Monday, 8/17 I saw the “Tumor Board” at the main offices in Los Angeles
One doctor talked with me quite a bit, and explained a lot about the disease, the testing and preparation needed for treatment, and the treatment itself. After a bunch of thoroughly undignified and painful examinations, the board conferred for a couple of hours, and recommended more testing and scanning in preparation for the expected 6-week course of radiation and chemotherapy.
I have to get a special dental checkup to see if any of my teeth would interfere with the radiation getting to the cancer cells. I also need a PET scan, much like a regular CT scan, but with radioactive dye (Glucose with Fluorine 18 attached to it) in my blood to show the shape and position of the cancer cells, and the healthy cells nearby. For the PET scan and all following radiation treatments, my head must be immobilized with a mask like these:
The radiation used will be photonic, either Gamma rays, or X-rays. They are forms of electromagnetic radiant energy, of much shorter wavelengths and higher energy than light. It will give me a sunburn (actually a radiation wound, different from a burn) on both sides of my neck, and my right jaw. My specific type of cancer is particularly susceptible to photon radiation, allowing them to spare more healthy tissue nearby, while still degrading the DNA of the cancer cells, thus interrupting their ability to reproduce or regenerate. They will use a linear accelerator to generate and direct the photon beam. The type of machine chosen is IMRT (Intensity Modulated Radiation Therapy) because it is the least messy and most accurate. It is the least damaging of the rotational methods. For the curious and technically oriented, more on types of radiation therapy:
The preparations will take a few weeks, so the scheduler said that my radiation treatments are not likely to begin any sooner than September 16th. In the meantime, I am learning as much as I can about my condition and treatment, and doing what I can in terms of nutrition and fitness to prepare. Dr. K made it clear that the goal is a cure, not just an improvement, and that we have a very good chance of obtaining that result. It will not be pleasant, but it is do-able, and I am confident I have a great team helping me, and a very good prognosis. Dr. K says that I will die of something other than this cancer, whenever the time does arrive. That is my plan.