It Might Get Messy

When my kids were younger, I used to tell them that my generation would be the last to die of cancer. I presumed we were close enough to cracking cell-specific mechanisms for cancers to be preventable, or at least easily treatable, diseases.


I missed it by a generation, maybe two. Still, the cutting edge of cancer research is in places where phenomenal treatment technologies are just a few meters further down the path. We are situated squarely between the brutal past and the subtle future of cancer therapy. 


Consider. The 2011 Nobel Prize in Medicine went to researchers unlocking molecular gates to the immune system. In particular, Jules Hoffman and Bruce Beutler discovered the molecules that allow the innate immune system (the initial response to infection, and the one most closely associated with inflammation) to recognize microbes and trigger response. In fruit flies, these are called Toll Receptors, the equivalent in mammals are Toll-Like Receptors. TLRs (and, I suppose, TRs, although I didn’t research them as rigorously) bind specific lipopolysaccharides (LPS) that characterize various pathogenic microbes. The combination of TLR and LPS induces innate immune response, including inflammation. Structural mutations of TLRs are associated with either increased risk of infectious pathology (because the immune system doesn’t work as well) or inflammation diseases (because the mechanisms don’t turn off). 


These were late 90s discoveries. Within the past few years, TLRs have been exploited in cancer research. Tumors suppress the inflammatory response. Researchers have found molecules that block the suppression by keeping TLRs functional, resulting in intense antitumor activity of the immune system. Indeed, a number of the susceptible mice in the studies completely rejected their tumors and were resistant to additional tumor formation.


This kind of thing is among the many lines of subcellular research likely to yield a host of new and efficient cancer treatments in the next couple of decades. Contrast that with where we are in the real world. 


Earlier this month (January, that is) Medical News Today reported a study that concluded that “a subgroup of advanced head and neck cancer patients treated with radiation therapy plus the chemotherapy drug cisplatin had more positive outcomes than patients treated with radiation alone, and continued to show positive results ten years post-treatment.” That’s the treatment I got. It is state-of-the-art for the time, including a linear accelerator to generate the particle beams and three-dimensional modeling to site the beam impacts. Much of the technology thrown at radiation therapy is intended to truncate side effects in non-malignant nearby tissues. The same is true of the mix of substances given with the cisplatin in the chemotherapy brew. 


Man. Assuming the side-effect-minimization methods worked in my case, I sure as hell am glad they were there. Because after my treatment ended, as you know from my rather insistent whining, the side effects nearly killed me, and for a couple of nights at least left me kind of wishing they would. 


And this week? A great week here in cancer-recovery-land. I worked 5 long (ish—it’s still hard to function on less than 10 hours of sleep, and mornings are particularly difficult) days, got a lot done, had a lot of energy. Speech and swallowing are both improving, the latter rather more slowly. But I’m down to just a small cap of thick mucous depositing itself on my dysfunctional epiglottis a few times a day, where until now I had a whole face full of thick, ropey mucous. I’m hoping—and sort of assuming—that when I can swallow that mucous cap away, my swallowing will be back, at least for some foods. The pain under my tongue isn’t gone, but it’s less. And I saw Dr. H, and he can’t see anything that could be causing the pain. He says if it persists we’ll do another PET scan (the one that images radiolabeled sugar uptake in metabolically active cells, i.e. tumors). But he’s skeptical. A malignancy that can cause pain should show some sort of lesion that a practiced eye (and I certainly trust Dr. H’s eye, along with therapists Bethany and Jessica and Dr. T) can see, and the back of my tongue is “as smooth as a baby’s butt” as one of the medical staff put it in a weak moment. This week I go to see the radiation oncologist who replaced mine when she retired. That’ll give me one more check. 


If things keep up like this, I may be back to full energy, and able to start posting bug and bunny photos for you this spring, along with additional weblogs. We’ll see. In any case, I’m traveling rather more regularly, so anxious to lose the feeding tube. When they take it out, I’m gonna frame it in a shadow box and hang it on the wall. Along with the rock and roll album covers. Rock on, all!!!