🇬🇧 #IMOK #IHOK: All the mist around chemotherapy

I believe that all of you, guys, have already met with the theme of chemotherapy more than once… Probably you’ve tried to sneak out the chat ASAP. Maybe because it’s not permitted to talk about cancer or its treatment or if so, it’s not something funny. Actually I completely understand this statement but I want to change it my way. I decided to translate my pretty well accepted article about chemo. Are you IN? Let’s go!

There’s a big misty cloud around cancer. The only thing most people know is that cancer IS dangerous. Well sometimes you need to enter this cloud and then… you’re lost. You have no idea where’s the north, where’s the truth and what’s the next step. Everybody is looking for the map. The one and only map which would show them the right path from the cloud to the clear landscape. Well… It’s like this to be honest. Cancer is one of the medical domains which are pretty well explored, but the essential is missing. Maybe once, we’ll find it, maybe not. But now we have to accept what we have and deal with it!

Sooo, do we did our poetical beginning and now let’s speak more specifically about chemotherapy.

I would love to start with the statement of a neurologist from St. Anne University Hospital during his lecture:

„There are lots of fields in medicine and you can describe them simply to your friends… For example, oncology is the ultimate destructive field. Oncologists aim to destroy tumours with might and main and to protect the patients as much as they can at the same time.“

Well… So how we can destroy any malignancy? Oncologists (including me hopefully once) have these powerful tools to do so:

  • surgically remove the whole tumour (or at least a part of it) = oncosurgery
  • irradiate the tumour with high intensity energy beams = radiotherapy
  • poison the tumour and make impossible cells to grow and multiply = chemotherapy
  • newly, we can abort the opportunity of cells to communicate between each other, to destroy their metabolism (specifically aimed to the precise gear of the cell) = targeted therapy (so-called biological)
  • and then, there’s a complete newcomer (or actually it’s more like a renaissance of the idea) – that’s the possibility to activate immune system of the patient by showing it some sneak peak about the cancer cells = immunotherapy

But there’s one tiny problem… Not every cancer type reacts to every type of treatment – it can resist or it’s impossible to reach it with some methods. For example, let’s use brain tumours. These tumours are resistant to almost each cytostatic drug. You can’t even irradiate them every time and the worst scenario is when the tumour is somewhere you can’t reach it with a scalpel due to their close relation to some vital neurons.

Now, what do you imagine when someone says CHEMOTHERAPY? I guess that there’s at least one of these ideas: hair loss, vomiting, whole body fatigue, it’s poison, I would never accept it… Simply it’s nothing positive, right? And basically it’s all truth: hair disappear often, you feel dizzy and weak after chemo really often, they ARE poisons to be honest. BUT that’s it. We missed one basic and the most important idea… This one:

I’m fighting for my life for god’s sake! And in that situation I need to you the strongest gear and weapons available! It’s the same with cutting down trees… You need a good big axe, chainsaw or even an explosive.

https://en.wikipedia.org/wiki/Catharanthus_roseus#/media/File:Catharanthus_roseus24_08_2012_(1).JPG

Cytostatic drugs are mostly synthesized on the basis of natural substances with proven positive (destructive) effect on cancer cells with least side effects. For example, our beloved vincristine (leukaemia, my Hodgkin’s lymphoma, lung cancer) is from the group of so-called vinca alkaloids that you can extract from periwinkles (you can find these lovely flowers in most of South Moravia gardens). These alkaloids and extracts are also used in Ayurveda and traditional Chinese medicine (to which lots of oncopatients incline nowadays). Interesting right?

img_8134.jpgAnd what about taxanes (for example docetaxel and paclitaxel) used for treatment of lung and breast cancer, gynaecological malignancies and so on. They were originally squeezed from the pacific yew. For nerd audition and little chemists, I add that some little amount of paclitaxel (and other taxanes) was discovered also in shells of hazelnuts and leaves of hazel tree.

Then there’s my beloved doxorubicin which is used in almost the whole spectrum of cancer diagnoses! Doxorubicin is well known by its greater toxicity to the cardiovascular system… Well, it was discovered in 1969 as one of the by-products of bacteria Streptomyces peucetius. These bacteria are pretty good and utile tiny thingings… They’ve given us some antimycotics (drugs against fungi), antiparasitics (against tiny worms), other cytostatic drugs, immunosuppressive drugs and so on.

Of course there are some cytostatic drugs that were originally synthesized and are not from the nature (like from an extract to be more specific). It’s the example of wonderfully efficient cisplatin and other its derivatives. They are used also in almost every type of cancer which is sensitive to it. Cisplatin was discovered in raw form and with not the best characteristics in 1845! It was approved for the clinical practice as late as 1978 with diagnosis of testicular and ovarian cancer.

Ok, ok this article is not about the history of oncology made ridiculously simple… By that I wanted to demonstrate that the statement „Huge amount of drugs used in chemotherapy are synthetic bullshits provided by pharmaceutical companies“ and other funny things are not that true. Still, it’s nature which has the biggest power and know exactly which poisons it has to create to make everything work smoothly.

Ups, I did it again! I used the word poison again and again. Cytostatic drugs are really poisons. That’s completely true. It’s the same with Botox, so popular in aesthetic medicine. It’s the same with monoxynol-9, which is a spermicide substance used in some condoms and vaginal foams. It’s the same with warfarin, the most used anticoagulant in medicine. Actually, it’s the same with the original principle of homeopathy :O… Well, you can see that we use so many poisons in medicine. But we know how to deal with them, to prosper from them and not to harm our patients.

AND HOW DOES THE CHEMO WORK? HOW YOU GIVE IT TO THE PATIENT?

There are multiple ways to serve chemotherapy. Patients usually come for infusions. They can be also given in pills. You can inject some cytostatics in specific places (for example, inside the spinal canal in case of metastatic disease or newly in the abdominal cavity for certain amount of time… also you can inject it in your love handles in case of some smaller doses – this is mostly used for targeted therapy).

And what does a chemo cycle mean? You often hear… „My auntie already passed 12 cycles!“, „He did his twentieth cycle yesterday.“. But what it actually means? One cycle means one application of cytostatic and other drugs followed by a period of „recovery time“. To make it more difficult, I found out that ABVD protocol (which I’m in) is made of 2 applications with 2 weeks in between! Nevertheless, it’s all about the aim of the biggest destruction of cancer, fast proliferating cells. But there are also many „normal“ cells in the body that are proliferating fast. Like cells of the intestinal lining, sperms and eggs, blood elements and others. To indulge in time for recovery for these cells and for the patient himself, you need some pause. And this is the whole chemo cycle. In my case, it was consisted of 2-3 hours of my Sex on the Beach cocktail (bleomycin, vincristine, doxorubicin, dacarbazine and dexamethasone) and 2 weeks of the recovery time. I did repeat this four times. It all depends on the response of the tumour and also of myself.

Sex on The Beach
My cocktail – actually one shot after another. It’s wrapped in aluminium foil to protect chemo from sunshine 😀

Are you wondering what do I mean by the response of myself to treatment? Well… It is important to monitor plenty of things during whole chemotherapy regimen. For example, there’s doxorubicin in my combination, which is known by its emetogenic activity in some patients (which means you can vomit after it – as much as after other cytostatic drugs – FYI cisplatin is the best for it). Doctors try their best to avoid this situation so they give you some antiemetics (drugs lowering the chance of vomiting). They have to choose wisely and sometimes add another antiemetic drug to really control this side effect. Then, there are some drugs toxic to your bone marrow. To monitor this toxicity, you have to check blood samples before each application or at least from time to time. Doctors take care about levels of red blood cells, white blood cells (and their special types – neutrophils mostly) and platelets. When there’s some decrease in those levels, you can use so-called growth factors for white blood cells – they are responsible for your immunity; or you can add some transfusion of red blood cells in case of severe anaemia – this can appear in patients as fatigue. They also control functions of your liver and kidneys, your intestines (as some patients suffer from diarrhea or constipation – this is not funny :D). Finally, it’s important to monitor specific toxicity of each drug during and also after treatment. And what about feared hair loss?

It happens. Each cytostatic drug has its own mechanisms of action, its side effects and one of them is a hair loss. It depends also on the patient himself. Someone could lose all his hair, someone just a part of it, someone will stay Tangled princess during the whole treatment. It’s highly individual and it’s taken really seriously by patients (mostly by women). Don’t worry though. Hair, eyebrows, eyelashes and other facial hair will grow back. That’s because these drugs aren’t that toxic to hair follicle itself. On the other hand, hair can change its characteristics after chemo (mine went darker and even thicker – that’s terrific as it looks like a pubic hair now :D).

Did I already mention fertility? I guess just on Instagram. So…

Cancer treatment can cause reversible decrease in your fertility. It is caused by multiple aspects. As I already mentioned, sperm and eggs (actually it’s all around much more) are cells which multiply and grow really fast. That’s why they’re often affected as much as tumour cells. In women, we can see menstrual and ovulation cycle irregularities and other things. In men, we can see decreased amount of sperm in ejaculate. Their ability to swim in the right way is also affected. They’re a bit dizzy, let’s say. Also there can appear some erectile dysfunction (and honestly, you can imagine it doesn’t have to be due to cytostatic themselves…). All this can appear. However, it’s not 100% sure. All this can be reversible. However, it’s not 100% sure. That’s why it’s important be aware of sperm conservation and not being shy about it! It’s good to have your swimmers stocked somewhere just in case… Also I would like to mention that it could be possible to make a baby. However, it’s not widely recommended because your baby would be affected by used drugs as well. Mother should be also healthy during whole pregnancy to help her baby to grow well. And cancer isn’t the best definition of health (physical and psychical). Please ask your oncologist about the right time after the treatment.

IMG_2301
Sperm cryopreservation form before the treatment.

Do you want to know more? I recommend lovely British site of Cancer Research UK. I find their patient information well written. You’ll find there most of the cancer care made simple. You can follow them on Instagram as well as international project called Stand Up To Cancer originally from USA (you can follow also their British branch). Also I loved World Cancer Day (4th February). On the site you can find, what’s going to happen in your country. Also you can find there some „impact tables“ to support this initiative on social media. You can join us even now and use #jsemsdodem on your Instagram. I would love to see it! 😀

I’m done. Did I forget anything? OK, just some final words…

Cancer is basically an uncontrolled growing of cells. We don’t know yet how to force them to obey and to return them to the state of „I know which cell I am, what’s my purpose and when I should die!“. Our bodies repair these mistakes hundred thousand times per day. Sometimes it doesn’t work enough. And then… there’s a time for handsome oncologist (or beautiful of course!) and things are going to change! Imagine cool Arnold in some cool action movie… It was never nice (except Kindergarten Cop – that was cute) but he won and he fight for good (or I hope so)! That’s what medicine do as well. It’s its purpose. Trust it please. That’s why it’s useless to fight against pharmaceutic companies, useless to run against the wall and stick just to healers. Let’s trust medicine. It’s that simple. And it’s the most important.

Please think about it. We’re not here to make you die or to hurt you. We’re here to help you. For this, we learn our self our whole lives. We’re listening and trying to find out what everyone is asking for – Being healthy. Fast and easy… It’s not possible all the time. There are exceptions. People speak about them so much. However, they don’t speak about those who refused the conventional treatment, sticked just to alternative ways and they died. That time vitamins and roots didn’t work. It’s forbidden to speak about it.

We, young doctors (me in a year hopefully) are going to show that you can trust us. I promise.

THE END

 

 

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