If there’s a word which is synonymous with cancer, it’s chemotherapy.  It’s what most people have in their mind when they are talking to a cancer patient…… ‘have you had chemotherapy‘ or ‘when do you start chemotherapy‘.

I was nonchalantly asked by a friend some time ago ‘how did you get on with chemotherapy’ – he was surprised to hear I hadn’t had it despite my widespread disease.  Cue – lengthy explanation!  I wasn’t annoyed by the question; I just think people automatically assume every cancer patient must undergo some form of cytotoxic chemotherapy.  If you read any newspaper article about cancer, they do nothing to dispel that myth, as many articles contain a story about a cancer patient with no hair.

Sure, chemotherapy is not the nicest treatment to receive, and it does have pretty awful side effects for most. I watched my daughter-in-law go through 3 or 4 months of this treatment where she seemed to be confined to a combination of her bedroom and her bathroom.  And it did shock me to see her without hair.  I would never want anyone to go through that and it really brings it home when it happens to a close member of your family.

Despite its bad press in regard to toxicity and its awful side effects, chemotherapy is widely used in many cancers.  Statistics show that it does work for many patients (….. my daughter-in-law is still here looking after two of my four grandsons and my son still has a wife ♥).  However, I suspect it has a limited future as more efficient and less toxic drugs and delivery systems come online downstream.  Immunotherapy is often touted as a replacement for chemotherapy, but this may be a while yet.  So, for now, millions of cancer patients worldwide will continue to be prescribed chemotherapy as part of their treatment regime.

However, for some cancers, chemotherapy is not particularly effective. Neuroendocrine Tumours (NETs) is one such cancer, particularly for the low-grade of well-differentiated tumours, although but can be more effective in particular anatomical locations and at the higher numbers in Grade 2 and in Grade 3 well differentiated NET. It’s a first line therapy for most poorly differentiated Neuroendocrine Carcinomas.   I’m not saying the lower grades will never receive chemotherapy – that door is always left open for those with progressive cancer who perhaps have run out of treatment options. 

Putting Grade 3 to one side, I’ve heard people say that NETs is the ‘good‘ cancer or the ‘good looking’ cancer often citing the chemotherapy thing as some justification. That is of course a stupid thing to say.  I accept that not everyone will lose their hair and not every chemo will cause hair loss.

Here’s the rub.  Many other treatments come with pretty challenging side effects. Moreover, the side effects and the consequences of these other treatments can last for some time, and for many, a lifetime. For example, with NETs:

Surgery can be pretty extensive, in some cases radical and life changing.  Many cancer patients receive surgery for NETs which is still the only real ‘curative’ treatment, although for most, it’s cytoreductive or palliative in nature.  If you lose bits of your small intestine, large intestine, liver, spleen, cecum and appendix, gallbladder, stomach, rectum, lungs, pancreas, thyroid, parathyroids, pituitary gland, adrenal gland, thymus gland, ovaries, oesophagus (…….I could go on), this comes with various side effects which can present some quality-of-life issues.  There can be huge consequences of having this treatment.

Other ‘consequences’ of cancer surgery include (but are not limited to), pulmonary emboli (blood clots), lymphedema, short bowel syndrome, gastrointestinal malabsorption, diabetes.

Somatostatin Analogues do a great job, but they do add to some of the effects of surgery (e.g. malabsorption).

Even the so-called ‘silver bullet’ treatment Peptide Receptor Radio Nuclide Therapy (PRRT) can have pretty severe side effects and presents some risk to kidneys and bone marrow as a long-term consequence.

I’ve not had chemotherapy and I would rather avoid it if I can. However, as I’ve hinted above, there are other harsh (….perhaps harsher?) treatments out there. Moreover, whilst hair normally grows back, your small intestines, lungs and pancreas won’t.  Many people will have to live for the rest of their life with the consequences of their cancer and its treatment.

It sometimes appears that every other cancer article involves someone undergoing chemotherapy.  I just wish someone would write an article about my lack of terminal ileum and ascending colon, the malabsorption issues as a consequence of that, my missing mesenteric lymph nodes, my retroperitoneal fibrosis, not forgetting to mention my diseased liver, my left axillary and supraclavicular lymph nodes, my thyroid lesion and my hypothyroidism which may be due to that, my small lung nodule, my rib lesion and my pulmonary emboli which after nearly 6 years of daily blood thinning injections made my abdomen look and feel like I’d done 12 rounds with Mike Tyson.  However, it just wouldn’t be a good picture, nor would it be as powerful as one of a person with no hair.  Just saying!

I look well, I still have all my hair – but you should see my insides!

I’m not playing ‘Cancer Olympics‘ with this post as I wish all cancer patients, regardless of type, regardless of treatment regimes, the very best outcomes.