Radioactivity, Diseased Royals and Salt Shakers - Diagnosis and prognosis

A lot of people have asked me how the diagnosis was made, and what the prognosis is. Two very good questions!

The diagnosis was a tricky one. I noticed a cervical (as in my neck, not female reproductive anatomy, I'm a man. Although it would have made for an interesting blog...) lymphadenopathy (glands). This is rather common. One can get it from a pharyngitis, an ingrown beard hair, a cut, many viruses, TB and of course cancer (whether primary or secondary). To differentiate one should look at the timeline and predisposing factors (such as immunocompromised patients). So if you develop a swollen gland, don't freak out! Keep an eye on it and discuss it with your doctor.

A short note on TB cervical lymphadenitis. It's also known as scrofula. Many moons ago it was a rather common condition to have. And by many moons ago I'm specifically referring to ye olde Europe. It used to be known as the King's Evil, as it was believed that one could become cured by the sovereign touch of a monarch. This of course led to many monarchs contracting the disease (as a result of poor hygiene practices and a lack of basic microbiological principles which came years after). It's thought that the royals used to wear those extravagant items of clothing with frills covering the neck to hide the touch of scrofula. How true this is, I'm not sure. If you're brave enough feel free to Google it.

Back to my story. My lymphadenopathy stuck around for a while. So I decided to have it investigated. I had an excision biopsy done (i.e. the cut a few lymph nodes out) and sent the samples to a pathology lab. Many tests were performed, looking for cancer, viruses, TB, signs of extraterrestrial life, etc. a few weeks ago which confirmed the diagnosis of Hodgkin Lymphoma.

We use something known as the Ann Arbor Classification to stage an,d in a way, prognosticate the cancer. For other cancers we use the Tumour Node Metastases (TNM) staging system. The Ann Arbor takes into account how many groups of lymph nodes are involved, whether it's above and/or below the diaphragm, and whether it involves other tissues such as liver, bone, etc. 

To help us get a better idea what's going on, I went for a PET CT scan. I'm going to get a little nerdy and technical here, please forgive me. A Positron Emission Tomography assisted Computerised Tomography scan was performed. A CT scan blasts you with gamma rays and, depending on the tissue type, will give you an image. The PET on the other hand involves being injected with a radioactive isotope of glucose, Fludeoxyglucose (18F). Highly metabolically active tissue, such as cancerous tissue, will gobble up this glucose like I would gobble up any free food in front of me. Once inside the cells the radioisotope starts to denature, releasing positrons, the vindictive twin of the electron. The positron then hits an electron and a process known as annihilation occurs in which, like magic, the two particles disappear and two gamma rays are shot out at 180 degrees of one another. The fancy machine then detects these gamma rays and plots it, in association with the CT image, to give a nice picture as to what is going on.

There are plenty of steps involved. No strenuous exercise 7 days before the scan, no exercise 48 hours before the scan and then a no carbs, high protein diet 24 hours before the scan (please let's not go into the banting diet here...). On the day you're not allowed to eat, just drink water. Once they've injected you, you lie in a dark room for an hour (how ominous). The actual scan takes about one hour (what a nice nap I had!). At no point does it hurt (except when they inject you) and you are radioactive for 6 - 8 hours after the procedure. I tried to use mind control (much to my wife's amusement) to move the salt shaker. It didn't work (yet). 

I'll have to have another PET CT scan midway through the chemotherapy to see the response to treatment. Salt shakers of the world beware!

There are other factors to take into account when prognosticating my cancer. Age, sex, certain blood results, the size of the nodes, etc. I won't go into too much detail, but my prognosis is great!

Next time I'll chat about the actual chemotherapy drugs, the side effects and the pharmacology.

#cancer

The big questions - "Who", "Why", "How" and of course, "Chicken or beef"

I suppose when one gets told the news that one has cancer (after which one can refer to oneself as "one"), many questions start to inundate the brain. From friends, family and your own self.

It's often not the questions that matter, nor the answers. Sometimes what matters is that you think of them and the way you think of these conundrums. (How's that for being philosophical?)

Let's have a look at some of the questions I've had to face...

"But isn't it that old people are supposed to get cancer?" - Firstly, that's slightly agist. Secondly, no. Unfortunately cancer can affect anyone at any age. The kind of cancer one may get may differ in different age groups (statistically speaking). No one is innately immune (if you've done 'Cancer and immunology' at university the pun was totally intended!).

"How do people get cancer?" - You're not going to like the answer - it's multifactorial and it depends. As a medical student I used to answer many questions with these words and, although it worked heavily in my favour (how can it not?), it doesn't help in practice, I'm afraid. Some cancers have a strong genetic link, others are associated with exposure to certain chemicals, viruses, and other factors. In most cases it's almost impossible to pinpoint the exact cause, but we can postulate as to what increases the risk. An example is the BRCA mutations associated with breast and ovarian cancer.

Be careful, though. Theories need to be rigorously put to the test before being accepted by the scientific community and one can generally trust these. Reading a post shared by your third cousin once removed about how cancer is associated with the orbit of Jupiter and how you can cure it by listening to "Rocket man", not so much...Or maybe I'm wrong, but I don't think I'll be using my iPod (people still have iPods, right?) instead of the chemo...

"Why do people get cancer?" - Ah, the inevitable existential-crisis-inducing question. Who knows. I suppose it depends on who you ask. It's rather tempting, and perhaps emotionally and psychologically fulfilling to believe that it happened for a reason. This can also be detrimental, for one can easily believe it is punishment for a previous dastardly deed (Remember that time at Billy's house? With the fireworks? Boom.) My personal opinion/view: I don't think it happened for a reason. I think it just happened, as it could happen to anyone. I do, however, believe that one can attribute meaning to it, if you choose. This is, in part, why I've decided to write this blog.

"Chicken or beef?" - I fly up from Pietermaritzburg regularly to get my chemo in Johannesburg (it's easier as a very large part of my support structure is situated in Gauteng). This naturally means that I get asked this question fairly often. There's no real contest here. I always go with beef. I'm too worried about the possibility of salmonella in the chicken. 

On that raw note (enter sarcastic laugh here.), until next time!

#Cancer

The dreaded C word - no, not Cornish Pies

For the record - don't let the title fool you, I quite enjoy cornish pies.

Now that I have that off my chest, let's get down to business. Cancer is a scary word. People are very frightened to utter it, almost as though they would summon Voldemort (uh, I mean he who must not be named). I noticed this when I was first diagnosed. 

When people found out, they kinda beat about the bush. People would say things like "I'm so sorry to hear about your...uhm...uh... illness" or "What terrible news! What a terrible...condition" and "I hear you have a...growth". The problem I have with this is that it makes it sound as though I have some venereal disease. I have cancer. I promise it's okay to say that. I won't get offended, I won't be upset, I won't spontaneously combust (theoretically). 

The stigma around cancer is quite pertinent. Let's talk about it, and let's use the word. People are comfortable using other words that make us all feel uncomfortable...  "Moist", "English Football", "Selfie"... So why not cancer?

So what is cancer? Apart form being something people associate socially with as a result of the arbitrary position of the stars at the time of their birth (yeah, I don't believe in that sort of thing, either), it is a collective term for a group of conditions associated with aberrant, rogue cells. 

Not all cancers are the same, though. Sometimes it's quite obvious (like the guy from down the road with the 3rd arm growing from his forehead), whilst other instances are rather subtle (such as leukaemias). 

Either way, it is thought that all cancers have a genetic component, meaning that the DNA (the stuff that makes us who we are) in a cell (or sometimes cells) changes (mutates) and becomes foreign. It happens all the time. Mistakes are made as our cells do their everyday job of dividing, making proteins, keeping us alive. The great thing is that there are mechanisms in place and once a mistake is picked up, our body sends that cell to the gallows. A problem arises when the mistake is in the part of the DNA that is meant to detect the mistakes, or the parts playing executioner. That's when things go a little awry. 

These mutations are not always a bad thing, per se. It may give rise to brand new species, or the Hulk. Before you get too excited, no, I didn't get any super powers (yet).

The cell with the dodgy DNA now divides and goes along happily, collecting mutations as it continues on its rampant path. These cancer cells now start to have the various effect, either by it's shear size (guy with the arm sprouting from his forehead), or subtly outnumbering normal functioning cells (leukaemias) or manufacturing faulty products (sometimes leading to something we call paraneoplastic phenomena) all giving rise to the symptoms we may experience.

I suppose it would be fit to share what I have. I have Hodgkin lymphoma, a cancer in my lymph tissue.

In the next post we'll dealve into the philosophical aspects of cancer.

I hope this post makes it a little easier to understand.

#Cancer

Doctors get Cancer too - What this blog is all about

Welcome to my blog, Hashtag Cancer! Some of you might have read my other blog, The Unofficial GEMP Guide and have grown accustomed to my style of writing. Some people even enjoy it!

So what's the point of this blog then? Well, I've been diagnosed with cancer (shock and horror!). Although this is a very personal challenge, I would like to share my experiences with others - from the viewpoint of a doctor with cancer.

This came about as I was sitting in the waiting room of the radiology department, waiting for my PET scan results. A wonderful lady sat across from me, visibly distressed. She commented on how "chilled" I look. I explained that I am a doctor, and that I too have fallen prey to the dreaded Crab (Latin Cancer, from the Greek word Cancinos, meaning Crab/crayfish). I sat and explained all the difficult jargon to her and she became, quite evidently, calm. This was repeated with another lady, just 15 minutes later. I then realised that I have the rare opportunity to help people with cancer, and people who know other people with cancer, and people who know people who know other people who have heard the word cancer before.

So here we are. I'm not yet certain where this blog will take us, but I look forward to sharing the journey with you.

I must stress that I am in no way a cancer expert and had to go through my textbooks to understand many of the things happening to me. I'm writing this from a personal point of view, describing my experiences - the psychology, the biology, the pharmacology, the humour and the eventual conquering of the Crab.

I will use many medical words, but will do what I can to explain what it all means, as we learn together. I use humour quite often. It's my personal coping mechanism. Be that as it may, please know that I am well aware of the seriousness, the dread, the heartbreak that cancer causes, and has caused for many of us. The lighthearted undertone that the posts may take is by no means meant to offend anyone, or detract from the heavy burden cancer may cause.

On that...cheerful note, I would like to welcome you to my world! I hope you enjoy your stay.

P.s. I hardly advocate the use of hashtags. I still think of the # (you just said hashtag in your head, didn't you?) as the pound sign - but it certainly makes for a pretty neat blog title!