Dr. Sue Yom is an expert in the radiation treatment and management of head, neck and lung cancers. In her research, she studies chemoradiation for these cancers as well as image-guided radiation therapy and ways to reduce toxicities using focused radiation techniques, emerging biological agents and radiation protectants.Dr. Yom was nice, I liked her.
Yom earned a medical degree and Ph.D. at the University of Pennsylvania and completed a residency in radiation oncology at the M.D. Anderson Cancer Center in Houston, Texas. She has received numerous awards recognizing her commitment to patient care and patient-oriented research. She is an assistant professor of radiation oncology at University of California, San Francisco
As I've written earlier there are "major disagreements" among the major cancer institutions on treatment plans for my type of cancer and the way it presented itself, occult primary. To date every doctor I've spoken with and every report of my case has suggested the full monty Chemo-radiation concurrent treatment. Though, all are clear that the treatment plan will ultimately be something that the radiation oncologist, Dr. Yom, and I agree upon.
The UCSF Helen Diller Family Comprehensive Cancer Center is a new facility. In the proud tradition of college bound parents everywhere, U.S. News and World report ranked the Diller Center as a top ten cancer hospital. The most highly rated in California.
The M.D. Anderson center in Texas is the nations premier cancer center. This is where Dr. Yom received her training. Enough on the bona fides, I am fortunate to be in a time and place where I'll be receiving good care.
Dr. Yom talked dispassionately about the two options for me.
- Radiation, on all glands and both sides of my neck - without chemotherapy
- Nothing - check in every three months
This is an incredible, and completely unexpected recommendation. It took me several minutes after I walked out of her office toward the 38-Geary muni bus (The 38 being an ordeal in and of itself) that this was good, really good. I smiled and realized that this was fantastic.
My burden is having a choice, Dr. Yom acknowledges the viability of having radiation therapy. Radiation therapy is commonly recommended and non-controversial. She said "radiation therapy is not that bad."
My situation is that if I choose, I can call the good folks at the Diller Cancer center and say "sign me up for that painful, damaging, couple of months of daily radiation treatment." Nobody would bat an eye and I would be scheduled for my first appointment. If I don't call, they will see me in a couple of months for an examination.
It is complex. The bogey-man is some future occurrence of a primary tumor. If it does reoccur I'll need more, and more difficult, treatment. The possibility of a future recurrence is very worthy of a bunch of anxiety-inducing speculation. It is all speculation. The chances of a reoccurring primary tumor following either treatment option are low(this is the most critical fact).
The chance of recurrence with Option 1, careful close observation, is low. The chance of recurrence with Option 2, full radiation, is lower. There are lots of quality of life issues with taking radiation like loss of salivary function, loss of taste, tooth loss, gum damage, etc. Another more complex issue with taking radiation is that if there is a post-radiation recurrence, it diminishes in some way the ability to do additional radiation treatment. Oncologist do not do radiation after radiation and so on. Dr. Tsai, my surgeon, described it as "you only have one shot". The other side of the coin is that with no radiation treatment, there is some evidence that a recurrence might be a type that is more difficult to treat.
To try and clarify these factors consider the following.
No Treatment
- No radiation damage
- Low chance of recurrence
- Consistent, careful, and regular follow up examination every three months
- Future cancer may be a more difficult type
Full Radiation Treatment
- Radiation damage, loss of teeth, loss of taste, loss salivary function, speech problems
- Low chance of recurrence, lower than no treatment
- Regular followups, probably not as much as no treatment
- Future cancer treatment might be compromised by having had radiation
5 comments:
Yyaaaay! I'm glad it's an option to skip the burly radiation till laters. Although it's interesting to hear that it might be *burlier* radiation later, when it can be focussed, vs the general radiation she's talking about now. Wha? I don't get it, because I am not the cancer scientist. That complicates the choice a little. But I know which way I'd vote.
Yes Pippi, I am very tempted to sigh and vote that way too. I'm going to try and dug up more info on lingering questions I have, and perhaps run this all by an independent other, to see if it passes the sniff test.
Well, Chris. I'm impressed with how well-written and clear this is. Thanks for laying out the options, and let us know when you have figured what you want. Sounds like you have some great medical support.
Thanks Michael,
Yes, I have a bunch of resources available, that is a luxury. I implied I had all of the data and now I get to choose, but as I noted in my "Mom" post I'm still accruing some more details. Give me another week or so, then I'll know.
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