March 10, 2022

When last seen, Our Heroine was waiting for a call with Dr. Radiology to discuss the “Enlarging ring-enhancing lesion in the paramedian right frontal lobe which is suspicious for metastatic disease,” as was reported in the  recent MRI results. What is there to say? Dr. Radiology did not mince words: “This is clearly metastatic.”  Welcome to Stage 4 lung cancer, baby.

Believe it or not, brain mets are common in lung cancer patients. However, do not believe the gawd-awful statistics about life-expectancy. They are descriptive of a certain time and place and can have little to do with reality. Some day, I’ll tell you about the stage 4 folks in my local cancer group, folks who have lived with the disease for more than one dozen years.

But I digress.

The next step is clear: Gamma knife surgery. Dr. Radiology has arranged for the head of the gamma knife program at the research center to perform my procedure. I’ve seen him in the hallways, a short smiling man with kind eyes (Covid masks make the eyes more noticeable.)  (Is it bad of me to think of him as Mack the Knife?) I’ll meet Dr. Neurology the morning of the procedure.

Gamma knife surgery is not a lot of things. It’s not a knife. It’s not “surgery.” It doesn’t involve an incision through the skull.

What it is: the most accurate type of brain surgery, used to control or eliminate small to medium-size brain tumors, which are also known as lesions or cerebral metastases. It’s a single procedure. You show up at the appointed hour and swallow some Xanax (they say it’s better for this procedure than lorazepam– the nurse says you don’t have a care in the world after Xanax.) They proceed to screw an aluminum frame to your head in four spots. (Jeez, that sounds really creepy, doesn’t it?)   The Cleveland Clinic explains it well:

The head frame acts as a “frame of reference” in the planning of your treatment and is essential in keeping the target perfectly aligned during the precision treatment. Your neurosurgeon positions the frame.

You’ll receive four injections of a local anesthetic, one on each side of your forehead and two in the back of your head. These are the areas where specials pins are placed to fasten the head frame to your skull. You may feel pressure as the pins are tightened, but this usually only lasts a few minutes. After the head frame is positioned, a radiation therapist will take measurements of your head.

They shoot you up with a contrast dye– the MRI contrast agent for this procedure contains a rare earth metal called gadolinium that in and of itself is seriously bad for you– and stick you in an MRI for about half an hour. Dr. Radiology earnestly compared the brain to a salami which the MRI will “slice” and image, typically every 3-5 mm.  Sometimes with this fine of a capture, other previously unseen stuff can show up, and they’ll treat that, too. Then all the -ologists huddle and make a treatment plan. This involves calculating the convergence of the radiation beams (yikes, that is some math!). Then, 192 beams of radiation zero in on the spot and you just lie around and wait for it to be done. When it’s done, you are sent on your merry way, to resume life as you knew it. Seriously. That’s it.

The biggest risk is swelling in the brain, so you have to sleep semi-upright for a week and drink only when thirsty. (None of this hydrate-because-hydration-is-good-for you.) There can be other things, but the incidence of badness is very slight.

I continue to digest this. To be honest, the prospect of starting on a systemic targeted therapy (TKI) is more distressing than gamma knife. But enough about that. Or, I should say, more about that down the road. What really matters most is FROSTING SCHOOL! Our final assignment: bring a tiered cake to class, frosted and ready to decorate.

Who knew there was so much to stacking tiers of cake??? I’ll spare you the gory details– except there really is a step called Stake Through the Heart: a food-safe dowel, sharpened to a point and thrust through the top two cake layers, their cardboard “plate,” then through the bottom two layers of cake. No sliding tiers here! Here’s how things ended up.

“Let them eat cake”

Thanks for reading. Here’s hoping you get a few tiers of sweetness in your life today.

Mack the Knife by armennano from Pixabay

Sunburst image by bluebudgie from Pixabay