Thursday, April 16, 2015

Meeting the Chemo Oncologists for the first time

March 31st ~~~ From my written journal.

Today we meet with Oncology.  We are ushered into a room with a Dr. R.  He has a foreign last name and Rich made a comment about it.  He wrinkles his nose in disgust.

We are called into the room and a very good looking Dr R. greets us.  Yes he is not white, but he is an immigrant doctor with nearly perfect English.  His manner is laid back and his tone is quiet.

Rich asks if I can use our digital recorder to record this meeting. 
Dr. R. says of course, he wishes more of his patients would do that.  It is helpful when you are not sure what was said, he explains.  Our first meeting is full of so much information it is hard to process it all.

We proceed.
Rich has Cancer.  

As I type this I'm not sure if I should give cancer a captial 'C' or not.  If I do, I feel I am making the cancer more important or powerful.  I'm not going to capitalize it.  I hate IT.  See there I did it again in a way.

The cancer is called Squamous Cell Carcinoma with left Tonsil involvement.  I don't know how much involvement and the doctor doesn't go into that.

He tells us that the cancer is HPV-16.  The 'good' news is that this type of cancer responds very well to radiation if treated at the same time with chemotherapy.

Cancer that comes from a virus that is in the human body.  In some people it simply never does a thing.  It just exists.  

In others it shows up as...the doctor glances at me and says "As Cervical Cancer."  

I am familiar with that virus, it had been all over the news a few years ago.  A vaccine had been produced for it to be given to kids around the age of 12 before they become sexually active.

Dr. R. goes on to explain that this virus is now showing up in other cancers.  He motions at Rich and says this HPV-16 has shown up as a marker in his cancer.  Rich asks what a marker is and Dr. R. carefully explains how they took his biopsy tissue and stained it for different things and one stain showed this 'marker'.

I sit back and am impressed this doctor is being careful and explaining everything.  He apologizes and says he has to answer a page.  He asks that we think of what he said and when he returns he will try to answer any questions that we may think of.

I talk to Rich and he asks me when are they going to call it a Stage?  What was staging?  I tell him I think it is something they will do after he has a PET scan.

Dr. R. comes back in to see us and apologizes.  Rich asks about the PET scan and Dr. R. tells him that Staging is something that is discovered by the PET scan.  He will be injected with some 'sugar' solution that will excite any cancer cells in his body and make them glow brightly on the scan.

The scan will be from his head to below his groin.  Rich is surprised. 

"It is only in my neck, why the rest of me?" 

Rich is a bit agitated now.  He insists it is only in his neck and that is what ENT told him.  

Dr. R. calmly answers his question by explaining that to do a thorough exam, they must make sure that the cancer has not spread.

At that point another doctor comes in, he introduces himself and picks things up from there.  

He explains that yes, the cancer is in Rich's throat and tonsil, possibly the lymph node which is swollen.  And they have to make sure the cancer has not traveled to other portions of his body.  

That could make a difference in treatment.

Rich shakes his head and states quietly, "If there is cancer other places, I won't have treatment."

Both doctors nod at this and the new doctor sits back.  

"Mr. Ewing, we cannot cure cancer, we simply can't.  But we can give you a longer life with treatment.  Non treatment is your option of course.  But let's have the PET scan and then we can review our options."

He then asks Dr. R. if he'd discussed the 'feeding tube' with Rich.  I shudder, as I'd read the literature on throat cancer.

"Feeding Tube?" he asks.

"A feeding tube will be possibly be needed and it will be inserted into your stomach.  Radiation to the throat sometimes makes it impossible to eat and we need to feed you nutrients in order to keep your strength up."

  [I think, to keep you alive too...]

Rich's eyes widen and he nods.  I think we've suddenly lost him in a way with too much information overload.  The cancer word is now looming in his head with a Capital C.  Cancer.

Both Rich and I have had this discussion before.  It is an easy one to have when you do not have cancer. we don't want treatment, no long prolonged suffering from chemo and radiation.

I see now that depending on the type and location of cancer, treatment can be helpful.  Yet the long difficult painful treatment looms in front of us and it is scary.

Now the clock seems ticking down towards the next big appointment.  The PET scan.  It will tell us more information.  I fear it and want to find out at the same time.  Rich wants to find out.  But he has to come back and see Dr. D., the dentist to have two teeth pulled.

Apparently PET scan or not, it sounds like the doctors had decided that the radiation treatment will affect his mouth and questionable teeth must be pulled.

Our drive home is mostly quiet.  We stop and eat.  It is another beautiful Spring day but it seems we aren't enjoying it at all.


  1. I remember these talks...........but not what was said............because "cancer" just kept bouncing in my head.

    1. I have depended on a cheap digital recorder for nearly all of our meetings...If I hadn't had it, I would have remembered a word.