Teleportation, Definitely (or All About My Radiation Treatment)

Back when I was a kid most superheroes got their powers from radiation, so if I had to pick a superpower I would take teleportation hands down.  I could visit family whenever I wanted, travel the world without lengthy plane rides, and never commute for more than an instant to any job.  Some might say that flying is better, because, after all, life is about the journey not the destination but I'm afraid of heights and I don't see that getting better just because I suddenly can't fall off and die.  

I joke about these things because it keeps me from doing the other thing my brain wants me to do: be angry about it.  Per my post yesterday, before seeing the doctor I had resolved to give myself vacation until I was done with all of the treatment for the cancer.  Then I met with the endocrinologist and he said "six more weeks" (in a not ground hoggish way at all).  For those of you who don't know me personally I will explain:  I do not Not Do.  I am a Doer.  We Do.  All the time.  Waiting until nearly September to be done with an ordeal that started in May makes me twitchy.  I am planning to stick to the resolution only because for the first time in 32 years I am realizing how important it is to put myself first, and that it means "taking care of myself" not "taking care of every little detail of my life without a gasp for breath in between."

Before I get in to the why of "six more weeks" let's step back and talk about why I'll be having radiation treatment. First, it turns out that some cancers respond better to radiation and some better to chemotherapy. If it's bad enough of a cancer, you do both.  These therapies are not used for treating primary cancer (e.g. the original site).  It is used for treating metastases (cancer that has traveled from the primary site).  In the case of papillary thyroid carcinoma, it happens that radiation is the best, and specifically i131 radioactive iodine.  Given that I am relatively young to have cancer, it means there are plenty of years of life left for cancer to recur so even though the cancer was only stage 1 and there was no visible tumor in the central lymph node, it doesn't mean that there isn't still cancer somewhere as apparently it had begun invasion of the lymphatic system so an errant cell could be hanging out some where, ready to spring up a new tumor.

The normal thyroid cells use iodine to create the hormones produced by the thyroid, and they are the only cells in the body that normally take up iodine (with one exception explained below), but it happens that papillary carcinoma of the thyroid will also take up iodine because it is a mutation of the normal thyroid cells.  This means that irradiated iodine can be used to fairly accurately target the cancer anywhere in the body with minimal risk to the surrounding organs.

The endocrinologist gave three reasons he was recommending the radiation treatment. First and most importantly it will kill any remaining cancer even on a microscopic level.  Second, it will kill any remaining normal thyroid cells in the body which will ensure that I no longer naturally produce a protein called thyroglobulin which is made by thyroid cells, but also by the thyroid cancer.  This is important because thyroglobulin assays are an extremely sensitive predictor of recurrence so they will be able to say that I am cured..  Lastly, about a week after taking the treatment I'll be able to have a special type of imaging done that will show whether there is any cancer anywhere else.  These three things combined is what gives this treatment plan (surgery + radiation) such an amazingly high success rate for my type of cancer.

Unfortunately, as much as I would have liked to have downed that radioactive iodine today (words one thinks they will never utter), there is some preparation involved.  This is where that six weeks comes in.  In order to ensure that all of the cancer cells gobble up the radioactive iodine, first I have to do everything I can to make sure those cells are starving for it.  The day I met the surgeon for the first time he had me do a CT scan with radioactive contrast that contained iodine, a whole lot of it.  Even though it's already been a few weeks, it takes some time for these things to pass so it is the reasons I have to wait until mid-August to begin.

In addition here's the treatment plan the endocrinologist has laid out for me:

1. Today: Change from the short acting thyroid medication to a longer acting thyroid hormone replacement.  The brain normally produces Thyroid Stimulating Hormone (TSH) when thyroid hormone levels are low, but TSH is also stimulates cancer growth so they will make me slightly hyperthyroid with this medication in order to prevent the release of TSH.  Add bonus is that it will boost my metabolism so it'll be easier to lose some of the weight I've gained since starting college.
2. 14 Days Prior to Treatment: I'll have a urine test to check my iodine levels to ensure that all of the iodine contrast from the CT scan has left the system.
3. 7 Days Prior: I'll begin a low iodine diet to reduce the amount of iodine in my system as much as possible.  This diet excludes things like chocolate and most bread products, so expect some whinging on my part when I start this.
4. 2 and 1 days prior: Thyrogen injections.  This will hyperstimulate any thyroid/cancer cells remaining.  Apparently this stuff is extremely expensive so I'm doubly glad for the financial aid.
5. Treatment:  Consisting of showing up and taking radioactive iodine then waiting for my superpower to manifest, hopefully nothing lame.
6. 1 week post treatment: Gamma camera imaging to look for any metastases that were missed with the original CT scan.  Essentially, at this point of it's taking up the gamma radiation in large amounts it's probably a met.
7. 6 weeks post: Get blood drawn to make sure my thyroid hormones levels are correct.
8. 6 months post: Meet with the endocrinologist again to see how everything went. 

As for side effects, there are very few.  I might get nauseated from the dose of iodine which would be treated with anti-nausea meds.  It may also cause the parotid glands (salivary glands below the jaw) to swell and a bit of dry mouth for a week or so after the treatment. This is due to those glands and the thyroid gland coming from the same embryologic tissue so sometimes some of the paratoid gland cells will mistakenly have iodine receptors.  Owing to the fact that the cancer was caught early, the dose of radiation being recommended is fairly low so the risks (known and unknown) are also lower.

They don't schedule appointments more than four weeks out so I don't yet have an exact date for when I'll have the treatment itself, but it will be some time during the week of August 12th. This means I may be tentatively cancer free in time for my 33rd birthday on August 25th, although we won't know for certain until they test me a year later.  It's not diamonds or bunnies, but I'll take the gifts I'm given graciously.  For the next month I'll be continuing my recovery from surgery, my voice is still not completely back, and then it will be on to phase 3, in which we finally, totally, completely kick this cancer crap.