BRI’s system uses an linac x-ray source that traverses several different arcs around the head, so that the beam always passes through the tumour but the surrounding tissues are only in the beam for a short period. To me, that sounds like an even better idea than using fixed beams. The side-effects are so mild that many people can resume their normal activities immediately after the treatment, but they keep people in hospital for a day or so for observation just to be sure.

Anyway, my dad will be going into hospital for an overnight stay on February 3. After that, he’ll have one to three weeks of radiotherapy to his leg. When all of that is out of the way, he’ll be on interferon for six months or a year, and that should be the end of his treatment. In about three months time he’ll have another batch of CT and MRI scans to see how effective the treatment has been, so there might be more courses of radiotherapy around then. I’ll keep you all posted with updates as I have more news.