Tuesday, July 15, 2008

Cancer's End-game

Multiple Myeloma destroys bone; it literally eats it away, usually starting with the lower spine. But the cancer itself is a disease of the blood, similar to leukemia. Since we start out with a lot of bone, the cancer may chew away on us for years before it's symptoms become obvious. After all, everyone complains of a sore back now & then.

Being a disease of the blood, myeloma is highly mobile. Soon after the cancerous cells appear, they begin to spread, attacking the bone at new sites, which explains the multiple part of its name. Once established and able to spread, there is no cure. On average, you've got about three years to get your house in order.

Although there is no cure, radiation and a number of drugs have proven effective in slowing myeloma's spread. If the bone damage has not been too severe such treatment may buy you some time. Unfortunately, once attacked by myeloma our skeletons can not mend themselves. Some drugs are able to strengthen the remaining bony structure but rarely to the extent needed for pain-free mobility.

As you know, this all pretty new to me; there may be factors I've completely overlooked. But it wouild appear that working out a careful strategy of treatment offers a strong probability we can stabilize the affliction sufficiently to buy the time needed to finish a favorite project or to wrap up our affairs.


I'm receiving radiation therapy at the local Cyberknife clinic, a neat little facility just minutes from our home where a computer-guided x-ray machine is used to kill the existing tumors a slice at a time. Doing so isolates the lesions and reduces the pain and no matter how you slice it, this story is really about the pain.

The location of the tumor(s) having been identified by prior x-ray and MRI scans, three dots of radio-opaque ink are tattooed on your belly allowing the system to realign itself with an accuracy of better than half a millimeter. The initial programming has defined the tumors as targets, determining the optimum amount of energy to deliver on each of three axies so as to limit the amount of damage to the healthy tissue. Hit the big red button and the system delivers its lethal barrage at the rate of several thousand hits per second, each precisely on target using feed-back from a separate x-ray camera to keep track of its progress.

The sessions, which are painless, take about fifteen minutes. They have scheduled one per day for the next couple of weeks with the option for a bit of sniper work toward the end.

At the same time, the physicians have been working out a chemical attack to compliment the radiation barrage. X-rays and other forms of imaging provides some of the feed-back needed to guide the chemical attack but the most useful information is derived from a series of vampire strikes to monitor the chemistry of my bloodstream. These procedures are slower than the dramatic strikes from the Cyberknifes linear accelerator but infinitely more subtle, capable (in theory) of tracking down a single cancerous cell.