The unfolding of the saga…

When I first started my treatment, I was clueless about what the next few months would be like. We had never been really close around anyone who was being treated for cancer. So, there were a lot of questions. How long would it actually take? How are the drugs going to be administered? What would it feel like? Will it hurt? What activities will I be able to do or not do? Will there be any other restrictions, for instance, regarding diet? What ‘side effects’ would I actually have? Would I be able to live a normal life during the treatment? What about life after the treatment?

I guess many such questions are at the back of minds of most patients and no doctor prepares the patient for all of these.

What option then is one left with except to let the events unfold as in a stage play, trying to extract bits of information every now and then from any doctors in the extended family and sometimes from the internet if one is brave enough to read. (Initially, I guess I was overwhelmed with the turn of events in my life and didn’t even ask my doctor much nor did I want to read much about my condition. However, that changed after the next couple of months, when I felt I could handle the situation better, with the support of my family behind me.)

So, I thought, I would at least tell my story, to the best of my ability, so that anyone who is about to undergo similar treatment and those caring for them, may be informed of what actually happens. I think one would feel more confident and more in control minus the surprises and anxieties, at least that popped up for me.

However, let me mention again that cancer treatment for each type of cancer, from the combination of drugs to their dosage, to the methods employed (chemotherapy, radiation or surgery or combination or all of these) varies. I feel, though, my story would help give a broad indication.

This is how the events unfolded:

After a tumour showed up in the initial CT scan (with contrast), things began to move quickly. (Here I may mention, I developed an allergy to the contrast a few hours after the scan which caused shivering and intense pain in the legs. So, I guess, one should check about this with the doctor beforehand). The ENT specialist that I had been seeing so far had suggested immediate removal of the mass. Not satisfied with this opinion, we checked for references to another hospital).

I was referred to a team of oncologist/hematologist who advised a nasal endoscopy and a biopsy to determine whether the tumour was malignant.  The procedure was done by a head and neck surgeon under general anesthesia. It took about a couple of hours from the time I entered the operating room till the time I was out. The doctor took out the tissue from the nasopharyngeal region through the nose. (However, I was told earlier, if that  is not possible, for instance, due to infection, an external incision would be made in the mass from the neck (where the swelling was visible)). After the recovery time of a couple of hours, one can go home the same day though it does take a couple of days to get over the effect of the procedure. One feels lack of energy and drowsy, which I understand is due to the effect of the general anesthesia.

The biopsy results took about 5 days and that is also when the staging of the cancer is done (IIE in my case). Subsequently, I underwent a PET scan (with contrast). This time I was given an anti allergen to prevent reaction from the contrast after I informed of the allergy.This scan confirmed the areas where the tumour had spread (neck and cervical region).  Around the same time, one has also to undergo the ECHO and blood tests.

The haematologist (who from then on was the consulting doctor for my treatment) then explained the chemotherapy regimen that was going to follow (6-8 cycles with a gap of 3 weeks between each cycle, following the R-CHOP medication protocol). (It may not always be possible to adhere to the 3 week schedule depending on the health of the patient. Also, one could schedule around one’s convenience, a couple of days before or after the scheduled 3 weeks).

First, however, there was a small procedure for bone marrow aspiration to be undergone. In this, the lower back was anesthetised. The doctor took out some spinal fluid with a special needle to test  whether the cancer had spread to the bone marrow. The procedure itself took about 15 minutes and one has to rest for about 20 minutes thereafter before one can go home.

Chemotherapy may be done in day care, where you are admitted for a few hours or for longer in the hospital, depending upon the circumstances in each case. Even for administration of intravenous drugs, the method varies. For some patients, a canula (a small tube generally inserted in the vein on the back of the hand or the arm) is used, for others, a PICC line (which is a longer tube inserted in the vein for longer periods).  In my case, the drugs were administered through a canula.

The drugs are administered as per the protocol for each patient. In my case, as mentioned in my earlier blog (of June 20), the first drugs were administered overnight and the rest were administered in day care.

An intrathecal (injected into the fluid surrounding the spinal cord) drug (IT MTXT) was administered through a procedure called lumbar puncture towards the end of each chemo session. This drug is prophylactic (preventive), which is given to prevent the cancer from spreading to the cerebrospinal fluid (fluid inside and around the brain and the spinal cord).

(Lumbar puncture, as the name indicates, involves insertion of the needle in the lower part of the spine. This may be done for administration of medicine (as in my case) or for extracting a sample of fluid from the spine for testing. One is supposed to lie down on one’s back without a pillow after this procedure for about an hour.)

Additionally, experiencing nausea post the chemo session, I asked for an anti emetic injection in subsequent sessions to be given towards the end, though that controlled the nausea only to a certain extent.

After all drugs have been administered, the attending doctor provides the discharge summary (including the medication) and one can go home!

If anyone has something to share on their treatment or their loved one’s, I would be very interested.


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