It's funny how something so out of the ordinary, like chemo, can become routine. I even choose to sit in the same chair each time. I like the light from the window and I like being right next to the nurse's desk. As we met with Dr. Wallentine today, we discussed having some sort of scan in the middle of treatment. We decided that we would not do that. It would not change the treatment schedule either way, so why go to the expense? An MRI would only show the mass, not whether it was still active cancer or not. So we might see the mass being the same size and not know whether the cells were being killed or not. And that would cause me to worry! A PET scan would show active cancer, but at this point we know that the drugs are having an effect and we might as well wait till after the last treatment to make sure all the cancer is killed. So we will just keep doing what we are doing and let the drugs do their work.
Here is the beginning of my day,
And back at home at the end of the day!
This rest of this post is about cancer and chemo drugs and may be more than you want to know about chemo. But I have had lots of people ask me about it, so I thought I would share what Ken and I have learned over the last couple of months.
One of the best books we have read is "The Emperor of All Maladies" by Siddhartha Mukherjee. It is a history of cancer and treatments and it is a fascinating read. There are so many types of cancer and each one reacts differently to the various drugs out there. So the development of chemotherapy has really been a trial and error testing of the different drugs at different levels of dosage to find what might kill the cancer without killing the patient. Chemo treatment began in the US in the 1940's.
We have also asked many questions of my oncologist about my cancer and the treatment I am going through. One question we had was why there was no universal test to find cancer in people. The answer was that everyone has cancer cells in them. But not everyone has cancer cells that get triggered in some way to start growing out of control. So a universal test would actually show that everyone has cancer.
Here is a short explanation of cancer. Cancerous tumors are out-of-control cell division. Normal cells stop dividing when they come into contact with like cells, a mechanism know as contact inhibition. Cancerous cells lose this ability. They no longer have the normal checks and balances in place that control and limit cell division. All cells, whether normal or cancerous, go through a cycle: resting phase, active growing phase, then division.
The ability of chemotherapy to kill cancer cells depends on its ability to stop the cell division. Usually the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in the division phase. If the cells are not able to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. (That is why chemo works better on aggressive cancers.)
The scheduling of chemo treatment is based on the type of cells, the rate they divide and the time the given drug is likely to be effective. Some drugs kill during a specific part of the cell cycle and others kill no matter what the stage the cell is in.
The thing that makes chemo so hard on the body is that the drugs do not know the difference between the cancerous cells and the normal cells. Chemo will kill all cells that are rapidly dividing. The normal cells will grow back and be healthy but in the meantime the side effects occur. The normal cells most affected by chemo are the ones that grow the fastest in the body - blood cells, cells in the mouth, stomach and bowel, and the hair follicles. Thus you get the low blood counts, mouth sores, nausea, diarrhea or constipation, and hair loss.
The treatment regimen they use for my Aggressive Diffuse Large B Cell Non-Hodgkins Lymphoma is called by the acronym R-CHOP. Each letter stands for a different drug in the chemo treatment. The CHOP part of this particular mix has been around for quite awhile. The R part, rituximab is a newer drug and has dramatically increased the effectiveness of the treatment.
R
Rituximab was approved for use by the FDA in 1997, but it wasn't until about 2005 that it started to be used with the already existing CHOP treatment. Rituximab is a monoclonal antibody. These monoclonal antibodies (MAB's) are often called immunotherapy or targeted cancer therapy. The drug is made to bind to a specific type of cell. In this case it binds to a protein on the large B cell that makes up my tumor. In a normal situation, the body produces antibodies to kill germs or foreign cells in the body. But cancer cells trick the antibodies that we produce into thinking that they are normal cells. So this MAB locks onto the B cell and our body now can recognize that cell as being abnormal and the body's natural immune system can kill the cancer.
C
Cytoxan. Just the name sounds bad, doesn't it? Trials of this drug were done in the 1950's. It is derived from mustard gas (yes, like the gas they used in WW1. Yikes!) and is most active during the resting phase of the cell.
H
Hydroxyldaunorubicin (also named Doxorubicin or Adriamycin) Also called the Red Devil. This is another drug from the 1950's. This is injected from a syringe (as opposed to a drip bag) into the IV line over about a 10 minute time period. The nurse sits by my side and slowly pushes the drug into the line. This is the drug that can really cause mouth sores. I keep ice in my mouth during the injection because the cold slows down the blood circulation in my mouth and helps keep the mouth sores from being so bad. This drug is called an anti-tumor antibiotic and is derived from the soil fungus Streptomyces.
O
Oncovin or Vincristine was approved by the FDA in 1963 but had been used in folk remedies for centuries. It is also injected by syringe into the IV line, but it is a much smaller syringe than the one used for the Adriamycin and goes in much faster. It is a plant alkaloid from vinca or periwinkle, the pacific yew tree, the May Apple plant and the Asian "happy tree". It stops part of the cell's apparatus from dividing and replicating itself, which causes cell death. It can cause numbness and tingling of fingers and toes. ( I haven't had that side effect!)
P
Prednisone. The drug that makes it hard for me to sleep! I take 100 mg a day for 5 days following the chemo treatment. It works to decrease inflammation and the swelling around tumors. It also affects the metabolism of carbohydrates, protein and fats and helps maintain the balance of fluids and electrolytes. And it works as an anti-nausea drug.
So, there are my chemo drugs. There is one more drug in the arsenal to help with this fight. The day after chemo I am given a Neulasta shot (This stuff is like gold One injection is about $4800.) It is called a granulocyte colony-stimulating factor. What that does is stimulate the bone marrow to produce more neutrophils (white blood cells) to fight infection in patients undergoing chemotherapy. Since the chemo kills the blood cells that are in circulation, this shot helps get my blood counts back to more normal levels faster.
Things I am thankful for:
- Insurance! Each treatment with the Neulasta shot is about $17,000.
- Knowledge, and the people who write about chemo in a way that makes it understandable.
- Drugs. I know I have said this before, but I am so thankful that there is a way to treat this cancer. I appreciate the doctors and researchers for their efforts to find a cure for cancer. And the patients who were willing to test these drugs. They really suffered!
- Ken's constant support and the priesthood blessings he gives me.
- Our family! I love them all so much!!
- Having very few of the side effects of chemo (and it is a very long list for each drug).
