Wednesday, 28 September 2011

Scalp radiotherapy

H started a daily course of radiotherapy early last week on the tumour on top of her head.  I went along for the first session and was allowed in the room until just before they turned the machine on.  This one is less technological: there's nothing sophisticated worth doing, they're just irradiating a circle centred on the tumour.

H will have a break for a few days now to avoid interaction with tomorrow's chemotherapy, then more radiation next week.  The end result will be that the tumour will, we hope, stop growing and eventually shrink, and that H will have a bald patch around it.  This is worth it because there's a danger that the tumour would ulcerate - break through the skin - if left untreated.

We looked at getting an intralace wig, which seems like a good option if you've got a bald patch with sufficient hair around it.  But there's not much point if H is going to have to switch chemotherapy soon to something that makes her bald.


We had a meeting with H's consultant today: for the first time H asked about her prognosis.  She asked because we've been planning some home improvements and H is thinking about how the building timetable might interact with her disease timetable.

The consultant was willing to be frank, but not specific.  She says that she thinks over the next two or three months Caelyx will become less effective in inhibiting progression.  In due course she'll switch H onto Paclitaxel. And when that stops working, she'll try Pazopanib.  At some point nothing will work.

Meanwhile the consultant thinks it better to treat H with as much Caelyx as she can tolerate than to ease up for surgery on the lung metastasis.  Additionally the surgeon she consulted is concerned that there may be adhesions resulting from radiotherapy that would make it more difficult to remove the tumour.  Radiofrequency ablation is another option, but again the consultant would prefer not to risk delaying chemotherapy.  Her recommendation is that we not worry about the lung met for now: she's more concerned about suppressing further metastases.

Meanwhile, H thinks the injection she had to her neck has improved her arm a bit, but not as much as she'd like.  She wants the neurosurgeon to give further consideration to microdiscectomy.

H talked to her GP about her sore toenail.  He's willing to cut some of it off, but concerned that it may take months to heal.

My guess is that she'll accept her consultant's treatment recommendation.  And leave her toe alone.  And we'll go ahead with the building work.

Thursday, 8 September 2011

Six months

It's six months since diagnosis.  H has got neuropathic pain in her left arm, like bad pins and needles, occasional stabbing back pain when she runs, a sore toenail, and assorted cuts and bruises that heal slowly.  And she's recovering from a cold.

On Monday she had a PET scan.  There was good news: the tumours in her vertebrae are showing no activity: apparently the radiotherapy has stopped them for the time being.  So the fear that she will be paralysed by spinal cord compression has receded.  She has one active tumour in her lung, and two on her scalp - one very obvious one on top of her head, and a smaller lump on the side of her head.

It should be possible to stop these lumps growing too with some sort of radiotherapy: H is considering the technological options.  Treating the lung tumour will cause some collateral lung damage, and treating the scalp tumour will leave bald patches.  We're looking into ways to conceal them.

If all the significant tumours can be stopped, H can go on less frequent chemotherapy, allowing her general health to improve.  She had chemotherapy today, and will have more in 3 and 6 weeks if her platelet and neutrophil counts hold up.  Then we'll think again.

Regarding the symptoms I mentioned at the start.  The neuropathic pain can plausibly be attributed to some combination of radiation myelopathy, which should improve with time, and a bulging cervical disc unrelated to the cancer.  H may have a nerve injection to reduce the discomfort.   The stabbing pain in her back may be caused by a bare rib-end where the bone has been eaten away.  And she may take her somewhat ingrowing toe-nail to her GP.  So it's all minor, albeit unpleasant to live with.

Overall, things now look much better than we expected they would.  There's no prospect of a cure, but there is some time.