Coasting

October 24th - Two weeks have passed since the first round of chemotherapy drugs. I feel quite normal, really. Very few side effects have manifested. I have experienced very mild nausea, upset stomach, a little tingling at the back of my calves & bottom of feet … but nothing like advertised. I’ve been back at work quite a bit the last couple of weeks; even doing some exercising including smacking a racquetball around (just myself because I don’t want to get hit).

I know my world is a little upside down when I’m worried that the drugs aren’t working because I don’t have serious side effects! Right now I’m more concerned about the outcome of state and national elections that how I’m feeling each morning.

I go in for a blood test & visit with my primary doc on October 31st (ironically appropriate don’t ya think?). If things go according to schedule, I’ll start the next round of chemo on Nov 5th at Virginia Mason in Seattle (IV), then continuing at home on the 6th & 7th..

It’s likely that most of you reading this will go through, or know someone who has received, chemotherapy for cancer of one kind or another. So, here’s my chance to give you a little info on how bladder cancer works, what the typical approaches are for treatment in Western medicine, and how chemotherapy works – particularly the two drugs I’m taking.

My information sources are primarily from the National Cancer Institute, the American Cancer Society, Wikipedia (what did we do before the internet??), and WebMD.

Bladder Cancer – cancer is uncontrolled, abnormal cell growth that causes a mass of cells to grow (tumor). Bladder cancer is 4 times more likely in men than women. Men have a 1:27 chance of getting it sometime in their lives.

The reasons for abnormal cell growth are difficult for me to understand or describe. It appears that the genetic material in cells is somehow damaged or transformed & those damaged/transformed cells continue to multiply. The genetic make up of cancer cells causes the normal protective measures in cells to be switched off or suppressed, plus it also causes the affected cells to become hyperactive and multiply more rapidly than normal.

Something the technician who worked with me on the PET (positron emission tomography) said stuck with me. He said that the reason the scan works is because the cancer cells have a metabolic rate 3 to 5 times faster than normal cells. These faster working cells take up & use more of the radioactive sugar, so they ‘glow’ in the PET Scan images.

The most common type of bladder cancer (up to 90% of cases) involves the cells lining the inside of the bladder. The other 10% are cancers involving different locations or layers in the bladder &/or different types of cancerous cells. I haven’t gotten a good description of the kind I have, but it is clearly in the less than 10% (may be much less than 1%) and involves small cell carcinoma.

Cancer Treatment – in Western medicine, cancer treatments typically involve three types and a combination may be used: application of drugs targeted to kill fast growing cancer cells (chemotherapy); radiation to kill targeted cells; and, surgery to remove impacted tissues.

There are also drugs & therapies used to boost the body’s immune system & help it suppress or eliminate the cancer cells.

The treatment plan I’m following involves chemotherapy & (most likely) surgery.

Chemotherapy for My Type of Bladder Cancer - As mentioned, my chemotherapy involves the following:
Day 1: intravenous carboplatin and etoposide, plus pills to control nausea & infection
Day 2: etoposide by mouth (8 pills), plus pills to control nausea & infection
Day 3; same as Day 2

So my limited understanding of the way carboplatin works is that goes into my blood stream & messes with the DNA of the fast growing cancer cells. Apparently, carboplatin interferes with a particular type of DNA structure (alkyl group) and results in cell death. It has a half-life in the blood stream of 30 hours. Nausea & vomiting are common side effects. Another is that this drug causes blood cell and platelet production in bone marrow to be reduced; often the lowest 3 to 4 weeks after the first dosage. This means that I have an increased risk of infection in the next couple of weeks.

Etoposide (VP-16) has the same result as carboplatin – death of fast growing cells – but works by interfering with enzymes that form the backbone of DNA strands. It causes the DNA strands to untangle & results in cell death. I couldn’t find info on the half-life of this drug.

Because the whole idea of using these drugs is to kill fast growing cancer cells, other normal fast growing cells in the body get hammered, too. These include hair, fingernails, stomach lining (nausea & vomiting), blood cell production in bone marrow, and who knows what else.

How do I feel about facing these side effects? Not great, but resolute. I hope they work as well as my doctor thinks they will.

I’m glad the research has/is being done & that these drugs are available for me. I’m also extremely glad to have health insurance to pay for most of this … I cannot imagine the anxiety, waiting, risk, and trade-offs that people make when they don’t have health care insurance and face major illnesses or injuries.