How bad can it get?

In these quiet days between having my mask fitted and starting treatment, there’s been a lot of time to think about the coming weeks. I’ve said that I’d let you know what I might go through. I’ve read some horrible stuff from previous cancer survivors – and I’ve read about some people who’ve just breezed through it all. So I’ve tried to put myself in everyone’s shoes. I can’t say I’m happy, but I can say – bring it on!

So where to start?

The head? What will I think? The heart? What will I feel? Or the body? How will it react?

I’ll start with the easiest. The body.

Part 1 of the treatment consists of two sessions of Chemotherapy. My brother-in-law, Kevan, came to visit last week and told me how interesting the chemo chemical was – I hadn’t given it any thought – he said he didn’t really know how it worked – so I thought I’d find out. My drug is Cisplatin.

Cisplatin is a simple, tiny, molecule. A square shape with two chloride ions at the top and two ammonia molecules at the bottom with the all-important platinum ion in the centre. I quote from a Royal Society for Chemistry lecture – “Platinum, like many heavy metals, is rather rare in the biosphere and as a result humans have not evolved to use it in our biochemistry, nor have we evolved any particular defence mechanisms against it. As a result, dosing yourself up on soluble forms of platinum results in some rather nasty toxic effects such as nausea and kidney damage (as the body tries to get rid of the stuff out of one end or the other), nerve damage and hearing loss.” In addition, there can be dizziness. For some, the nausea can be violent and can last for weeks. For others, the nerve damage can result in months of hiccups or cold feet or loss of taste or smell. The tongue can become very sensitive so much that it feels like it is burning, or it can become very insensitive so much that you can’t feel hot or cold food. Kidney damage isn’t obvious but it can also be accompanied by constipation – which is odd, you’d expect diarrhoea. For me, the greatest, probably my only fear is deafness – not being able to hear birds, music, traffic, whispers, sobs, laughter, streams, thunder, conversation, “You’ll never walk alone”, BigglesFM. “The point, of course, is that cisplatin also fights cancer, and while partial deafness and nausea are not nice, they don't kill you like cancer does. Moreover, medical research has some excellent ways of minimising side effects and maximising the effectiveness of small doses of the drug.” “So why is cisplatin so good at fighting cancer? When cisplatin gets into the body, its neutral overall charge means that it can cross the cell membrane. Once in a cell it becomes activated by the replacement of one of the chlorides by a water molecule. The chloride falls off because the concentration of chloride within a cell is much less than it is in the bloodstream. The water itself is, in turn, easily displaced by the basic nitrogen atoms on DNA, specifically on a guanine nucleobase. Once bound to DNA the second chloride ion is replaced by a guanine nitrogen atom from an adjacent DNA strand. 

The result is a platinum fragment cross-linking two DNA strands within the double helix. This cross-linking prevents the cell dividing by mitosis and so the tumour stops growing. The damaged DNA can be repaired in healthy cells by DNA repair enzymes, but in tumour cells the 'kink' induced by the platinum cross-link is not recognised and the DNA cannot be fixed. As a result the cell undergoes programmed cell suicide - apoptosis - and the tumour shrinks.” The stunning thing is that the size of the cisplatin molecule is exactly the size of the gap between the two helix strands of DNA.

There’s more at http://www.rsc.org/chemistryworld/podcast/CIIEcompounds/transcripts/cisplatin.asp

Part 2 consists of thirty sessions of Radiotherapy. For details and an understated view of side-effects see - http://www.canceractive.com/cancer-active-page-link.aspx?n=261

Nausea again.

Pain – from none (I don’t believe that) to almost unbearable leading to taking Fentanyl which is the only thing to control it. I’ve read that Fentanyl is only used on cancer patients. It kills children and animals. It is also highly addictive. The pain will mainly be inside the mouth, especially around the tonsil site, but also the neck – I’m apprehensive as my neck is still sore from the lymph node operation and the throat is still sore from the tonsil operation.
The tongue and gums can become ulcerated. Mean ulcers.
Oral thrush is common: Symptoms:  sore, white patches (plaques) in the mouth that can be wiped off. a painful, burning sensation on the tongue. an unpleasant taste in the mouth that can be bitter or salty. redness and soreness on the inside of the mouth and throat. cracks at the corners of the mouth (angular cheilitis). difficulty swallowing

Saliva as thick as wallpaper paste and as smelly as socks worn by sheep. Or NO saliva at all. Which is worse.

Tiredness. Can’t be bothered to open your eyes tiredness.

Skin reactions: From redness, to black or blueness, from mild irritation to blistering or suppuration. Sometimes severe enough to have to suspend the treatment.
Hair loss – bizarrely both from where radiation enters the body – the front of the neck – and from where it leaves the body – the back of the head. I’m told that I’ll not need to shave my neck, sideboards or cheeks ever again – just my moustache and chin.
Anaemia – the treatment upsets the number of red or white cells or the platelets in the blood (by stopping the bone-marrow from creating them – because, like cancer, they grow faster than anything else in the body except hair. At worst, blood transfusion(s) are needed. At best, Guiness is good for you.
Stiff joints and muscles.

Oh, and one more. Radiotherapy can cause cancer. But hardly ever. And not in me.

 The head. Well, in the first weeks I knew I had cancer (but not which type) I did my bucket list. Nothing grand. But that was a waste of time as I now know that I will survive this. So if I know I will survive this – and my medical team have confirmed this – then I will survive all of the symptoms above. My head says it’s only 6 weeks of treatment followed by two weeks of worsening symptoms – just like summer school holidays – it’ll pass quickly and when I look back it will be sunshine with a few grazed limbs.

The heart. Hmm. The heart says THANKS. For all of your support and especially to Row. My heart tells my head – Numpty – of course it will be OK. My heart breaks for everyone who is going through this – and especially for those who are on-lookers and carers. I can and do cry and then I feel better – you can and do cry and nothing has changed. Please, please, please. Know that I feed from your care and your belief in me and my ability to get through this and my faith in the people who have chosen to specialise in this medical arena.

Love to you all
Frank